USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 103
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genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- Inus," "Old age," " "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- l'ERAL peritonitis," ctc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine 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." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions 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, Exposure, etc.
3. Sudden deathis 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 dcad, etc.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY PHYSICIAN.
R 15. 1-'18. 100,000.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
nantucket (City or town)
1 PLACE OF DEATH .
County
middlesex
State
mass.
Registered No ..
41
Township
or Village
............... .or
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Harriet S. (Parker) Folger
(a) Residence. No. Winthrop
(Usual place of abode)
Length of residence in city or town where death occurred years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
Mute
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Widowed
5a If married, widowed, or divorced HUSBAND of (or) WIFE of garnes Folger
6 DATE OF BIRTH (month, day, and year)
7 AGE
Years
94
Months 10
Days
2
If LESS than 1 day ......... hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or particular kind of work.
(b) General nature of industry, basiness, or establishment in which employed (or employer) (c) Name of employer
artéria Sclerosis
Interstitial nephritis
CONTRIBUTORY
(SECONDARY)
(duration) ......... yrs .............. .. mos .. .........
.ds.
18 Where was disease contracted if not at place of death ?
Did an operation precede death? Date of.
Was there an autopsy ?.
What test confirmed diagnosis ?
(Signed).
S. K. Reed, agy, Bd, Health
M.D.
5/2, 1918 (Address) Medford, Mass
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
of certificate.
14
Informant
Charles J. Parker
Winthrop, mass (Address)
15 Filed May 4, 1918 Lamindre Box REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
may 1,
19/8
17 I HEREBY CERTIFY, That I attended deceased from 19. .. , to 19
that I last saw h ... alive on 19
and that death occurred, on the date stated above, at
.m. The CAUSE OF DEATH* was as follows :
(duration)
.yrs.
.mos.
ds.
9 BIRTHPLACE (city or town)
Barnstable
(State or country) masz.
10 NAME OF FATHER Joshua Parker
PARENTS
11 BIRTHPLACE OF FATHER (city or town) Barnetable (State or country) mass.
12 MAIDEN NAME OF MOTHER
Deborah Black
Barnstable
13 BIRTHPLACE OF MOTHER (city or town). (State or country) mark,
19 PLACE OF BURIAL, CREMATION, OR REMOVAL Prospect High Cemetery nantucket, mass
DATE OF BURIAL May 3, 1918
20 UNDERTAKER Charles W. Leins
ADDRESS narituell wars.
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
City
medlord
No.
....... , ......
St.,
Ward
2 FULL NAME
St., Ward. ... .
(If non-resident give city or town and State)
June 29, 1824
=
[Approved by U. S. Census and American Public Health Association]
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, Compos- itor, Architect, Locomotive 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer." "Foreman," "Manager,". "Dealer," etc., without more precise specification, as Day laborcr, Farm laborcr, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Hlousekcepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestie 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death. - Namne, first, the DISEASE CAUSING DEATII (the primary affection with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cercbrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, ete., 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 (secondary or inter- current) affection need not be stated unless important. Example: Mcasles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Comna," "Convulsions," " Debility" ("Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness , " etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from ehild- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicidc. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated
.
under der the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.) Cases for the Medical Examiners. - Under the provi- sions 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, Exposure, 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 dead, etc.
.
-
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PHYSICIAN.
R 15. 1-'18. 20,000.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Winthrop
BOSTON (City or town)
1 PLACE OF DEATH
County.
Suffolk
State Massachusetts .Registered No.
Township
Winthrop.
or Village.
or
City.
.......
BUST.ON.
No.
36 Cliff Ave.
St., ... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Charles Jenkins.
(a) Residence.
No.
847 Beacon Street Boston . Ward.
(If non-resident give city or town and State)
(Usual place of abode)
Length of residence io city or towo where death occurred
years 6 months
days.
How loog io U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, an
May 1 1918
19
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
married.
5a If married, widowed, of divorcedence S.Jenkins.
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and yell April 8 1844.
7 AGE
Years
74
Months
Days
23
If LESS thao 1 day, ........ hrs. or ....... min. Cinebral Hemorrhage
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
none.
particular kind of work.
(h) General nature of industry, hasiness, or establishment io which employed (or employer) (c) Name of employer
.. (duration)
5
mos.
.ds.
CONTRIBUTORY
mitral regnigitation
(SECONDARY)
(duration)
... yrs.
......
mos.
ds.
18 Where was disease contracted
if not at place of death?
Did an operation precede death ?
200
Date of
Was there an autopsy ?
FOR WHAT ?
no
What test confirmed diagnosis ?
(Signed)
Frank E. Haskins.
M.D.
5/1.1918 (Address) Fort Huntington One.
* State the DISEASE CAUSING DEATH, OF In deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Forest Hills
DATE OF BURIAL May 4 1918.
ADDRESS
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.
14 Mrs. Jenkins.
Informant
36-Cliff Ave.
(Address)
15 Filed 19
REGISTRAR
17
I HEREBY CERTIFY, That I attended deceased from
July
19/ 6
/
15
to
19.
that I last saw he was alive on
apr 29
1918.
and that death occurred, on the date stated above, at 6 9.m. The CAUSE OF DEATH* was as follows :
9 BIRTHPLACE (city or town).
Boston Mass.
(State or country)
10 NAME OF FATHER
Nathaniel Jenkins.
PARENTS
11 BIRTHPLACE OF FATHER (city or town).
(State or country)
Boston Mass
12 MAIDEN NAME OF MOTHER Mary Tucker.
13 BIRTHPLACE OF MORUES tion Mass
(State or country)
20 UNDERTAKER
ErmanDons.
.. yrs ....
GRISLY UNIICU JIAIDS STANDARD CERTIFICAIL OF DEATH [Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits ean be known. The question applies to cach and every person, irrespective of age. For inany occupations a single word or terin on the first line will be . sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ina- terial 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 Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestie 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 indi- cated 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: Cerebrospinal fever (the only definite synonyın is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Comna," ""Convulsions,"" "Debility" ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- Inus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birtli or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine 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 (c. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions 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, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized liscase, 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. .
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PIIYSICIAN.
R 15. 2-'18. 100,000.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1918.
CITY OF BOSTON
FULL NAME
MICHAEL O DONNELL
Registered No.
5258
Place of Death ¿ and Residence S
Boston
FENWAY HOSPT .
Date of Death
MAY 9
1918,
Age 50
years
months days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
M
W
M
Maiden Name
Husband's Name
Birthplace
BOSTON
Name of Father
JOHN O DONNELL
Birthplace of Father
IRELAND
Maiden Name of Mother
Birthplace of Mother IRELAND
Occupation
FISH MERCHANT
Informant
Place of Burial or removal
Undertaker
WINTHROP
J.F.O MALEY
WINTHROP
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness, from 1918, to
1918, 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:
ACUTE GASTRIC DILATATION - ACUTE CARDIAC DILATATION - 2 DAYS
Contributory: ( INCARCERATED OBSTRUCTED INGUIN- (Duration)
AL HERNIA -PROGRESSIVE -- 4 YRS
(Signed) C.C.CARROLL M D
1918
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence
WINTHROP (4 PRESCOTT ST)
Filed
MAY 13
1918.
A true copy.
Attest :
1
RAR' Primary: (Duration) SOBIS
T PATRIBU
CITY
OFFICE
TVY BOSTONIA
CONDITAAL
1884.
S
CGIMINE DONATA A MASS.
Registrar.
May 9, 1918.
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
11 BIRTHPLACE
OF FATHER
(State or country)
Russia
12 MAIDEN NAME OF MOTHER Hola Solomon
13 BIRTHPLACE OF MOTHER (State or country) Russia
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Morais Price
(Address)
16
Filed
191
REGISTRAR
16 DATE OF DEATH
15-
8
(Month)
(Day)
191 (Year)
* DATE OF BIRTH
.....
(Month)
(Day) (Year)
7 AGE
If LESS than
day.
25
... yrs.
mos.
ds.
... min. ?
B OCCUPATION
(a) Trade, profession, or
particular kind of work,
House-Wife
(b) General nature of industry, business, or establishment In which employed (or employer) ...
Peritonitis following
Caczania, See (cpuAtion)
4.
ds.
Contributory ..
for contractual fatura
(SECONDARY)
.. (Duration) ...
yrs.
....... da.
-
(Signed) ...
Lowing At Toquand
....
M.D.
....
* 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.
5 ds.
State ............ yra.
........
Where was disease contracted, If not at place of death ?. Former or
usual residence ..
31- Tudent que wil il man
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL Wobum, Ohel Leof May 16 1918
Tem.
20 UNDERTAKER ADDRESS Jacob Stanetep Jong Boston
Winthrop (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
oulu Pauline Tresa Price
' FULL NAME
[If married or divorced woman or widow give maiden name, also name of busband.] @RESIDENCE 3H Trident ave.
Pauline Tresa Wolpert wife Woning
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
$ SEX
Female W.
5 SINGLE
MARRIED,
WIDO WED.
OR DIVORCED
(Write the word)
17
I HEREBY CERTIFY that)I attended deceased from
Decay 11. 1918, t
Liny 15-1818
that I last saw h ............ alive on
Le (E), 1.5. 1918
and that death occurred, on the date stated above, at
2 1-m.
m.
The CAUSE OF DEATH* was as follows :
9 BIRTHPLACE
(State or country)
Russia
10 NAME OF
FATHER
Samuel Wolpert
....... yrs.
in the
mos. ............
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Metcalf Hospital ...... St. : Ward)
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, c. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engincer, Civil engineer, Stationary fireman, ete. 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) Forcman, (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, Laborcr - Coal minc, cte. 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 domestie 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 faet may be indicated thus: Farmer (retircd, 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 tiine and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie cerebro-spinal ineningitis"); 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, ete., 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 (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," "Uracmia," "Weakness," cte., when a definite disease can be ascertained as the eausc. 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. Deathis following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly eaused 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 ...
(City or town)
1 PLACE OF DEATH
County.
Suffolk
State
mass
Registered No .........
Township
or Village
No. 3H. Thornton Pack
St.,
Ward
(If death occurred in a hospital or institution, fixe its NAME instead of street and number)
2 FULL NAME
Lennie Larkin
(a) Residence.
No. 34 Thouston Park
Ward.
(Usual place of abode)
Length of residence in city or town where death occurred 30
years
months
days.
How long in U. S., if of foreign hirth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
W
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year)
7 AGE
Ycars
58
Months
2
Days
6
If LESS than
1 day, ........ hrs.
or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
athome
(h) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
9 BIRTHPLACE (city or town)
El Bonton,
(State or country)
mars
10 NAME OF FATHER James Larkin
11 BIRTHPLACE OF FATHER (city or town) ...
(State or country) no. Ireland.
12 MAIDEN NAME OF MOTHER Rachel War nock
13 BIRTHPLACE OF MOTHER (city or town).
Poston
(State or country) mais
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