USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 41
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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 discasc. Examples: Cercbro-spinal fever (the only (lefinite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never rc- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite); Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, ctc., of ... .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Measles; Whooping cough; Chronie 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- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Wcakness," etc., when a definite disease can be ascertained as the cause. Always qualify all discases 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, ctc.
3. Sudden deaths of persons not disabled by recognized diseasc, 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.
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 EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No.
71 Collage Ph Road S.
village
.Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Fencale
4 COLOR OR RACE
Alite
6 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
Single
· DATE OF BIRTH
October
22
6, 1952
17
I HEREBY CERTIFY that I attended deceased from
(Month)
(Day)
(Year)
may 15
1915,
to.
.....
" AGE
64
„yrs.
2
mos.
...........
.......
ds.
... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Retired
(b) General nature of Industry.
business, or establishment
which employed (or employer)
-
9 BIRTHPLACE
(State or country)
Bustin mass
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Dublin Trebands
12 MAIDEN NAME
OF MOTHER
anne Gilbride
18 BIRTHPLACE
OF MOTHER
(State or country)
Roscommon Leland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
marquer Ficley
(Address)
TV Cottage Pk Road
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
28
(Day)
(Year)
Den. 2.8
1915
that I last saw ha alive on
...
Lan- 23
1916
and that death occurred, on the date stated above, at Y Am.
The CAUSE OF DEATH* was as follows :
.... (
(Duration)
.yrs.
mos.
............
ds.
Contributory
Hemiplegia
(SECONDARY)
.(Duration)
yrs.
mos. ............... dr.
M.D.
(Signed)
Du. 28. 1916 (Address)
3562mcharles
* 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).
In the
At place
of death
.yrs.
mos ..
ds.
State
......... yrs.
.......
mos. ............ ds .________...
Where was disease contracted, If not at place of death ?. Former or usual residence
19 PLACE OF BURIAL OR REMOVAL Perly andten Brokline mais
DATE OF BURIAL
DEC 30
1916
20 UNDERTAKER
Dunas & Ley, no
ADDRESS
Filed 191
Catherine DEcler
atturine
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
71 Cottage Park Road-
Registered No.
......... 1916 ....
If LESS than
I day ........ hrs.
10 NAME OF
FATHER
Timothy FERley
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 agc. 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, 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. 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-
Agent.
Board of Health, City of Newton. The within return countersigned and approved this. 191
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 nced not be stated unless im- portant. Example: Measles (discase 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 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.
day of.
R. 15-8-'15. 100,000.
1 1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1916.
CITY OF BOSTON.
FULL NAME
ANNIE E. EDDLEM
Registered No. 12453
Place of Death ¿
Boston
and Residence §
Date of Death
DEC.29
1916.
Age
12
years 8
months
22
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
W
S
Maiden Name
Husband's Name
Birthplace
BOSTON
Name of Father
THOMAS EDDLEM
Birthplace of Father
-N.F.
Maiden Name of Mother
EVA CARTON
Birthplace of Mother
ENGLAND
Occupation SCHOOL GIRL
Informant
Place of Burial or removal
CAMBRIDGE(CAMB.CEM
C .R .BENNISON
Undertaker
WINTHROP
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1916,
from 1916, 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 :
S
RAR'S
JT PATRIRUS
S. SIT D Primary
SICUT (Doratoin)
OFFICE
CTVTTA
TONDETAA
A. 182%
B TS REGIMI
NE DONATA A.
N. MASS.
Contributory · 2 (Duration)
(Signed) G.A.MAC IVER M. D.
DEC.29 1916
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
IN HOSPT. 17 DAYS
Usual Residence
WINTHROP ( 11 NEPTUNE AV)
JAN . 3
Filed
1916.
A true copy.
Attest :
ErMSlenen
Registrar. -. 1 :1
ACUTE OSTEOMYELITIS - 20 DYS
CITY
BOSTONIA
OSTO
F
MASS. GEN.HOSPT.
APERMANENT RECORD.
31 ʻ
... $ SEX Male · DATE OF BIRTH 7 AGE particular kind of work PARENTS Important. See Instructions on back of certificate. 16 Filed 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 5.2
The Commonwealth of Massachusetts
1 PLACE OF DEATH
(No.
4 PEYFPE ST.
.St. ............. .Ward)
(City or town.)
{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)
(Day)
19
(Year)
17
I HEREBY CERTIFY that I attended deceased from
, 1915 __ , to.
191 ...
that I last saw h be alive on
Www. 30
191.4.
and that death occurred, on the date stated above, at trim.
The CAUSE OF DEATH* was as follows :
ty hostatic pneumonie
(Duration)
........ yrs.
mos
ds.
Contributory.
Cerebral Hemollinage
(SECONDARY)
(Duration)
... yrs.
mos.
ds.
(Signed)
....
Charles 7. malmin.
, M.D.
Dan- 31
.........
....
1916 (Address)
356 Limette
* 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
... 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 Moly Cross Kalden
DATE OF BURIAL
Jan. 2 1017, 191
20 UNDERTAKER
John F. O' Maley
ADDRESS
Finthrop
1. : ,
(Month)
(Day)
1
(Year)
If LESS than
I day ......... hrs.
(a) Trade, profession, or
yrs. ................... .. mos.
ds.
or ........ min. ?
& OCCUPATION
Tils Setter
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Treland
10 NAME OF
FATHER
Andrew
Tudge
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland
12 MAIDEN NAME
OF MOTHER
Ann Tinsey
13 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mary Judge
(Address)
4 Pevere St.
REGISTRAR
STANDARD CERTIFICATE OF DEATH FINTMPOP
2 FULL NAME
JAMES TUNGE
[If married or divorced woman or widow
give maiden name, also name of hughand. ]
@RESIDENCE
4
PEVERE ST.
{ COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED Married
(Write the word)
191
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 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, 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, Laborcr - Coul minc, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- keepcrs 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 110 occu- pation whatever, write Nonc.
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: Cercbro-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, peritoneum, 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 ean 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.
٠
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
FINTHROP
(No.
I FILSHIRE ST
St .;
...... Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
? FULL NAME MAPGAPFT MURPHY MAGUIPE
[If married or divorced woman or widow give maiden namc, also name of husband.] @RESIDENCE I TILSHIPE ST.
idow of Peter Maguire
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
· DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE
86
.yrs. ............ mos. ds.
.............. or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
At Home
(b) General nature of industry, business, or establishment In which employed (or employer) ......
9 BIRTHPLACE
(State or country)
Ireland
10 NAME OF
FATHER
Unknown
11 BIRTHPLACE OF FATHER (State or country) Ireland
12 MAIDEN NAME
OF MOTHER
Mary Burke
13 BIRTHPLACE
OF MOTHER
(State or country) Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs, E. F. Keen
(Address)
Wilshire St.
15
Filed
191
- REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
(Day)
7. 1917
(Year)
17
I HEREBY CERTIFY that I attended deceased from
3
, 191.2 .. , to.
7
1917.
that I last saw he alive on
191 ... 7.,
and that death occurred, on the date stated above, at
11 Am.
The CAUSE OF DEATH* was as follows :
........
.. (Duration)
.yrs. ...
mos.
ds.
1
Contributory.
artelia Delensio.
(SECONDARY)
(Duration)
.............. yrs.
.........
.. mos. ds.
(Signed)
Charles Fmahoney
M.D.
1917 (Address)
856 Umalles,
V * 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).
In the
At place
of death.
yrs.
mos.
ds.
State ............ yrs.
mos.
ds .............
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Moly Cross Cem. Malden
20 UNDERTAKER
John F. O'Maley
DATE OF BURIAL
Jan ATOTT
191
ADDRESS
Fint
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
' COLOR OR RACE
White
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widow
If LESS than
day.
„hrs.
0
CORD
-
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, Architect, Loco- motive engineer, Civil cngincer, 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 nceded. 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 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 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: Cercbro-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," unqualificd, 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 ncoplasms); 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," "Scnile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL scpticaemia," "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.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
FAST BOSTON MASS.
12 MAIDEN NAME
OF MOTHER
CATHERINE EOYLAN
13 BIRTHPLACE
OF MOTHER
(State or country }EASTON MAse
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
JAMES T GPADV
(Address)
60 QUINCY AVE
16
Filed
191
REGISTRAR
(City or town.)
{If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
៛ COLOR OR RACE
Male
White
$ DATE OF BIRTH
JUNE
12
"Month)
(Day)
PI5 (Year)
? AGE
T.
yrs.
mos. .27 .ds.
or min. ?
& OCCUPATION (a) Trade, profession, or particular kind of work ....
The CAUSE OF DEATH* was as follows : Gastroenteritis
strato crocus infection
.(Duration)
...... .... yrs.
........... ... mos.
Contributory
(SECONDARY)
(Duration)
.. yrs.
............
mos. ..............
ds.
(Signed)
M.D.
Jan 8
191 ....... (Address)
VIf 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).
in the
At place
of death ............ yrs.
... mos. ...........
State ............ yrs. ............ mos. ............
ds ..........
Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
Holy Cross
Malden
DATE OF BURIAL
Jan. 91917
191
20 UNDERTAKER JOHN M. Q'Maley
ADDRESS Winthro
(Month)
87
1917
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from
Jan
5
1917
.... , to
) .......
191
7
that I last saw h MMM alive on
191.2
and that death occurred, on the date stated above, at 3 A m .
(b) General nature of Industry, business, or establishment which employed (or employer).
16 DATE OF DEATH
MEDICAL CERTIFICATE OF DEATH
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
GO QUINCY AVE.
St. :
Ward)
......
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH WINTHROP
(No.
60 QUINCY AVE.
? FULL NAME
JAMES GPADY
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word) Single
If LESS than
[ day ......... hrs.
9 BIRTHPLACE
(State or country)
"INTMPOP MASS.
10 NAME OF
FATHER
JAMES GRADY
CORD.
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 applics to each and every person, irrespective of agc. 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 inay 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 sehoo' 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.
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