Town of Winthrop : Record of Deaths 1916-1918, Part 50

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 50

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WIDOWED,

OR DIVORCED

(Write the word)

MARRIED

16 DATE OF DEATH

march

(Month)

(Day)

(Year)

S DATE OF BIRTH

(Month) (Day)

(Year)

7 AGE

yrs.

mos. ds.

or ........ 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)

BOSTON MASS

10 NAME OF

FATHER

JOHN

PARENTS

11 BIRTHPLACE OF FATHER (State or country) UNKNOW

12 MAIDEN NAME OF MOTHER UNKNI UNKNOWN

13 BIRTHPLACE

OF MOTHER

(State or country)

UNKNOWN

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

SOPHIA A. GRIMES

(Address)

507 SHIRLEY ST

Filed 191

REGISTRAR

I HEREBY CERTIFY that I attended deceased from 76.18 to 191 ...... that I last saw him alive on Manche 6, 197. and that death occurred, on the date stated above, at. 3 45Pm.

The CAUSE OF DEATH* was as follows :

Cerebral Nacmorrhage

(Duration)

ds.

yrs.

mos.

Contributory

antonio - silicosis

(SECONDARY)

(Signed)

Charles 7. mahoney

(Duration)

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

.........

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

ds.

march 7, 1917 (Address) 856 Umathurpsp

* 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).

Åt place

In the

of death

. yrs . ...

.. mos.

...........

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

... mos.

.......

ds.

State

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

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

Former or usual residence ....

19 PLACE OF BURIAL OR REMOVAL CALVARY CEMETERY

DATE OF BURIAL

MAR.8. 1917

ADDRESS

20 UNDERTAKER JOHN F. O'MALLEY

WINTHROP

.....

Ward)

2 FULL NAME.

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

507 SHIRLEY ST.

AMBROSE

GRIME

St. ;

ICHAEL

If LESS than

[ day ......... hrs.

, 191

....

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, Architcet, 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) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Forem ~~. " "Managua," "Dealer," etc., withwut more precise specification, as Day laborcr, 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 homc. 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 DEATII, state occupation at beginning of illness. If retired froin business, that fact may be indicated thus: Farmer (rctired, 6 yrs.). For persons who have no occu- pation whatever, write Nonc.

Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affcetion with respect to time and causation), using always the same accepted terni for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie 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 ncoplasms); Measles; Whooping cough; Chronic valvular heart discasc; 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," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "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 deathis of persons not disabled by recognized disease, as A death upon the street, or onc supposed to be duc to Alcoholism, etc.

4. Deatlıs under circumstances unknown, as A person found dead, etc.

COMMONWEALTH OF MASSACHUSETTS

RETURN OF A DEATH-1917.

CITY OF BOSTON

FULL NAME CHARLES A. GRANT

Registered No. 2765

Place of Death } and Residence S

Boston

MASS. HOMEO.HOSPT .

Date of Death

MAR.8

1917,

Age 69

years

months 22

days.

STATISTICAL DETAILS.

SEX.

COLOR.

SINGLE, MARRIED, WID., DIV.

Maiden Name

Husband's Name

mary PAT RIBUS PAULINE (Duration)

PULM.EMBOLISM

Birthplace

KENNEBUNKPORT.ME. CITY

BORIS A

Name of Father

IRA GRANT

Birthplace of Father YORK.ME.

Contributory: {OPR. FOR HERNIA FEB.20. 1917

(Duration )

Maiden Name of Mother MARY MERRILL

Birthplace of Mother

KENNEBUNKPORT.ME.

(Signed)

W.F .WOOD M.D.

Occupation WHOLESALE FISH DEALER

MAR.8

1917

Informant

( RETIRED ) SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.

Place of Burial or removal

WINTHROP (WINTHROP CEM.)

Usual Residence

WINTHROP(85 SARGENT ST)

Undertaker

C .R.BENNISON

Filed

MAR .12 1917.

WINTHROP

A true copy. Attest :

Registrar.

PHYSICIAN'S CERTIFICATE.

I HEREBY CERTIFY that I attended deceased during last illness, from 1917, to

1917, 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'

TVM BOSTONIA

CONDITAA

B IMINE DONATA A STON. MASS.

A 1822.

-march 8 1917

COMMONWEALTH OF MASSACHUSETTS

RETURN OF A DEATH-1917.

CITY OF BOSTON

FULL NAME

FRANK H.CONVERSE

Registered No.

2827

Place of Death ¿ and Residence

Boston

Date of Death

MAR.8

CITY HOSPT.

1917, Age 54

years

months

days.

STATISTICAL DETAILS.

SEX.

COLOR.

SINGLE, MARRIED, WID., DIV.

Maiden Name

Husband's Name

SEPTIC FRACTURE BOTH BONES OF

Birthplace

BOSTON

Name of Father

BENNING CONVERSE

Birthplace of Father

STAMFORD.CONN.

Contributory : (Duration )

ACC.FALL FROM LADDER

Maiden Name of Mother

MARY A. SAUNDERS

Birthplace of Mother

AT SEA

(Signed)

T.LEARY MED.EX. M.D.

MAR . 9 1917

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

Place of Burial or removal

CEDAR GROVE

Undertaker

J.S.WATERMAN & SONS

PHYSICIAN'S CERTIFICATE.

I HEREBY CERTIFY that I attended deceased during last illness, from 1917, to

1917, 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 :

R PATRIBUS Primary

CITY

HOBIS

OFFICE

LEG-SEPTIC HAND

BOSTONIA

TAT

CONDITA /O. 1231.

MINE DONATA A STON. MASS.

Occupation

CLERK

Informant

WINTHROP (118 LOCUST ST)

Usual Residence

MAR. 13

Filed

1917.

A true copy. Attest :

Registrar.

march 8, 1917

1 PLACE OF DEATH 3 SEX male 6 DATE OF BIRTH 7 AGE $ OCCUPATION (a) Trade, profession, or particular kind of work PARENTS important. See instructions on back of certificate. 15 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 (b) General nature of industry, business, or establishment in which employed (or employer)

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

B. RBIL. RR, Playstead

2 FULL NAME albert Colter

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

375 Smiley ST., Winthrop

Registered No. 126

MEDICAL CERTIFICATE OF DEATH

(Month)

(Day

191

(x)

1 HEREBY CERTIFY that I have investigated the

death of the deceased.

175

The CAUSE OF DEATH* was as follows : Multiple junies including.

fracture

eta Pelins of the

leg (compound) and i the lord caused by xo Steam mos ds.

dent

...

SECONDARY )

fry

Brno A.L. R.R.)

ds.

(Signed) Burgers Magnet, ., M.D.

(Address)

MEDICAL EXAMINER

* State the DISEASE CAUSING DEATII, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.

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

At place

of death

yrs

mos.

ds.

State .. . ....

.yrs.

In the

mos.

ds ..

Where was disease contracted,

if not at place of death ?.

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL It Josephe

DATE OF BURIAL

médio 1917

ADDRESS

Filed 191

REGISTRAR

8647

St.

Ward)

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

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

White

6 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Vingla

(Month) (Day)

(Year)

If LESS than

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

.yrs.

mos.

ds.

. min. ?

Student

9 BIRTHPLACE

(State or country)

Anthropo

10 NAME OF

FATHER

Daniel

11 BIRTHPLACE OF FATHER (State or country) Lunicy

12 MAIDEN NAME

OF MOTHER

Ellens Fini leary.

13 BIRTHPLACE OF MOTHER (State or country) Doston)

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Estu Galter

(Address)

375 Alley NO

16 DATE OF DEATH

March

STANDARD CERTIFICATE OF DEATH.

Statement of occupation. - Precise statement of occu- pation is very important, so that the relativo healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupation ? 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, 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) 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 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, 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 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, peritonacum, etc., Carcinoma, Sar. coma, etc., of ... ...... ..... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasmns) ; Measles; Whooping cough; Chronic valvular heart disease; Chronie 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" (Inerely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility." ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Ifacmorrhage," "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," cte. State eause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."

Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:

1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.

2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.

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

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

12 16. 7.'16. 5,000.

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

Chelsea Ma.s.8. (No .............. , Frost ..... Hospital St. i. ..................... Ward)

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

" FULL NAME

Flynn

[If married or divorced woman or widow

give maiden name, also name of bushand.]

@RESIDENCE

62 Park Ave., Winthrop, Mass.

..... Registered No. 205

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

$ SEX

Male

4 COLOR OR RACE

White

· SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Single

18 DATE OF DEATH

March .... 12 1917

191

(Month)

(Day)

(Year,

· DATE OF BIRTH

(Month)

(Day)

(Year)

TAGE

If LESS than

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

ds.

Or ......... min. ?

17 I HEREBY CERTIFY that I attended deceased trom Mar. 12 !13, .. , to 191 - 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 :

Still Born

9 BIRTHPLACE

(State or country)

Chelsea, Mass.

10 NAME OF

FATHER

Daniel Flynn

PARENTS

II BIRTHPLACE

OF FATHER

(State or country)

Boston, Mass.

12 MAIDEN NAME

OF MOTHER

A gnes Hart

18 BIRTHPLACE

OF MOTHER

(State or country)

Ireland

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Daniel Flynn

(Address)

62 Park Ave Winthrop

16 Filed Mar. 19, 19,7 C

REGISTRAR

(Duration)

.. mos.

ds.

Contributory

(SECONDARY)

(Duration)

mos.

.yrs.

.ds.

(Signed)

J. H. Strong

M.D.

Mar. 12 , 197 (Address) 211 Saratoga

* 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.

........

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

Former or usual residence

1º PLACE OF BURIAL OR REMOVAL

Bunker Hill Cem.

DATE OF BURIAL

Mar. 14, 1917

20 UNDERTAKER

Thos .

J.Lane

ADDRESS

E. Boston,

.....

* OCCUPATION

(a) Trade, profession, or

particular kind of work

(b) General nature of Industry. business, or establishment in which employed (or employer) ..

mar 14, 1917

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

12 MAIDEN NAME

OF MOTHER

"Catherine Seoghogan

13 BIRTHPLACE

OF MOTHER

(State or country)

Seeland

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Thomas MEdireency

(Address) 23 Elm St. Lyan The

Filed 191

REGISTRAR

8788

(City or town.)

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

2 FULL NAME games [If married or divorced joman or widow give maiden name, NNso name of husband.] @RESIDENCE 23 5

outh Elvy Lyan

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

: SEX

male

4 COLOR OR RACE

White

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Supple

6 DATE OF BIRTH

(Montlı)

(Day)

(Year)

7 AGE

If LESS than

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

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

& OCCUPATION

(a) Trade, profession, or

particular kind of work

leuk

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

9 BIRTHPLACE

(State or country)

Contributory (SECONDARY)

mos. ds.

(Signed)

(Duration) Burgers magath, M.D.

(Address)!

MEDICAL EXAMINER

* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.

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 Sh Joseph, leem.

DATE OF BURIAL

Mary J, 1917

....

20 UNDERTAKER

Michael Ou Haven

ADDRESS

Summon Nicole

16 DATE OF DEATH

Chanh 22.

1911

Borde

read apa 50 )

(Month)

(Day)

(Year)

1895 17 I HEREBY CERTIFY that I have investigated the death of the deceased.

The CAUSE OF DEATH* was as follows :

(Duration) ............ yrs. .......... mos. ds.

10 NAME OF

FATHER

Thomas ME Lucency

11 BIRTHPLACE

OF FATHER

(State or country)

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

I PLACE OF DEATH stan

St. Ward)

MEDICAL CERTIFICATE OF DEATH

... yrs.

La mos.

. ds.

STANDARD CERTIFICATE OF DEATH. PERMANENT RECORD THIS IS A HNI DNIOVINO HLM VAINIVHI JIIHM

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 eaclı 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) Salcs- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in 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; 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 discase 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. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."

Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deatlis 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- posurc, etc.

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

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

R. 16-8-'15. 5,000.

3 SEX m 17 AGE & OCCUPATION PARENTS important. See instructions on back of certificate. 15 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 51.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

Shore.

St. ...... .Ward)

2 FULL NAME [If married or divorced woman or widow give maiden name, alse name of husband.] @RESIDENCE

64 Condicact are.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

$ SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

6 DATE OF BIRTH

December 24

1866 17

(Monthı)

(Day)

(Year)

If LESS than

I day, .......

hrs.

or ....... min. ?

(a) Trade, profession, or

particular kind of work

Printer

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

9 BIRTHPLACE

(State or country)

abbinaton mass

10 NAME OF

FATHER

John david

11 BIRTHPLACE

OF FATHER

(Stifte or country)

Dieland

12 MAIDEN NAME

OF MOTHER

Ellen Shanahan

13 BIRTHPLACE

OF MOTHER

(State or country)

Sulaud.

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Hife

(Address)

6+ Endiccost are Beachment Cabra

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Town of Winthrop : Record of Deaths 1916-1918, Part 50

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

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