Town of Winthrop : Record of Deaths 1919-1921, Part 35

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 35

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).

Weymouth Ware

9 BIRTHPLACE (City)

(State or country)

10 NAME OF

FATHER

amis S. newton

11 BIRTHPLACE OF Braintree Mars. FATHER (City ). (State or country)

12 MAIDEN NAME

OF MOTHER

E Sabrina Bucknell

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

noWeymouthluca

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH ..

June 20 -1919

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

19/7

to.

JULIE 30, 1919,

that I last saw

* alive on

lunes 30, 1919.

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

320 a .m. The CAUSE OF DEATH was as follows :

Cancerous papilloma

of Bladda

.(duration)

yrs ....

.mos ..

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

CONTRIBUTORY.

(SECONDARY)

Septicativa

(duration)

mos.

ds.

18 Where was disease contracted

if not at place of death ?

FOR WHAT?

yrs ..

Did an operation precede death ?.

Date of

Was there an autopsy ?

What test confirmed diagnosis ?.

Clinical

(Signed)

Orvelte & labusay

(Address)

Date

July

1919

( Month) /

( Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

no Weymouth Mass

(Cemetery)

(City or town)

20 UNDERTAKER

Chas Q Bollino.

ADDRESS

15 Fil Daly 2 1919 (Month) (Day) (Year)

REGISTRAR

21 I HEREBY CERTIFY that a- satisfactory stan- dard certificate of death was filed with me BEFORE the harial or transit permit was issued .. J.J. Maur!

Official position. Weatthe Office Permite July 2 Date of

Permit No .... 998

150,000. -XXM.)

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

PARENTS

14 Clara I newton

Informant

(Address)

205 Paucune It.

mass

DATE OF BURIAL July 2/19

2 FULL NAME

City or Town

BOSTON Winward

( Year)

If STILLBORN, enter that fact here

If STILLBORN, state period of uterogestation

mos.

June 50, 1719

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 bs 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, 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 additionai iine 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 "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who ars 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 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, ctc. If the occupation has been changed or given up on account of the DISEASE CAUSINO 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 occupation whatever, write None.

Statement of cause of death. - Namc, first, the DISEASE CAUSING NEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, 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; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection need not be stated uniess important. Example: Measles (discase causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (mcrcly symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Oid age," "Shock," "Uremia,""Weakness," etc., when a definite discase 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.

(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)

Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.

Certificates will be returned for additional information which give any of the following diseases, without expianation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipeias, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be ciassified under the international classification of causes of death], where contracted, the duration of his iast illness, when iast seen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.

No undertaker or other person shall bury a human body . . . until hs has received a permit from the board of health or its agent, . . . or . . . from the clerk of the city or town in which the person died; . .. no such permit shall be issued until there shall have been delivered to such board, agent or cierk, .. . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... shali be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of heaith, if a physician, or any physician employed by said board or by the ssiectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . .. The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thercafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.

Medical examiners shall, in ali cases, certify to the city or town cierk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.

RULES OF PRACTICE

The fuifilment of the purpose of these laws calls for the observancs of the following rules of practice:

(1) Attending physicians will certify to such deaths only as thess of persons to whom they have given bedside care during a iast illness from disease unrelated to any form of injury.

(2) Board of Health Physicians will certify to such deaths only as thoss of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medicai attendance or whess physician is absent from home when the certificate of death is needed.

(3) Medical examiners wili investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by ths action of chemical (drugs or poisons), thermal, or clectrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabied by recognized disease, and those of persons found dead.

The Commomuralth of Massachusetts STANDARD CERTIFICATE OF DEATH

Melrose

(City or town)

1 PLACE OF DEATH

County ..... Middlesex

State .. Massachusetts

Registered No.

Township

or Village.

City

Melrose

No.

Melrose Hospital

St.,

.Ward

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

2 FULL NAME

Herbert G. Batchelder.

(a) Residence.

No. Winthrop Yacht Club.

.. St.,.

Ward.

Winthrop, Mass

(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

Male

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Widowed .

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Roslyn Lois Ferren

6 DATE OF BIRTH (month, day, and year) June 6, 1870 .

7 AGE

Years

Months

Days

If LESS than

TOWN OF ME EXPLORED 28 . ROSE

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Job printer

.A.M.ALDE NORTH FIND 1649

1850.

ORATE ONTRIBUTORY (SECONDARY)

(duration)

......... yrs ................. mos .............

.ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death ?

Yes Date of .....

Feb.1919.

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed).

Ernest C. Fish,

M.D.

12 MAIDEN NAME OF MOTHERarriett Evelyn Chases 7(Adres 19 Melrose, Mass

13 BIRTHPLACE OF MOTHER (eity or town) ... Lynn .. (State or country)

* 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

Pine Grove Cem. Lynn,

DATE OF BURIAL

July 21919

(Address) 242 E. Foster St. Melros2

Filed July 211919. I deitaren Son 20 UNDERTAKER REGISTRAR

Filed July 8.1919

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year) June 30,19919.

I HEREBY CERTIFY, That I attended deceased from

May 27

, 19.

to.

June ..... 30

, 19 ..

1.9.

that I last saw h

im alive on

..... June ..... 30.,.1919 ... 19 . . and that death occurred, on the date stated above, at .... 5 .... 2.0.P. m. The CAUSE OF DEATH* was as follows :

LROSE Cancer of Prostate.

(duration)

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

ds.

(b) General nature of industry,

business, or establishment in

which employed (or employer)

T.O . Metcalf Bosto 1.

VCO

NGORPORAT

9 BIRTHPLACE (city or town).

Winchester,

(State or country) Mass.

10 NAME OF FATHER Cornelius Batchelder

11 BIRTHPLACE OF FATHER (city or town)

Salem

(State or country) Mass .

PARENTS

of certificate.

Informant

Mrs Frank A. Ross.

F. T. Churchill,

ADDRESS

Melrose, Mass.

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

CHARLESTOKHABEN POND FEILDE 638

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

[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 terin 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 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- 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 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- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, 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; 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 terminal conditions, such as "Asthenia," "Anemia" (inerely 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 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 (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 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 SPACE

FOR FURTHER STATEMENTS

PHYSICIAN.

R 15. 1-'18. 20,000.

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. 63 atlantic

St. :..

..........

Ward)

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

2 FULL NAME.

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

Jannis E. Jucker

@RESIDENCE

63 attantie Sv.

Winthrop

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

21.

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

'Write the word)

Married

DATE OF BIRTH

1 1858

(Month)

(Day)

(Year)

7 AGE

...... rs.

ds.

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

8 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)

north chelsea.

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

Milton Mast

12 MAIDEN NAME

OF MOTHER

anna & Darimport

13 BIRTHPLACE

OF MOTHER

(State or country)

Dorchester

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Lawia R. Dunn. husk

Wir thrane

(Address)

July 21, 1919 Enlalig Churchill ....

aint REGISTRAR

16 DATE OF DEATH

July

(Month)

(Day)

., 1919 ( Year)

I HEREBY CERTIFY that I attended deceased from

af 10

1919.

July 2-

....

1919

...

that I last saw hes.

alive on

July 2

1919.

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

.. m

The CAUSE OF DEATH* was as follows :

Chronic Mitral mouffeency

Chronic Bronchitis.

.. (Durangh)

1 yrs. +

ds.

Contributory.

(SECONDARY)

.(Duration)

2 yrs+

mos.

ds.

signed)

Storace & Brandon

M.D.

Sely 3

191.9 .... (Address).

7 Central to

...........

* If death followed injury or violence the certificate of death must be made outby 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

......

ds.

....

Where was disease contracted, If not at place of death ?. Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

Woodlawn.

DATE OF BURIAL

July 5, 1919

20 UNDERTAKER

a. V. Sanborn

ADDRESS

REVEN.

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

Jannis E. Dunn

Lewis R. Dunn.

10 NAME OF

FATHER

John Tucker

If LESS than

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

July 2,1919

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 occupation ? a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salcs- man, (b) Grocery; (a) Forcman, (b) Automobile factory. The material worked on may form part of tho second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborcr, Laborer - Coal minc, ete. Women at home, who are engaged in tho 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 gaill- fully employed, as At school or At homc. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who liave no occu- pation whatever, write None.

Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATHI (thio primary affection with respect to time and causation), using always the same accepted term for tlie samo disease. Examples: Cercbro-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) ; Tubc

culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of .... ....... .... (name origin: "Cancer" is less dcunite; avoid uso of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. Tho contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (mercy symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., when a definite discase can bo ascertained as the cause. Always qualify all Aiseases resulting from childbirth 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, 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.

R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH folks. County.

State mass

Registered No.

St.

Ward

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

2 FULL NAME

(a) Residence. No.

(Usual place of abodey

Judentare

St.,

Ward.

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

Length of residence in city or town where death occurred

2.0

years

months

da ys.

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

5 (Day)

1919

(Year)

17 I HEREBY CERTIFY, That I attended deceased from 1hoch 6, 1919, to , 19 '7,

that I last saw her alive on

, 19 /

and that death occurred, on the date stated above, at. 7

The CAUSE OF DEATH was as follows :

Carcinoma of Where.

.(duration)

yrs ........

mos. ...

ds.

CONTRIBUTORY

(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).

Francis P. Brrrich

, M.O.

(Address) L) South st gps

Date : 1

Monthi)

(Day)

19/19

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

It Josefine Boslow

(Cemetery)

(City or town)

20 UNDERTAKER

form J. O maley

DATE OF BURIAL July, 82019

ADDRESS

July 21,1919 Eulalie Churchill

Filed

(Month) [ (Day) (Year)

List REGISTRAR

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued 8.2. maury

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Town of Winthrop : Record of Deaths 1919-1921, Part 35

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

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