USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 70
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
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 duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
R 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
WINTHROP
(No ...
482 WINTHROP
St. ;............. .Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME Instead of street and number.]
? FULL NAME
RODERICK
MCPHEE
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 482 WINTHROP ST
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
$ SEX
' COLOR OR RACE
MALE
WHITE
$ DATE OF BIRTH
(Month) (Day)
1
(Year)
7 AGE
If LESS than
I day ......... hrs.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
RETIRED
(b) General nature of Industry, business, or establishment In which employed (or employer).
9 BIRTHPLACE
(State or country)
SYDNEY C.B
10 NAME OF
FATHER
JOHN
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
SYDNEY.
12 MAIDEN NAME
OF MOTHER
UNKNOWN.
13 BIRTHPLACE
OF MOTHER
(State or country)
UNKNOWN
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
MAS. M. WEIBEL
(Address)
482 WINTHROPST
16
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
aug
(Month)
15
1917
% ....
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
arce 4, 197, to.
1917.
....
that I last saw h .......... alive on
and 4
1917
and that death occurred, on the date stated above, at
......
4P m. The CAUSE OF DEATH* was as follows :
interior silupis
......
... (Duration)
.......... yrs. ................ mos. ..............
ds.
Contributory. (SECONDARY)
(Duration)
.. yrs. ................ mos.
.............
ds.
(Signed)
M.D.
191 ........ (Address).
* If death followed injury or violence the certificate of death must he made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
In the
of death .........
.yrs.
.mos. .......
ds.
Stato ............ 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
AUG 18, 1917
20 UNDERTAKER
John F. O maley
ADDRESS
Winthrop
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
.......
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
WIDOWED
67 yrs.
... mos. .............. ds.
(
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 age. For many occupations a single word or term on the first line will be sufficient, c. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive 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 necdcd. 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," cte., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, cte. Women at home, who arc 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: Cerebro-spinal fever (the only clefinite synonym is "Epidcinie 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 necd 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," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "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.
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
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
WINTHROP
(No
82 HERMON
.St. ;..
.Ward)
..
2 FULL NAME
THERESA
BEATR
EATRICE
BURKE
URKE
...
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 82 HERMONST.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
FEMALE
4 COLOR OR RACE
WHITE
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
S INGLE
· DATE OF BIRTH
(Month) (Day)
1
(Year)
7 AGE
28 yra. .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)
BOSTON
PARENTS
12 MAIDEN NAME
OF MOTHER
THERESA HENNESSEY
13 BIRTHPLACE
OF MOTHER
(State or country)
IRELAND
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Final Downey.
(Address)
83. Hermon St.
16
Filed
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
amy
(Month)
16
., 191.2.
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
July 1916
191
amy 16 ~
191 )
to
.........
that I last saw him alive on
Why 16
191 )
and that death occurred, on the date stated above, at 7 pm.
The CAUSE OF DEATH* was as follows; Chronic Indicarditis
Ambral insufficiency
(Duration)
1 yrs.
................ mos. ........ ds.
Contributory.
(SECONDARY)
(Duration)
.yrs. ............... mos.
ds.
(Signed)
631 not call
M.D.
C117. 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.
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
CALVARY
DATE OF BURIAL
AUG 18, 1917
20 UNDERTAKER John F. lli granicy
ADDRESS
Winthrop.
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
10 NAME OF
FATHER
MICHAEL
11 BIRTHPLACE OF FATHER (State or country) IRELAND
If LESS than
! day ......... hrs.
Lang . 16, 171%
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 cxamples: (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 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 discase; 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," ctc.), "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 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.
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 Winthrop
.(No.
35 Jagamor
St. ;................... .Ward)
John YJaunty
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 95 Sagamore, Che.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
& SEX
Inale White
· DATE OF BIRTH
(Month)
(Day)
(Year)
7 AGE
If LESS than 1 day ......... hrs.
56
.yrs. mos. ds.
or ....... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer)
Clothing
9 BIRTHPLACE
(State or country)
Boston !!
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Leland
12 MAIDEN NAME OF MOTHER Mary Lea
alian
18 BIRTHPLACE OF MOTHER (State or country)
Asland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
bormidauntro
(Address) 35 Vadamots du
16 Filed
/
-+ 191
..........
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
ana. 18
191 .. 2., to.
191
..........
that I last saw halive on
191 .......
and that death occurred, on the date stated above, at
2 Pm.
The CAUSE OF DEATH* was as follows :
Carcinoma A stomaco
(Duration)
............ yrs. ................ mos. ..............
ds.
Contributory (SECONDARY)
(Duration)
............ yrs.
.. mos. ................ ds.
(Signed)
Charles f. Mahoney M.
Cung 14, 1917 (Address).
356 miltudo
* 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 Holy Cross,
DATE OF BURIAL
Caud2/ 1997
20 UNDERTAKER
Solin J.O. maley
ADDRESS
Witterof
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
(City or town.)
{If death occurred In a hospital or institution, give its NAME instead of street and number.]
Registered No.
' COLOR OR RACE
§ SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Adoua
16 DATE OF DEATH
august
(Month)
(Day)
1917
(Year)
........
10 NAME OF
FATHER
Comoilque
Ung. 18, 171/
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 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 cxamples: (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," "Forcman," "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 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 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-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. ....... (name origin: "Cancer" is less definite; avoid usc of "Tumor" for malignant neoplasms) ; Measles; 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 (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 can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieacmia," "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
12 MAIDEN NAME
OF MOTHER
Sarah Pendleton
18 BIRTHPLACE
OF MOTHER
(State or country)
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
15
Filed
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
$ SEX
Mac.
4 COLOR OR RACE
Ituto
5 SINGLE,
MARRIED,
WIDOWED,
Marmer
OR DIVORCED
(Write the word)
$ DATE OF BIRTH
2 1878
(Month)
(Day)
(Year)
7 AGE 39.
... yrs.
1
mos.
21
ds.
„min. ?
8 OCCUPATION
(a) Trade, profassion, or
particular kind of work
Drug Clerk
(b) General nature of industry,
business, or establishment
which employed (or employer) ........
Pharmacy
General stuthecus perfection
Cause undkuron (BIJ ..
(Duration) ......... yrs. ........... .mos. ds.
Contributory
(SECONDARY)
(Duration) yrs ..
mos. ds.
(Signed)
M.D.
an 24/ 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).
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.
19 PLACE OF BURIAL OR REMOVAL dearshort me
DATE OF BURIAL
8/26, 1917
20 UNDERTAKER
ADDRESS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH
(NO .....
29 1 houston 1/2
Ward)
[If death occurred in a hospital or institution, giva its NAME instead of street and number.]
Edmund Brandare Staples
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 29 Thornton Pack
.... Registered No.
PERSONAL AND STATISTICAL PARTICULARS
DATE OF DEATH
any
23. 1917
(Year)
(Month)
(Day)
17 I HEREBY CERTIFY that I attended deceased from July 26" .... . ....
1917, to
Cy 23
1917
that I last saw ham
alive on
any 23
1917.
and that death occurred, on the date stated above, at
3$
m.
The CAUSE OF DEATH* was as follows :
Saptamania.
yals
9 BIRTHPLACE
(State or country)
Transport me
10 NAME OF
FATHER
Ga. 18. Staples
11 BIRTHPLACE
OF FATHER
(State or country)
If LESS than
I day ......... hrs.
(City or town.)
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
PERM SIHL- ANI ONIOVANA ALIM ATNIVT4 A SI $
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits ean 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," 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 House- keepers who recive 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, ete. 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 "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuher-
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; 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" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old agc," "Shock," "Uraemia," "Weakness," 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 eause for which surgical operation was undertaken.
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.