Town of Winthrop : Record of Deaths 1919-1921, Part 3

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 3

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).

11-3184

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

important. See instructions on back of certificate. 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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH 1 PLACE OF DEATH Metcalf Hochital Suffolk County, mage.

(City or town

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

" FULL NAME

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

15 Court Road.

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

January

(Month)

. 1919

(Day)

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

(Year)

I HEREBY CERTIFY that I attended deceased from

Jam. 9.

1919

Jan.4

1919

7 ......

that I tast saw hl.na alive en

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

The CAUSE OF DEATH* was as follows :

Stillborn.

Was in aixthe

month of pregnancy.

(Duration)

... yrs.

mos.

ds.

Contributory. (SECONDARY)

.(Duration)

yrs.

mos.

... ds.

(Signed)

frank Stateman

M.D.

Jan. 10, 1919

, Somerville, mase

* 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. .........

nos. ..

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

Where was disease contracted,

If not at place of death ?. Former or usual residence

19 PLACE OF BURIAL OR REMOVAL

DATE OF BURIAL

1/14 mb, 191.

ADDRESS

5 SINGLE,

MARRIED,

WIDOWED.

OR DIVORCED

(Write the word)

Single

& DATE OF BIRTH January (Month)

9th

/(Day)

1919

(Year)

7 AGE

If LESS than

did not der

2 hrs.

& OCCUPATION

none

(a) Trade, profession, or

particular kind of work

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

9 BIRTHPLACE

(State or country)

Winterof

Massachusetts

10 NAME OF

FATHER

Wendell albert Hodgkins

11 BIRTHPLACE

OF FATHER

(State or country)

Bath, maine

PARENTS

12 MAIDEN NAME

OF MOTHER

alice Louise Walker

1ª BIRTHPLACE OF MOTHER (State or country)

West Warren.

massachusetts.

" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant) (Address)

Filed gay 21 199

REGISTRAR

.. Ward}

Baby Hodgkins

* SEX male

COLOR OR RACE

White

.yrs.

........ .mos. ds.

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

MARGIN RESERVED FOR BINDING

20 UNDERTAKER ERZ.

Jan. 9, 1919

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 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) 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 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 fcvcr (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, ete., of .... .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronie 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," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all 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, ete.

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

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

( City of town )

1 PLACE OF DEATH

County.

Suffolk

State

Mass.

Registered No ..

Township

Winthrop

or Village

....... .or

No ..

................ Fremont .... S.

St.,

.. Ward

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

2 FULL NAME WILLIAM HENPY MCLAUGHLIN

"(If in the Army of Navy of the United States, give rank, organization, etc.)

(a) Residence.

No.

IA Fremont St.

St.,

.Ward.

(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

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

1.1€

Married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Nora Feeney Mclaughlin

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

7 AGE

Years

Months

Days

8 OCCUPATION OF DECEASED

(a) Trade. profession, or

Chaffeur

particular kind of work

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

9 BIRTHPLACE (city or town).

Madison

(State or country) Ind.

10 NAME OF FATHER

John J.

11 BIRTHPLACE OF FATHER (city or town) Madison

(State or country) Ind.

12 MAIDEN NAME OF MOTHER gry MCHugh

13 BIRTHPLACE OF MOTHER (city Madison (State or country) Ind

Informant

Mrs Mclaughlin

(Address)

1º Fremont St.

15 Filed Du. 21, 19

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

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

17 I HEREBY CERTIFY, That I attended deceased from

19/9, to

pan 10

19.12.

that I last saw h ...._ alive on

19 ........ 1.

and that death occurred, on the date stated above, at 2 3 0 a.m. The CAUSE OF DEATH* was as follows :

If LESS than

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

or ........ min.

General Tubeculosis

(duration)

yrs .......

mos.

ds.

CONTRIBUTORY

Chimie Puls

buculosis

(SECONDARY)

(duration)

2 yrs. 6

mcs.

ds.

18 Where was disease contracted if not at place of death ?

Did an operation precede death ?

Ty Date of.

Was there an autopsy ?.

What test confirmed diagnosis ?

(Signed)

Ofichard hateatt?

M.D.

5/1.1919 (Address) 502 Shirley Ist Whoop mas.

* 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 space.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL 1/12/1918,19

Winthrop

20 UNDERTAKER

ADDRESS

MARGIN RESERVED FOR BINDING

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.

PARENTS

1886

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

City.

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 linc 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 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 indi- eated thus: Farmer (retircd, 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 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; Bronehopneumonia ("Pneumonia," unquali- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, ete., 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 (secondary or inter- eurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broneho- 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- inus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all discases resulting from ehild- 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 dc- 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 (c. 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.)

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 eaused by violenee, 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 be due to Alcoholism, etc.

4. Deaths under circumstances unknown, as A person found dcad, 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 important. See instructions on back of certificate.

1 PLACE OF DEATH

DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS

STANDARD CERTIFICATE OF DEATH

State of

Massachuset

Pool thospital

Registered No.

City

Winthrop

(No.

Fort Banks, Warst .;

Ward)

[If death occurred In a hospital or institution, give Its NAME Instead of street and number.]

2 FULL NAME

Carl If. Wilson

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

Jan

191.9

(Month)

(Day)"

(Year)

I HEREBY CERTIFY, That I attended deceased from

See. 11

1918

____ , to

tan 10

191.2,

that I last saw h was alive on

191

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

8:20 Pm.

The CAUSE OF DEATH* was as follows:

Thoma

Brain

(Duration)

. ds.

yrs.

mos.

Contributory.

(SECONDARY)

ds.

------ yrs. .___...

mos.

( Duration) .

Cappy Path and the

Jam/1,1919

(Address)

It BankMan

* 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

In the

mos.

ds.

Where was disease contracted, ha

If not at place of death ?

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

Conneaut Ohio

DATE OF BURIAL

1/14

1912

20 UNDERTAKER

@ R Benson

ADDRESS

Wirthof.

Township

Village

3 SEX

7 AGE

10 NAME OF

FATHER

PARENTS

CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very

4 COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

( Write the word)

Lung le

6 DATE OF BIRTH February

1890

( Month)

(Day)

( Year)

If LESS than

1 day .---- hrs.

or ____. min. ?

8 OCCUPATION

(a) Trade, profession, or

particular kind of work

(b) General nature of Industry,

business, or establishment in

which employed (or employer)

Solalehr

9 BIRTHPLACE

(State or country)

ashtabula County

Ohio.

Job. R. Wilson.

11 BIRTHPLACE

OF FATHER

(State or country)

Conneaut This

12 MAIDEN NAME

OF MOTHER

Carrie Laughlin

13 BIRTHPLACE

OF MOTHER

(State or country)

Connect 6 his.

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Mrs. Come Wilson

(Address)

Conneaut Ohio.

Filed __

Jan 21, 199

REGISTRAR

11-3184

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

V. S. No. 98

County

Suffolk

yrs.

mos.

29.

ds.

(Signed

yrs.

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH 0

[Approved by U. S. Census and Americau 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- itor, Architect, Locomotive enginecr, 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) Forcman, (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, Houscwork, 0" .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, 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 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," unqualified, 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); Mcasles; Whooping cough; Chronic valvular Icart disease; Chronic interstitial nephritis, etc. The con- tributory (secondary or intercurrent) affection need not de stated unless important. Example : Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal condi- tions, such as "Asthenia," "Anaemia" ( merely symptom-

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 DEATHS 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 and refuse to accept certificates containing them. Thus the form in use in New York City states: "Certificates will be returned for additional information which give auy of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, haemorrhage, gangrene, gastritis, crysipelas, meningitis, miscarriage, necrosis, peritonitis, phlebitis, pyaemia, septichaemia, tetanus." But general adoption of the minimum list suggested will work vast improvement, and its scopo can be extended at a later date.

11-3184

ORM R-301

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

The Commonwealth of Massachusetts

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County ...

Suffolk

City or Town

No.

State.

Metcalf Hospital

St. .

.Ward

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

2 FULL NAME

Florence. Ferguson

Stuart

(If in the Army or Navy of the United States, give rank, organization, ete.)

(a) Residence. No

198 Sommerset are

St.,

Ward.

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

( 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

4 COLOR OR RACE

voluto

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

manuel

5a If married, widowed, or divorced

HUSBAND of

for) WIFE of

Wallace ,

n. Stuart

6 DATE OF BIRTH

( Month)

(Day)

(Year)

7 AGE

Years

Months

20 Days

If STILLBORN, enter that fact here If STILLBORN, state period of uterogestation mos.

If LESS thao

1 day,

brs.

mio.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particolar kiod of work. (b) General oature of industry, business, or establishment in which employed (or employer)

9 BIRTHPLACE (City)

(State or country)

Canada

10 NAME OF

FATHER

Concien Ferguson

11 BIRTHPLACE OF

FATHER (City)

(State or country)

12 MAIDEN NAME

OF MOTHER

Many nic thligne

13 BIRTHPLACE OF MOTHER (City) (State or country)

14 Wallace. 21. Start

Informant

(Address)

198 Pommeset and Wichof

15 Jan 21 1919 Filed .. (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

January 11 (Month )

1414.

(Year)

I HEREBY CERTIFY, That I attended deceased from January 1 , 19 19, to January 11, 19 19, that I last saw h & r alive on January 1, 1919; 1 9 h. and that death occurred, on the date stated above, at m. The CAUSE OF DEATH was as follows : Puerperal Eclampsia

(duration) -

yrs.

mos.

Influenza, about

ds.

CONTRIBUTORY

( SECONDARY)

2 weeks ago.

(duration)

yrs ... .

mos.

ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death?

no Date of

Was there an autopsy ? ..

What test confirmed diagnosis ?

Clinical

(Signed)

frank EBateman

, M.D.

(Address) .

Somerville, masa.

Date

January

( Month)

(Day)

)

(Year)

1914.

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

1/14

(Cemetery)

(City or town)

19/9

20 UNDERTAKER

Char R Semanas

ADDRESS

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued S. a.Poury

Official position, Health officer 22 Date of issue of burial or transit permit

Jan. 1 4,1919.

MARGIN RESERVED FOR BINDING

PARENTS

10.'18. 100,000.

STANDARD CERTIFICATE OF DEATH Man

Registered No.

Female

22,882

Jan. 11, 1919

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

[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 he 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 he sufficient, o. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, 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 material worked on may form part of the second statement. Never return "Lahorer," "Foreman," "Manager," "Dealer," etc., without more precise specifieation, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At homc, and children, not gainfully employed, as At school or At home. Care should hc taken to report spe- cifieally the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has heen changed or given up on account of the DISEASE CAUSINO DEATH, state occupation at beginning of illness. If retired from husiness, that fact may he indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

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Town of Winthrop : Record of Deaths 1919-1921, Part 3

Author: Winthrop (Mass.) Publication date: 1919 Publisher: Number of Pages: 1192

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192