USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 68
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Dar- coma, etc., of .. ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mcrc symptoms or terminal conditions, such as "Asthenia," "An- aemia" (mercly symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important. See instructions on back of certificate.
The Commonwealth of Massachusetts
1 PLACE OF DEATH
STANDARD CERTIFICATE OF DEATH Winthrop (No Metcalf Hospital)
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.f
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Homale White
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Midou
& DATE OF BIRTH
(Month) (Day)
5
(Year)
7 AGE
59
yrs. mos. ds.
Or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
At Some
(b) General nature of Industry. business, or establishment in which employed (or employef)
9 BIRTHPLACE
(State or country)
Ireland
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Ireland
12 MAIDEN NAME OF MOTHER Unknown
18 BIRTHPLACE OF MOTHER (State or country) Ireland.
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Timothis mahana
(Address)
Filed __: 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
October
(Month)
(Day)
170
1914 (Year)
17
I HEREBY CERTIFY that I attended deceased from
Oct 14th
1914.
to.
Oct 17th
1914,
that I last saw her
alive on
191
Oct 17
4
and that death occurred, on the date stated above, at
m.
1
The CAUSE OF DEATH* was as follows :
Broncho Pneumonia from
Bronchoeclases
(Duration)
.......
.yrs.
4
........
mos.
ds.
Contributory ...
Bronchokclain
(SECONDARY)
Several
(Duration)
.. yrs.
mos. ds.
(Signed)
Horace & Joule
M.D.
Oct 17, 1914 (Address)
180 Waltherof St Walton
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
In the
of death .....
... yrs.
mos.
ds.
State ............ yrs.
...........
Where was disease contracted,
mos.
ds ......
....
if not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL It touchlies. Com
DATE OF BURIAL
Oct 19, 1914
20 UNDERTAKER
John F. O Maley
ADDRESS
77 Atlanticsd
2 FULL NAME
Hanora Mi Carthy widow
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 441 Wantthat 26
of Dennis Mccarthy
10 NAME OF
FATHER
Unknown
If LESS than
day,
„hrs.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, ctc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.
Statement of cause of death. - Namc, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same diseasc. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sa coma, cte., of .... (name origin: "Cancer" is less definite; avoid usc of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report merc symptoms or terminal conditions, such as "Asthenia," "An- aemia" (mcrely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1914.
CITY OF BOSTON. 94.26
FULL NAME
Place of Death l and Residence S
Boston
Date of Death
1914.
Åge
73
years
2
months 17
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
W
WID.
Maiden Name
Husband's Name
NEW YORK. N. Y.
Birthplace
Name of Father
JOHN BLAKE
Birthplace
NEW YORK. N.Y.
of Father
Maiden Name of Mother
ELLEN BROWN
Birthplace of Mother
NEW YORK. N.Y.
Occupation
AT HOME
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1914, to
1914, that to the best of my knowledge and belief death occurred, on the date stated above, and that the CAUSE OF DEATH was as follows :
EGIST
RAR'S
T PATRIGIS
Primary ( Duration)
FFICE
CTVTT
BOSTDNIA
CONSITAA.
B ISREGIMINE DONATA A 1181.
STO
Contributory : Į
CERE. HEMORRHAGE - 3 MOS.
(Duration)
F. A. MACKENZIE
M.D.
(Signed)
Ост. 18 1914 SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
WINTHROP ( 143 PLEASANT ST.)
Usual Residence
Filed
OCT. 21
1914.
A true copy.
Attest :
EumSeinen
Registrar.
O
FOREST HILLS
Place of Burial or removal
Undertaker
R.& E.F. GLEASON
CITY R
SIT DE
CHR. NEPHRITIS - 2 YRS
A.113
N. MASS.
LOUISA BLOUNT
Registered No.
GORDON HOME
ост . 18
BLAKE
AMBROSE A BLOUNT
Oct 18, 1914
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very N. B. - Every item of information should be carefully supplied. AGE should be stated EX. IL molANS should state important. See instructions on back of certificate.
1 PLACE OF DEATH
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH (No. 96 Winthrop St. :.. ......
Winthrop.
.Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
96 inthron St Ninthrok
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH Oct 25, 1914 (Month) (Day) (Year)
1 HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows :
Fracture of the Skull and the Right Trist sustained On accidentally falling from appletied
Contributory apples. -
(SECONDARY)
{Duration) yrs.
mos. ds.
(Signed)
SpearsRichardson
M.D.
Det:26. 1914 (Address) associate MEDICAL EXAMINER Suffolk
* State the DISEASE CAUSING DEATH, or, in deaths frony VIOLENT CAUNES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
.yrs.
mos.
ds.
State .
.yrs.
In the
mos. ..
ds .....
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
191
0 UNDERTAKER
ADDRESS
Fied . 191
REGISTRAR
5 SINGLE,
MARRIED,
WIDOWED
OR DIVORCED
(Write the word)
6 DATE OF BIRTH
(Month)
(Day)
6 1868 17 (Year)
7 AGE
If LESS than 1 day, .... hrs.
45 yrs. 4
.yrs ..
mos.
17
ds.
or ......
min. ?
8 OCCUPATION
·Principal High School
(a) Trade, profession, o particular kind of work
(b) General nature of industry, business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country)
garbow more
10 NAME OF
FATHER
Charles Osborne
PARENTS
11 BIRTHPLACE OF FATHER (State or country)
gerbow more
12 MAIDEN NAME OF MOTHER Janou ) Holmer
13 BIRTHPLACE OF MOTHER (State or country) Profton muss
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
(Address)
Ervine Davey Offame
3 SEX
male
4 COLOR OR RACE
Mlute
A
WRITE PLAINLY, WITH UNFADING INK - THIS IS
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- kccpers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite); Tuber
coma, etc., of .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old agc," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dcad, etc.
Wald state
ATION is very
PHYSIA:
= ============
CAUSE OF DEATH in plain terms, so that it may be proper ..
N. B. - Every item of Information should be carefully supplied. Pus important. See Instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Residence
(No.
96 Winthrop
St. :
Ward)
Mintha. (City or town.) [If death occurred in a hospital or institution, give ita NAME Instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
M DATE OF DEATH
(Month)
(Day)
191
(Year)
$ DATE OF BIRTH
6
1869 11
(Month)
(Day)
(Year)
" AGE
45
........ yrs ...........
.mos.
ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Sin of High School
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Sonham Maine
10 NAME OF
FATHER
Charles Osborne
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country}
Gorham Ollami
12 MAIDEN NAME
OF MOTHER
Sarah& Holmer
13 BIRTHPLACE OF MOTHER (State or country)
Grafton Caso
1' THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Other E. D. Osborne
(Address)
96 Win thought Centrach
Filed 191
REGISTRAR
(Duration)
.... yra.
.............. mos.
.........
ds.
Contributory
(SECONDARY)
(Duration)
........ yrs.
..........
mos.
ds.
(Signed)
M.D.
191 ........
(Address).
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
in the
of death ....
... yrs.
.... mos. .........
de.
State ..
... mos.
............ ds ............
Where was disease contracted,
If not at place of death ?.
Former or
usual residence.
1 PLACE OF BURIAL OR REMOVAL Wanthoch Class
DATE OF BURIAL
Det2791
" UNDERTAKER
Kelley T Hawa
ADDRESS
Manchester
.
3 SEX
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
If LESS than
I day ......... hrs.
I HEREBY CERTIFY that I attended deceased from
191.
to
191
...... --
that i last saw h
alive on
191
...
and that death occurred, on the date stated above, at
m.
The CAUSE OF DEATH* was as follows :
Evine Dewey Osborne
2FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Winthrop
7
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, c. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salcs- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- DASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pncuinonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of ... ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1914.
CITY OF BOSTON.
EUNICE BARRY
FULL NAME
Place of Death ¿ and Residence S
Boston
ост. 25
1914.
Age
94
years
months days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
W
WID.
Maiden Name
Husband's Name
WILLIAM BARRY
Birthplace
- N.S
Name of Father
Birthplace of Father
Maiden Name of Mother
Birthplace of Mother
Occupation NONE
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1914, to that to the best of my knowledge and belief death occurred, on the 1914, date stated above, and that the CAUSE OF DEATH was as follows :
RAR'S
RE
T PATRIEL
Primary ( Duration)
BRONCHO-PNEUMONIA - 21 DYS+
FFICE
BOSTONIA
CONCITA A
SREGE
ST
N. MASS.
ARTER IO-SCLEROSIS
Contributory : ?
(Duration)
(Signed)
ISIDOR PERLSTEIN M. D.
1914
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence
WINTHROP ( 148 BARTLETT
ROAD'
OCT.29
1914
Filed
A true copy . Attest :
ErMSlenen
Registrar.
O
MASS. CREMATORY
W. H. GRAHAM
Undertaker
G
S. SITD
CITY
SICUT
D. 1822
12$1.
DONATA D.
Piace of Burial or removal
Registered No. 9600
Date of Death
BOSTON STATE HOSPT.
Oct. 25, 1914
FORT!
COMMONWEALTH OF MASSACHUSETTS
derpy REVERE.
RETURN OF A DEATH
(CITY OR TOWN.)
AVERE 18
FULL NAME
Man tha K. Hammond
Registered No.
252
Place of )
Death * Revere, 1/2 Kimball Ave
Death S
Date of ¿
Cet. 25, 1984.
-
months. 24 .days
STATISTICAL DETAILS
SEX Hemale
COLOR
White
SONOLE, MARRIED, WIDOWED, OTT DIVORCED
Widow
MAIDEN NAME Ť
Nearthe Kempton
HUSBAND'S NAME +
Andrew Hammond
BIRTHPLACE # Wild N.J
NAME OF
FATHER
Joseph Kemplow
BIRTHPLACE
OF FATHER+
Nova Scotia
MAIDEN NAME
OF MOTHER
Mary Hammond
BIRTHPLACE
OF MOTHER +
Nova Scotia
OCCUPATION
Housekeeper
INFORMANT §
Nen Kempton (Brother )
PLACE OF BURIAL OR REMOVAL !!
Winthrop, Meas
UNDERTAKER
Anthony Santos
DATE OF BURIAL
Cax. 28
ADDRESS Pevere, Means.
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from . 19
.4to Qx.25,191 4 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Angina Pectoris
.(DURATION)
. DAY 8
Contributory :
(DURATION)
.. DAY8
(Signed)
M.D.
Oct.27 1964 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death ?
.. years
months
.. days
Where was disease contracted,
if not at place of death ?.
Filed Nov. 7, 1964 Albert ). Buon Tours Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI. DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. || Name of cometery.
ALL NAMES TO BE IN FULL
178 4
Residence
Winstwok 106 Washington Ave
64
... years.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH
.
(No.
27 pleasant PK RS.
Ward)
(City or town.)
[If death occurred la a hospital or institution, give its NAME instead of street and number.]
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.