Town of Winthrop : Record of Deaths 1913-1915, Part 78

Author: Winthrop (Mass.)
Publication date: 1913
Publisher:
Number of Pages: 1094


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 78


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).


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Statement of cause of death. - Name, first, the DISEASE 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 cercbro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never ro- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- 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 (disease 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," etc.), " Dropsy," " Exhaustion," "Heart failure," "Haemorrhage," " 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 septicemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of tho Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


1. Doaths 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 duc 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 STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Huntwohl (No


1


1


St. :


Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


(Month)


18


(Day)


1915


(Year)


I HEREBY CERTIFY that I attended deceased from


191


191.


, to


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 :


stilllow


(Duration)


.....


.. yrs.


mos. ds.


Contributory (SECONDARY)


(Duration)


... yrs.


mos. ...


ds.


(Signed)


Charles 7 mahoney


M.D.


Jan 20


1915 (Address).


3.55 mmchlop


* 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


of death


yrs.


mos.


In the


ds.


State


.yrs.


mos.


ds ..........


Where was disease contracted, If not at place of death ?.


Former or usual residence


1ª PLACE OF BURIAL OR REMOVAL


(Informant)


(Address)


34


16 Filed 191


REGISTRAR


.....


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


Yan


20


1916


11


(Month)


(Day)


(Year)


7 AGE


If LESS than t day ......... hrs.


yrs. mos. ds.


or.


min. ?


8 OCCUPATION (a) Trade, profession, or particular kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer)


BIRTHPLACE


(State or country)


10 NAME OF


FATHER


PARENTS


11 BIRTHPLACE OF FATHER (State or country)


12 MAIDEN NAME OF MOTHER Etter Vanzel


18 BIRTHPLACE OF MOTHER (State or country)


" THE ABOVEY'S TRUE TO THE BEST OF MY KNOWLEDGE


DATE OF BURIAL


Cin Q.Q 193


20 UNDERTAKER 5


ADDRESS


79


(City or town.)


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


32


E


3 SEX thatE


4 COLOR OR RACE


1


Jan. 10 -


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion 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 Ilouse- 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 occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE 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-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- 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 (disease 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," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childhirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


(No


494 Shirley


St. :


Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX -


female


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


2vidon


6 DATE OF BIRTH


Oct -


(Month)


(Day)


5th 1849


(Year)


7 AGE


If LESS than


I day, ........ hrs ..


65 yrs. 3


... yrs.


mos.


11 ds.


.. min. ?


$ OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry.


business, or establishment in


which employed (or employer)


9 BIRTHPLACE


(State or country)


Burton mars


PARENTS


12 MAIDEN NAME


OF MOTHER


Cenna Tener


13 BIRTHPLACE


OF MOTHER


(State or country)


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


Y


(Informant)


Gertrude 7. Veinteband


(Address)


16


Filed 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


lan


(Month)


19.1915


(Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from


Och. x5.


19175


Jan . 14,


to


1913 ....


that I last saw her


alive on


Som 17 th 1915. and that death occurred, on the date stated above, at .m. The CAUSE OF DEATH* was as follows :


(Duretion)


.yrs.


mos.


ds.


arterio sclerose


Contributory


(SECONDARY)


Andel


.(Duration)


yrs.


mos.


Us.


(Signed)


Millique &. Portes


M.D.


Srce 19., 1913 (Address)


Drinetrop


* 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


of death.


....... yr$


mos.


ds.


State


.yrs.


....


mos.


ds .............


Where was disease contracted, If not at place of death 7.


Former or usual residence.


17 PLACE OF BURIAL OR REMOVAL


Novellaun


maso


DATE OF BURIAL


Jan 2.2. 1915


* UNDERTAKER


ADDRESS


Windland 1


(City or town.)


....


Sarah.


Frances. Tay low


2 FULL NAME


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE


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.


2


10 NAME OF


FATHER


Shadrach. Kien


11 BIRTHPLACE


OF FATHER


(State or country)


In the


Jan. 11, 1/1


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion 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 Ilouse- 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 occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE 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-


culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- 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 (disease 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," etc.), "Dropsy," " Exhaustion," "Heart failure," "Haemorrhage," "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 septicemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


(No.


410 Breveelér ceve


St. :


Ward)


{if death occurred in a hospital or institution, give its NAME instead of street and number.]


2 FULL NAME


Chrubros.


arms.


Stiles


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


410 1 reweter ave wonetterof Man.


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


Mute


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


16 DATE OF DEATH


Jan


24


1915


(Month)


(Day)


(Year)


6 DATE OF BIRTH


30


1842


(Month)


(Day)


(Year)


7 AGE


73


.. yrs.


12


ros.


5


ds.


Or ....... min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Releve C Machen. fr


(b) General nature of industry,


business, or establishment in


which employed (or employer).


138221. RIR


9 BIRTHPLACE


(State or country)


10 NAME OF


FATHER


azro.


Elites


11 BIRTHPLACE


OF FATHER


(State or country)


12 MAIDEN NAME


OF MOTHER


Hellen Wwilling


13 BIRTHPLACE


OF MOTHER


(State or country)


Perfume ville p.f


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(informant)


(Address)


Filed .. 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


17


I HEREBY CERTIFY that I attended deceased from


19


. 1915, to.


24


1915.


that I last saw him alive on


24


191.3.,


and that death occurred, on the date stated above, a


9 1 m.


The CAUSE OF DEATH* was as follows :


Cereal hemorrhage.


(Duration)


.. yrs.


mos.


ds.


Contributory


artir seunosis


(SECONDARY)


(Duration)


.. yrs.


mos.


ds.


(Signed)


M.D.


... am 25


191 ...... (Address).


14.4


* 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


of death


........ yrs.


mos.


ds.


State


In the


yrs.


mos.


ds.


.......


Where was disease contracted,


if not at place of death ?.


Former or


usual residence


19 PLACE OF BURIAL OR REMOVAL


Keene 11.H


DATE OF BURIAL


1/27


1915


20 UNDERTAKER


ADDRESS


(City or town.)


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.


PARENTS


If LESS than 1 day ......... hrs ..


Jan. at, 1


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion 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 Ilouse- 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 occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE 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-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- 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 (disease 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," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " 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 septicemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following 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-1915.


CITY OF BOSTON. 854


FULL NAME


Place of Death ¿


Boston


and Residence S


Date of Death


JAN.26


1915.


Age


60


years months


days.


STATISTICAL DETAILS.


SEX.


COLOR.


M


W


SINGLE, MARRIED, WID., DIV. WID.


Maiden Name


Husband's Name


Birthplace GERMANY


Name of Father


LOUIS KALMUS


Birthplace


of Father


GERMANY


Maiden Name


of Mother


BERTHA JACOBY


Birthplace of Mother


GERMANY


COLLECTOR


Occupation


Informant


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


1915,


from 1915, to 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 : RAR'S


IST


PATRICIA Primary ( Duration ) in IS. SIT DE


. IFICE


ITA


TONTITAA


ISREGIMI


STO


V. MASS


SUICIDAL DURING TEMPORARY


INSANITY


(Signed)


T. LEARY MED. EX.


M. D.


JAN. 261915


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Place of Burial or removal


Undertaker


FOREST HILLS


J. P.CLEARY & SON


Usual Residence


WINTHROP HDS.


Filed


FEB. 1


A true copy.


Attest:


Eumylenen 1915 .


Registrar.


ILL. GAS POISONING


E


BOSTONIA


T.1 0.1822.


DONATI A.


Contributory : {


(Duration)


O


OTTO KALMUS


Registered No.


767 WASHINGTON ST.


Jan 26, 1915


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Winthrop


(No.


34 Madison Avenues.


...... .. Ward)


" FULL NAME


Margaret- Mary Murphy


[If married or divorced woman or widow give maiden name, also name of husband.] aRESIDENCE 34 Madison Avenue


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


' COLOR OR RACE


Female White


5 SINGLE,


Single


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


16 DATE OF DEATH


Jan


(Month)


(Day)


(Year)


" DATE OF BIRTH


Han


18


908


(Month)


(Day)


...


(Year)


7 AGE


7 . -


mos.


13


ds.


or ........ min. ?


$ OCCUPATION


(a) Trade, profession, or


particular kind of work.


School


(b) General nature of industry, business, or establishment In which employed (or employer).


9 BIRTHPLACE


(State or country)


East Boston


PARENTS


12 MAIDEN NAME


OF MOTHER


Mary A, Aberly


18 BIRTHPLACE


OF MOTHER


(State or country)


Salem mass


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Dennis J. Murphy


(Address)


34 Madison Avenue


Filed


191


REGISTRAR


17


I HEREBY CERTIFY that I attended deceased from


Jan 25"


1915, to


tam 3/2


1915


Stan 31


and that death occurred, on the date stated above, at


10m.


The CAUSE OF DEATH* was as follows : Dipirona Paralysis of heart


Did a surgical operation precede death? no


Date


i.


(Duration)


........ yrs.


mos.


3


ds.


Contributory


(SECONDARY)


(Duration)


„yrs.


mos.


ds.


(Signed)


(3) met calf


M.D.


um 315- 1915


(Address)


Waltherp


* 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


of death.


.......


.. yrs.


... mos.


ds.


In the


State ..


..........


.yrs.


mos. ds ............. Where was disease contracted, If not at place of death ?.


Former or usual residence.


1º PLACE OF BURIAL OR REMOVAL Holy Cross


DATE OF BURIAL


Jul 2


1915


UNDERTAKER


M. J. Kelly 11 Meridian Six


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.


N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state


Winthrop


BOSTON ..........


(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]


Registered No.


= MEDICAL CERTIFICATE OF DEATH


31


, 1915


....


If LESS than


day»


... hrs.


that I last saw h.


5


alive on


1915,


..


10 NAME OF


FATHER


Dennis J. Murphy


11 BIRTHPLACE


OF FATHER


(State or country)


East Boston


Jan. 31, 1915 STANDARD CERTIFICATE OF DEATH.


Statement of occupation. ---- Preeise 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 linc 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 laborcr, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- 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, cte. 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.




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