USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 64
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121 | Part 122 | Part 123 | Part 124 | Part 125 | Part 126 | Part 127 | Part 128 | Part 129 | Part 130 | Part 131 | Part 132 | Part 133 | Part 134 | Part 135 | Part 136 | Part 137 | Part 138 | Part 139 | Part 140 | Part 141 | Part 142 | Part 143 | Part 144 | Part 145 | Part 146 | Part 147 | Part 148 | Part 149 | Part 150 | Part 151 | Part 152
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," unqualificd, is indefinite) ; Tube :-
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- 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 disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieaemia," "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, Suieidc, 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-1917.
CITY OF BOSTON
FULL NAME
EDWARD JOHNSTONE
Registered No. 6294
Place of Death ¿
Boston
and Residence S
Date of Death
JUNE II
1917, Age
8
years
8
months
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
M
W
S
Maiden Name
Husband's Name
Birthplace
Name of Father
GEORGE U. JOHNSTONE te 31.
Birthplace of Father
BOSTON
Maiden Name of Mother
ANNIE TIERNEY
Birthplace of Mother
BOSTON
Occupation
SCHOOLBOY
Informant
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
TRIBUS. Primary
SOBIS
SOFFICE
BOSTONIA CONDITA A.
A. 1822.
STON CTYITATIS COTMINE DONATA A MASS. - Contributory: (Duration) -
(Signed)
J.L.MORSE M.D.
JUNE12
1917
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
Undertaker
CALVARY
J.F. O MALEY
WINTHROP
Usual Residence
WINTHROP (43 FRANKLIN ST)
Filed
JUNE 16
1917.
A true copy.
Attest :
ErMSlenen
Registrar.
TUBERCULOUS MENINGITIS
BOSTON (DOR.) CITY
CHILDRENS HOSPT.
SIT L-ANT DNIOVANA
Jump 11 1917
1 FTLIM ATI
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. 410
Shirley
St. :
Ward)
2 FULL NAME
Capt John Flanagan
[If married or divorced woman or widoy give maiden name, alsomame of husband.] @RESIDENCE Minthiago 410 Smiley st
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
m
4 COLOR OR RACE
SINGLE, ma
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
· DATE OF BIRTH
2
19
1828 17 (Year)
7 AGE
If LESS than [ day ......... hrs.
88 y
.... yrs.
3
... mos.
26 ds.
or ....... min. ?
8 OCCUPATION
Retired- Heatthe office
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE (State or country)
Ireland
10 NAME OF
FATHER
James Flanagan
PARENTS
12 MAIDEN NAME
OF MOTHER
May Elhatt
13 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Ihr John Flanagan
(Address)
H+10 Shirley of
16
Filed 191
REGISTRAR
(Duration)
... yrs.
.........
mos.
16
ds.
Contributory.
Vitoria selevanta
(SECONDARY)
Undak. (Duration)
.yrs.
mos. ..............
ds.
(Signed)
Mal. Porter
M.D.
June 16, 1917 (Address) Winetwork
* 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 ............ y:8.
........
.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 anthropo Cenet 6-18, 1917
20 UNDERTAKER W.C. Skaygo
ADDRESS
1
.
-
en/ une 1 , 191.7 .... , t and that death occurred, on the date stated above, at 5 a. m. The CAUSE OF DEATH* was as follows :
(Month)
16
(Day)
191.7.
(Year)
I HEREBY CERTIFY that I attended deceased from June 1917 , to Scare 16, 1917. that I last saw heer alive on Quem/v
(a) Trade, profession, or
particular kind of work
(Month)
(Day)
16 DATE OF DEATH
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
WHILE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
-
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland
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 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 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: 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 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- 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 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 dcad, etc.
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important. See instructions on back of certificate.
The Commonwealth of Massachusetts
1 PLACE OF DEATH
STANDARD CERTIFICATE OF DEATH Belmont
Belmond (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Evelyn Y Gard
*FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Plummer ar. Winthrop
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
* SEX
female
4 COLOR OR RACE
White
$ SINGLE,
MARRIED,
married
WIDOWED,
OR DIVORCED
(Write the word)
f
(Month)
16
(Day)
4
191.
....
(Year)
* DATE OF BIRTH
april (Month)
11
1848
(Day)
(Year)
" AGE
If LESS than 1 day, ....... hrs.
2.
mos.
.5
ds.
or ........ min. ?
· OCCUPATION
(a) Trade, profession, or
particular kind of work
House wife
(b) General nature of industry,
business, or establishment in
which employed (or employer).
' BIRTHPLACE
(State or country)
Boston, mass.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Boston, Mass.
12 MAIDEN NAME
OF MOTHER
Sarale &. Rogers
18 BIRTHPLACE
OF MOTHER
(State or country)
Portland, me.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Walter R. Whiting
(Address)
16 Filed 6/16 arthur Ettough
REGISTRAR
16 DATE OF DEATH
17 I HEREBY CERTIFY that I attended deceased from
, 191
, to.
191
that [ last saw h.
alive on
19|
and that death occurred, on the date stated above, at
m
The CAUSE. OF DEATH* was as follows :
multiple Quejunio.
(Run over by train)
l'eatle Immediate
(Duration)
.yrs.
mos. ds.
Contributory
(SECONDARY)
.(Duration)
............ yrs. .
ds.
......
(Signed)
Willianu S Levan
.... a, M.D
June 16. 1917
(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.
5 mos. 12. ds.
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
Woodlaure bruneterg
DATE OF BURIAL
June 19, 1917
20 UNDERTAKER
10
Menge Dr. Gregat form
ADDRESS
Valthan)
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
......
.(No ..................
Erlyn G. Whiteria
Free & Card
....
St. ;.....
.Ward)
1
mos.
10 NAME OF
FATHER
Charles Whiting
STANDARD CERTIFICATE OF DEATH. 1
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 occupation 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 cxamples: (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 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 .Vone.
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 ferer (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) ; Tuhe-
culosis of lungs, meninges, peritonaeum, ctc., Carcinoma, Sar- coma, etc., of. .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Mcasles; 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 (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (mercly symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senilc," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertaincd as the cause. Always qualify all discases resulting from childbirthi 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, E.c- posure, etc.
3. Sudden deaths of persons not disabled by recognized discase, 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.
R 18. 3.16. 10,000.
1 PLACE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH
State of
or
Village
City
(No ..
Fort 3 ambis Hospital
St .;
Ward)
[If death occurred 'n a hospital or institution, give Its NAME Instead of street and number j
2 FULL NAME
Charles Adanos Burton
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
June
( Month)
17 1017
(Day) (Year)
I HEREBY CERTIFY, That I attended deceased from
June
9
1917, to June 17", 1917,
that I last saw hyralive on June 17 , 191-7-, 1 and that death occurred, on the date stated above, at 5 A. m.
-
The CAUSE OF DEATH * was as follows:
Cerebral Hemorrhage
Left Hemiplegia.
(Duration) XIS.
Mos.
cs.
Contributory'
Terminal Dianhoca
(SECONDARY)
{ Duration) 3 . ds.
(Signed)
Richard Mitcall
I. D.
fraise 17, 1917
(Address)
For Banks Maso.
* 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)
At place
of death
yrs.
mos.
in the
ds.
State
yrs.
mos.
ds.
Where was disease contracted, If not at place of death ?
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Riverside Comeley
Worth Reading Ma
DATE CF BURIAL
June, 20, 1917
Filed. 191
REGISTRAR
17
1867
(Month)
(Day)
(Ycar)
7 AGE
66
yrs. !____ mos. 30 ds
If LESS than
1 day, ____ hrs.
or ___. min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Carpenter
(b) General nature of industry,
business, or establishment in
which employed (or employer)
9 BIRTHPLACE (State or country)
North Reading Man
10 NAME OF
FATHER
Ebenezer Buxton
11 BIRTHPLACE
OF FATHER
(State or country )
Richmond N.H.
12 MAIDEN NAME
OF MOTHER
Ruth Hord
13 BIRTHPLACE
OF MOTHER
(State or country)
Danvers Man,
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mus J. R. 704 (Daughter)
(Address)
19. Salam Place Malden
11 -- 3184
:
---
--
15 CAUSE OF DEATH in plain terms, so that it may bo proporly classified. Exact statemont of OCCUPATION is very Important. Soe instructions on back of certificate. N. B .- Every Item of information should be carefully supplied. AGE should be statod EXACTLY. PHYSICIANS should state PARENTS
3 SEX
Thala
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
( Write the word)
widmen
6 DATE OF BIRTH
Abril
.
15th 1851
County
Township
Winthrop Man
Registered No.
20 UNDERTAKER
ADDRESS
Frank Wo Edgerley Reaching Vans
1
----
[Approved by U. S. Census and American Public Health Association]
Statement of occupation .- Precise statement of occupation 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- ilor, 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) Foremun, (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 ouly (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 Serrant, 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 Nonc.
Statement of cause of death .- Name, first, the DISEASE CAUS- ING 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 "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualificd, is indefi- nite) ; Tuberculosis of lungs, meninges, peritonaeum, etc., Car- cinoma, Sarcoma, etc., of. -. (name origin; “Can- cer" is less definite ; avoid use of " Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The con- tributory (secondary or intercurrent) affection need not be stated unless important. Example : Measles (disease cansing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal condi- tions, such as "Asthenia," "Anaemia" (merely symptom-
1
atic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital." "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inani- tion," " Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascer- tained as the cause. Always qualify all diseases result- ing from childbirth or miscarriage, as "PUERPERAL septi- chaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHIS state MEANS OF INJURY and qualify as ACCIDENTAL, 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." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
NOTE .- Individual offices may add to above list of undesirable terms aud refuse to accept certificates containing them. Thus the form in uso in New York City states: "Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convuistons, haemorrhage, gangrene, gastritis, erysipelas, meningitis, miscarriage, necrosis, peritonitis, phlebitis, pyaemia, septicbuemia, tetanus." But general adoption of the minimum list suggested will work vast improvement, and its scope can be extended at a later date.
11-3184
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Chelsea (No ... Frost Hospital ....... St. : ..... Ward)
? FULL NAME
John Richardson
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
88 Somerset Av. ,Winthrop
Registered No.
426
MEDICAL CERTIFICATE OF DEATH
1ª DATE OF DEATH
June
23
1917
(Month)
(Day)
(Year,
17 I HEREBY CERTIFY that I attended deceased trom June 18 191
7
to
June 23,
7
191
that I last saw h.i.m ... alive on
June 23
191.7
and that death occurred, on the date stated above, a
5.45p.
-
The CAUSE OF DEATH* was as follows : Gastric Haemorrhage
Immediate
(Duration)
.yrs. .
mos.
ds.
Contributory
Gastric perforating ulcer
(SECONDARY)
.(Duration) ***
5
yrs .....
mos.
(Signed)
Orville ?
Johnson
M.D.
June 23 . 191 7
(Address)
Winthrop,
Mess .
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
F
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
of death.
.. yrs ..
mos. ..
ds.
State
......
In the
.. yrs ..
........
mos.
.........
Where was disease contracted, If not at place of death ?.
Former or usual residence.
1º PLACE OF BURIAL OR REMOVAL Winthrop Cemt.
DATE OF BURIAL
June 25, 1917
UNDERTAKER . Skaggs
APDRESS
Winthrop
-
- -
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
Married
25
, 369 (Year)
If LESS than f day ........ hrs.
or ......... min. ?
* OCCUPATION
(=) Trade, profession, or
particular kind of work
Dairy Products
& SEX Male · DATE OF BIRTH TAGE 9 BIRTHPLACE (State or country) 10 NAME OF FATHER 12 MAIDEN NAME OF MOTHER PARENTS WHITE TLAINET, WITIT ONFADING INA THIS IS A FENMARENT NEVUn. (b) General nature of industry. business, or establishment in which employed (or employer).
1 PLACE OF DEATH
{ COLOR OR RACE
White
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
March
(Month)
(Day)
England
John Richardson
11 BIRTHPLACE
OF FATHER
(State or country)
England
Unknown
13 BIRTHPLACE
OF MOTHER
(State or country)
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.