Town of Winthrop : Record of Deaths 1916-1918, Part 90

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 90

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).

Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to tiinc 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," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, etc., of_

(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection necd not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col-

lapse," "Coma," "Convulsions,"""Debility" (“Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock,"" "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ctc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolie 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.)

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

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

2. Deaths supposedly caused by violence, as Criminol abortion, Poisoning, Starvation, Suffocation, Exposure, etc.

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

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

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY

PHYSICIAN.

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

N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very

[5-'17-XXM.}

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop.

BOSTON

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

2 FULL NAME William H.Flanigan

[If married or divorced woman or widow give maiden name, also name of husband.1 @RESIDENCE 36 Bates Ave. Winthrop.

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

& SEX

male

4 COLOR OR RACE

white

$ SINGLE,

MARRIED,

WIDOWED,

OR DIVORCEOi dowed

(Write the word)

· DATE OF BIRTH

May

(Month)

(Day)

(Year)

7 AGE

If LESS than

day ....... hrs.

73 9 .mos. y ds.

or ..

min. ?

& OCCUPATION

(a) Trade, profession, or

particular kind of work

none

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

9 BIRTHPLACE

(State or c

Cohoes N.Y.

10 NAME OF

FATHER

Dennis Flanigan

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

Unknown

12 MAIDEN NAME

OF MOTHER

Esther

13 BIRTHPLACE

OF MOTHER

(State or country)

unknown

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

nelli- Fi White.

(Address)

36 Bates ave, Smilerole

15 Filed 191.

....

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

Feb 14 1918

191

...

(Month)

(Day)

(Year)

Sac

to.

201918.

Seb, 14

that I last saw hace alive on

Heb. 14.

1918,

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

910

.m.

The CAUSE OF DEATH* was as follows :

aneurisma of abdom, worth.

Did a surgical operation precede death ?

Date

Indefinito

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

......... yrs. ............... mos,

ds.

Contributory.

Valvular heart disease

(SECONDARY)

Indef

(Duration)

yrs.

mos.

ds.

(Signed)

N.C. Porto

M.D.

Heh. 65, 1918

(Address)

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

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

At place

In the

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

Cohoes N.Y.

DATE OF BURIAL

725.5. 1918

D UNDERTAKER

S Vaterantsaus

ADDRESS

Boston

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

important. See instructions on back of certificate.

1 PLACE OF DEATH

Winthrop. (No 36 Bates Ave.

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

I HEREBY CERTIFY that attended deceased from

.yrs.

........ ......

.....

KE VISLD UNITED STATES SIANDAKU CEKHITIGAIE VEDEnIN [Approved by U. S. Census aod American Public Health Association]

under the head of "Contributory. WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD. on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)

Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer,"

"Foreman," " Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death .- Name, first, the DISEASE CAUSING DEATII (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," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, etc., of_

(naine origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," " "Debility" (“Con- genital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ete. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably suclı, if impossible to de- terinine 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

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

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

2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, ete.

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

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

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY

PHYSICIAN.

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

N B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very

important. See instructions on back of certificate.

[5-'17-XXM. ]

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Winthrop

BOSTON ...........

...

(City or vown.) Ilf death occurred in a hospita or institution, give its NAME nstead of street and number .!

*FULL NAME

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

Martha Clarkewidow of Augustus H. Porter

@RESIDENCE

Norfolk Vir.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

female

4 COLOR OR RACE

white

5 SINGLE.

MARRIED,

WIDOWED,

OR DIVORCEDWidowed

(Write the word)

16 DATE OF DEATH

Feb 18 1918

(Month)

(Day)

(Year)

$ DATE OF BIRTH

Aug 28 1846.

(Month)

(Day)

(Year)

7 AGE

If LESS than 1 day ......... hrs.

.. yrs.

mos.

ds.

Or ....... min. ?

& OCCUPATION

(a) Trade, profession, or

particular kind of work ..

none

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

9 BIRTHPLACE

(State or cowMin) li amsburg Vir.

PARENTS

11 BIRTHPLACE OF FATHER (State or count Williamsburg Vir.

12 MAIDEN NAME

OF MOTHER

Jane Walthall.

1$ BIRTHPLACE OF MOTHER ate or c

Prine Edward Co. Vir.

" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

W.J.Porter

(Address)

Winthrop Mass.

Filed 191

REGISTRAR?

....

191.2 .... , to.

I HEREBY CERTIFY that I attended deceased from

Feb. 11.

Jul. 18.

191

that I last saw h .. c. alive on

Jich 18

....

1918 and that death occurred, on the date stated above, at 108 m. The CAUSE OF DEATH* was as follows :

Pneumonia (Gruppe)

Did a surgical operation precede death? no Date

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

Contributory. arterio- activação .... (SECONDARY) Index. (Duration) .......... yrs. .mos. ........... ds. .........

(Signed)

....

M.D.

Juk. 19

1918

.......

(Address)

Miniturato.

* 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.

...........

In the

ds. State ............ yrs. ............ mos. ............ ds ............. Where was disease contracted, If not at place of death ?.

Former or usual residence

IS PLACE OF BURIAL OR REMOVAL

Hollywood Cem. Richmond

DATE OF BURIAL Vir. 2/22 1918

@ UNDERTAKER

ADDRESS

Boston

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

1 PLACE OF DEATH

(No. 562 Shirley Street St.

........ .. Ward)

Martha C.Porter

.... Registered No.

191

10 NAME OF

FATHER

Thomas T. Clarke

Feb . 18, 1918

STANDARD CERTIFICATE OF DEATH.

Statement of occupation. - Precise statement of oeeu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to caelı 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 inaterial 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, ete. 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 faet may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no oecu- pation whatever, write Nonc.

Statement of cause of death. - Name, first, the DIS- CASE CAUSING DEATHI (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, peritonacum, etc., Carcinoma, Sar- coma, ete., of .... ........ (namo origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. Tho contributory (second- ary or intereurrent) affection need not bo stated unless im- portant. Example: Meastes (diseaso causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, sueli as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," ete., when a definite disease ean bo ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," ete. State cause for which surgical operation was undertaken.

Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of tho Revised Laws deaths under tho 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.

R. 15. 1-'17. 100,000.

noy.

"pujiddne Alınjouo

WHOOBY ANINVWY3d V SI SIHL -XNI ONIGVJNA HLM ATNIVIJ 3LIUM-UN

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Chelsea

(City or town)

1 PLACE OF DEATH

County

Suffolk

State

Mass.

Registered No ..

142

Township

or Village.

City

Chelsea

No.

Frost Hospital

St.,.

Ward

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

2 FULL NAME

Edith King

........

St. .Ward. Winthrop

(a) Residence.

No ..

27 Marshall

(Usual place of abode)

Length of residence in city or town where death occurred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Female

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Archie King

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

7 AGE

Years

Months

Days

If LESS than

I day, ........ brs.

or ........ min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

At Home

(b) General nature of industry,

business, or establishment in

which employed (or employer)

(duration)

.yrs.

mos.

.ds.

CONTRIBUTORY

Salpingitis, peritonitis

(SECONDARY)

(duration)

yrs ....

... mos .... ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death ?

Date of.

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed)

L.R.G.Crandon

., M.D.

2/2119 ] &Address) 366 Commonwealth Av. Boston

* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional spaee.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL Winthrop Cem., N.Y.

DATE OF BURIAL

Feb . 23 191 8

(Address)

27 Marshall St. Winthrop

15 Feb. 22, 1918 273

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

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

Feb.21, 1918

I HEREBY CERTIFY, That I attended deceased from

14 Feb.

19.18

21 Feb.

that I last saw h.G.T_ alive on

21 ..... Feb.

19.1.8

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

7 8 .

.. m.

The CAUSE OF DEATH* was as follows :

Extra-uterine pregnancy (operation)

9 BIRTHPLACE (city or town)

(State or country)

New York

10 NAME OF FATHER

Joseph Kirkey

PARENTS

11 BIRTHPLACE OF FATHER (city or town) Messina (State or country) N.Y.

12 MAIDEN NAME OF MOTHER

Unknown

13 BIRTHPLACE OF MOTHER (city or town).Unknown (State or country)

Informant

Husband

20 UNDERTAKER

R.C.Kirby

ADDRESS

E. BOSTON

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

of certificate.

Filed

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

H N

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]

Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engincer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return " Laborer,"

"Foreman," "Manager,' "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully eniployed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING 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 None.

Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. 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," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, etc., of _.

(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasıns); Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terniinal conditions, such as "Asthenia," "Anemia" (mcrely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions,"" "Debility" ("Con-

genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- Inus," "Old age," "Shock," "Uremnia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated

under the head of "Contributory."

on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)

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

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

2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.

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

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

ADDITIONAL SP

FOR FURTHER STATEMENTS BY

PHYSICIAN.

R 15. 1-'18. 10,000.

THIS IS A PERMANENT RECORD WRITE PLAINLY, WITH UNFADING INK

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

I PLACE OF DEATH 1

Elijah

Brown

[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 19 Underhill

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

WidowEd

6 DATE OF BIRTH

18/4$ 17

(Month)

(Dấy)

(Year)

7 AGE

If LESS than [ day, hrs.

75 yrs.

9 mos.

/ ds.

or ....... min. ?

8 OCCUPATION

(a) Trade, profession, or

particular kind of work

Franner-Jeanstes

Cando

diseases

(Duration)

yrs.

.........

mos.

ds.

Contribute found dead)

(SECONDARY)

(Duration)

mos.

ds.

(Signed) ......

The 230by

(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).

At place

of death

yrs.

mos.

ds.

State

yrs.

mos.

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

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.

Town of Winthrop : Record of Deaths 1916-1918, Part 90

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

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