Town of Winthrop : Record of Deaths 1916-1918, Part 148

Author: Winthrop (Mass.)
Publication date: 1916
Publisher:
Number of Pages: 1316

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 148

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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 Crimina. abortion, Poisoning, Starvation, Suffocation, Exposure, 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.

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY

PHYSICIAN.

R 15. 2-'18. 100,000.

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

(No ..... 26 Sturges

St. :

Ward)

2 FULL NAME

Robert. H. Chakra

[If married or divorced woman or widow give maiden name, also name of busband.] @RESIDENCE 26 Sturges St Winter 2 Registered No.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

Whit.

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Maril

· DATE OF BIRTH

4 1857

(Month) (Day)

(Year)

7 AGE

6 $ 6 yrs. 5 mos. 25 ds.

.yrs.

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).

9 BIRTHPLACE

(State or country)

England

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

12 MAIDEN NAME

OF MOTHER

13 BIRTHPLACE

OF MOTHER

(State or country)

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Robert. If. Cluhan

(Address)

26 Theys .

Filed

2 191.5

REGISTRAR

16 DATE OF DEATH

(Month)

26.198

....

(Day)

(Year)

17 I HEREBY CERTIFY that I attended deceased from

, 191 __ , to

www.26

1917

that I last saw he

alive on

.....

nr. 24 . 191 ....... , and that death occurred, on the date stated above, at 1.7 Am. The CAUSE OF DEATH* was as follows :

(Duration)

............... yrs. ................ mos. ..............

ds.

Contributory

(SECONDARY)

(Duration) ..

........... yrs. ..........

... mos. ...

ds.

(Signed)

M.D.

......

1. 1918 (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

of death.

.yrs.

In the

mos.

„ds.

State ............ y:s.

............. mos. ...........

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

Former or

usual residence

19 PLACE OF BURIAL OR REMOVAL Winthrop

DATE OF BURIAL

7av.29. 198

20 UNDERTAKER

ADDRESS

(City or town.)

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

If LESS than

| day ........ hrs.

10 NAME OF

FATHER

John Logogron

0. 26. 1918

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 applics 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, Loeo- 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 laborcr, Farm laborer, Laborcr - Coal minc, 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 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 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; Broneho- 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); Mcasles; 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 (discase causing death), 29 ds .; Broneho-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," "Hacmorrhage," "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-1918. ----- WALSHAW

CITY OF BOSTON

FULL NAME

Place of Death l and Residence

Boston

MASS . HOMEO .HOSPT .

Date of Death

NOV.26

1918,

Age

years

months 1 days.

STATISTICAL DETAILS.

SEX

COLOR.

SINGLE, MARRIED, WID., DIV.

Maiden Name

Husband's Name

PA PS : (Duration

1CU

SOBIS

OFFICE

Name of

Father

PERCIVAL WALSHAW

Birthplace of Father ENGLAND

Maiden Name of Mother

LILLIE RICHARDSON

Birthplace

of Mother

ENGLAND

(Signed)

H.M.POLLOCK M D

NOV.26

1918

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

Place of Burial or removal MT .HOPE

Usual Residence

WINTHROP ( TOMOORE ST)

Filed

A true copy.

Attest :

DEC . 3

1918.

Filed Dec . 18, 1918

Registrar.

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:

STRAR

PREMATURITY

Birthplace

BOSTON

CTVTT BOSTONIA

CONDITAAA

B 1880. COTMINH DONATAA.

MASS ·Contributory: (Duration)

Occupation

Informant

PHYSICIAN'S CERTIFICATE.

I HEREBY CERTIFY that I attended deceased during last illness, from 1918, to

CITY R

A. 1822.

Undertaker

J.S.WATERMAN & SONS

Registered No.

15593

nov. 26, 1918

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City or town)

State

Mass

Registered No.

or Village

No.

224 Lincoln St.

St.,

.......

Ward

(If death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME .Mary .... Frances Murphy (If m the Army or Navy of the United States, give rank, organization, etc.)

(a) Residence.

No ....

224 Lincoln St.

(Usual place of abode)

mooths

days.

How loog in U. S., if of foreign birth ?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year)

19 LL

.19

, to ...

I HEREBY CERTIFY, That I attended deceased from

75.1. 14.5.

Ww 25

......

hTV. L,

that I last saw h. 22

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.

CONTRIBUTORY

itero

(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 ?

(Sigoed

, M.D.

4,24.19 (Address) @ Je nach !!

* State the DISEASE CAUSING DEATII, 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.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Holy Cross Malden

DATE OF BURIAL

11/30/18.

(Address)

224 Lincoln St.

Filed Luc 2, 19

REGISTRAR

20 UNDERTAKER

John F. V maly

ADDRESS

Winterof

12 MAIDEN NAME OF MOTHER Mary Laracey

N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be

1 PLACE OF DEATH County Suffolk Township Winthrop City Length of residence in city or towo where death occurred years 3 SEX 4 COLOR OR RACE Female White 5a If married, widowed, or divorced HUSBAND of (or) WIFE of Anthony Murphy 6 DATE OF BIRTH (month, day, and year) 7 AGE Years Months Days 78 8 OCCUPATION OF DECEASED (a) Trade, professioo, or At Home particular kind of work (b) General oature of industry, business, or establishment io which employed (or employer) (c) Name of employer St. Johns 9 BIRTHPLACE (city or town) 10 NAME OF FATHER David Lannigan 11 BIRTHPLACE OF FATHER (city or town) (State or country) Ireland PARENTS 13 BIRTHPLACE OF MOTHER (city or town) (State or country) Treland 14 Informant Mrs. Marsh of certificate. 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 (State or country) Newfoundland

St.,

.Ward.

(If non-resident give city or town and State)

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Widowed

If LESS thao

1 day, ....... hrs.

or ........ min.

[Approved by U. S. Census and American Public Health Association]

"Foreman," "Manager," "Dealer," ete., 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 domestic service for wages, as Servant, Cook, Housemaid, etc. It the occupation has been changed or given up on account of the DISEASE CAUSING DEATII, 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 synonym is "Epidemie 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- loneum, 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 nced not be stated unless important. Example: Measles (disease causing death), 29 Gs .; Broncho- pneumonia (secondary), 10 ds. Never report mere symnp- toms or terminal conditions, such as "Asthenia," "Ancmia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions,"" "Debility" ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- 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 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 Comninittee 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,

ete.

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.

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY

PHYSICIAN.

R 15. 1-'18. 100,000.

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

14 Teulf Hospital No

.....

St. ;.................. .. Ward)

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

2 FULL NAME Amelia Cheil.

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

8.3 amersil

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

{ COLOR OR RACE

Female White

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word) Married

. 148 17

(Month)

(Day)

(Year)

! 7 AGE

If LESS than [ day ........ hrs.

yrs.

mos.

ds.

or .....

... min. ?

8 OCCUPATION

(a) Trade, profession, or

particular kind of work

(It home

(b) General nature of industry, business, or establishment in which employed (or employer) .... at home

9 BIRTHPLACE

(State or country)

R. Island

PARENTS

11 BIRTHPLACE OF FATHER (State or country) England

12 MAIDEN NAME

OF MOTHER

Grand Miller

18 BIRTHPLACE OF MOTHER (State or country)

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Caff Brendridge

(Address)

83 Somerset Are WellfluHabe Cod

16 1205.29 191

Filed

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

November

(Month)

28-

191

I HEREBY CERTIFY that I attended deceased from 15 de Novembre 1918 to November 28 99 .........

8. that i last saw her alive 191.8 ... and that death occurred, on the date stated above, at % 10h.m. The CAUSE OF DEATH* was as follows : ' fenile myvousdites und

arteriosobileurio

.... yrs.

mos.

.ds.

Contributory.

adeno Carcinoma of

(SECONDARY)

(Duration) .............. yrs.

mos.

ds.

(Signed)

Okrank Ex. Salersion

M.D.

29Nov., 1918 (Address)

MetalsHospital

* If death followed injury or violence the certificate of death must be made ont by the Medical Examiner.

18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).

At place

of death.

.yrs

mos.

9 da.

In the

State ............ yrs.

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

Dec 1

1918

191

20 UNDERTAKER

ADDRESS

.......... ...... C R. Bennison 147 the Short REGISTRAR

...

(Day)

(Year)

$ DATE OF BIRTH

WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.

(City or town.)

the

10 NAME OF

FATHER

Games ! Prendity

nov . 20 1918

STANDARD CERTIFICATE OF DEATH.

Statement of occupation. - Precise statement of oecu- 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 oceupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, Loco- motive cngincer, Civil engineer, Stationary fireman, ete. But in many eases, 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 necdcd. 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 sceond statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborcr, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepcrs who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At sehoo' or At homc. Care should be taken to report specifically the occupations of persons engaged in domestic service for wagcs, as Servant, Cook, Houscmaid, etc. If the oceupation 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 eausation), using always the same accepted term for thic same disease. Examples: Cercbro-spinal fever (the only definite synonyın is "Epidemic eerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualificd, is indefinite) ; Tuber-

culosis of lungs, meninges, peritonaeum, ete., 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 eausing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," ete., when a definite disease can be ascertained as the causc. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicacmia," "PUERPERAL peritonitis," ete. State eause 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, ete.

3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or onc supposed to be duc to Alcoholism, etc.

4. Deaths under circumstances unknown, as A person found dead, ete.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City or town)

1 PLACE OF DEATH

County ..

Suffolk

State

Registered No ..

Township

Winthrop

City

or Village

44 Pleasant St.

St ...

.Ward

(If death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME

Margaret Fannie Corcoran

(If in the Army or Navy of the United States, give rank, organization, etc.)

(a) Residence.

No.

44 Pleasant St.

St.,

.. Ward.

(Usual place of abode)

Length of residence in city or town where death occurred

years

months

days.

How long in U. S., if nf foreign birth ?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

Female

hite

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of Tilliam F. Corcoran

6 DATE OF BIRTH (month, day, and year)

7 AGE

Years

Months

Days

If LESS than

1 day, ........ hrs.

or ........ min.

The CAUSE OF DEATH* was as follows :

acute Lobar Pneumonia

8 OCCUPATION OF DECEASED

(a) Trade. profession, or

particular kind of work.

At Home

(b) General nature of industry, business, or establishment in which employed (or employer). (c) Name of employer

(duration)

.mos.

2 ds.

CONTRIBUTORY

Influenz as

(SECONDARY)

.(duration)

yrs.

......

... mos.

... ds.

9 BIRTHPLACE (city or town).

East Poston

(State or country)

10 NAME OF FATHER

John HI, Sullivan

11 BIRTHPLACE OF FATHER (city or town)

(State or country)

Ireland

12 MAIDEN NAME OF MOTHER Katherine Sullivan

13 BIRTHPLACE OF MOTHER (city or town)

(State or country)

Treland

Informant

Husband

(Address)

Filed Acc 26, 1912

REGISTRAR

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) ..

Edmund Fr.

M.D.

12-1, 1918 (Address) 664 Bennington St, E Boston

* 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.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Holy Cross Malden

DATE OF BURIAL

12/3/18

ADDRESS

20 UNDERTAKER

John F. O malley.

Winthrop

of certificate.

N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year)

Dec. 1, 1918

I HEREBY CERTIFY, That I attended deceased from

19.

Nov. 27

, 1918, to Dec. 1

Nov. 30,

that I last saw

her

alive on

19.

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

545 Am.

3.3

PARENTS

. yrs ....

(If non-resident give city or town and State)

No ..

REVISED UNITED STATES STANDARD CERTIFICATE 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 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 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 domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATII, 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.

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Town of Winthrop : Record of Deaths 1916-1918, Part 148

Author: Winthrop (Mass.) Publication date: 1916 Publisher: Number of Pages: 1316

Author: Winthrop (Mass.)
Publication date: 1916
Publisher:
Number of Pages: 1316