Town of Winthrop : Record of Deaths 1919-1921, Part 62

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 62


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 | Part 153 | Part 154 | Part 155 | Part 156 | Part 157 | Part 158 | Part 159 | Part 160 | Part 161 | Part 162 | Part 163 | Part 164 | Part 165 | Part 166 | Part 167 | Part 168 | Part 169 | Part 170 | Part 171 | Part 172 | Part 173 | Part 174 | Part 175 | Part 176 | Part 177 | Part 178 | Part 179 | Part 180 | Part 181 | Part 182 | Part 183 | Part 184 | Part 185 | Part 186 | Part 187 | Part 188 | Part 189 | Part 190 | Part 191 | Part 192 | Part 193 | Part 194 | Part 195 | Part 196 | Part 197 | Part 198 | Part 199 | Part 200 | Part 201 | Part 202 | Part 203 | Part 204 | Part 205 | Part 206 | Part 207 | Part 208 | Part 209 | Part 210 | Part 211 | Part 212


5


mos ..


-. ds.


PARENTS


11 BIRTHPLACE OF FATHER (city or town)


(State or country)


Eng la nd


What test confirmed diagnosis ?.


Michael J O'Meara


(Sigoed)


M.D.


City of Town


Worcester


No.


Worcester State Hospital


St.


Length of residence in city or town where death occurred


2


years


10


mooths


7


days


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 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," 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 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 homc. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, cte. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATII, 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 .- Namc, 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- 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; 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" (merely symptomatic), "Atrophy," "Col- lapse," "Comna," "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," cte. 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 hcad - 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.)


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 onc 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 303. 6-'18. 50,000.


so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back


of certificate.


14


Informant


Ruth Clack Gordon.


(Addr


36 Semmit Tev2.


15


Filed Dec. 26., 199.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Single


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


6 DATE OF BIRTH (month, day, and year) Feb. 4,1917


7 AGE


Years


Months


10


Days


If LESS than 1 day, ........ hrs. or ........ min.


8 OCCUPATION OF DECEASED


(a) Trade. profession, or


particular kind of work


nong


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


CONTRIBUTORY


(SECONDARY)


(duration)


yrs ...


......


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


ds.


18 Where was disease contracted


if not at place of death?


at home


Did an operation precede death ?


mi Date of


Was there an autopsy ?


no


What test confirmed diagnosis ?


Chacal


(Signed)


Birmet calf


M.D.


12/0, 19/9 (Address) 174 Worldup at Der Rap Tors


* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, jetate (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


Lancaster, Mars12-10-19/


20 UNDERTAKER


H.C. Skaggs


ADDRESS


Wielkos


carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


(City or town)


1 PLACE OF DEATH


County.


suffolk


State Mark


Registered No.


Township


Winthrop


No. 36


.or


VAlage


Mucethiop


........... or


City


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


2 FULL NAME


fif to the Armypr Navy ofthe United States, give rank, organization, etc:)


(a) Residence.


No. 36 Suas of the Un


(Usual place of abode)


Length of residence in city or town where death occurred


1


years


months


days.


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


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


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


12-8-


19/ 9


17


HEREBY CERTIFY, That I attended deceased from


19.19,to ..


19


19


that I last saw


alive on


1919


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


130


30 pr.


The CAUSE OF DEATH* was as follows : acedores


(duration)


.......


.... yrs .............


mos ..


2


ds.


9 BIRTHPLACE (city or town)


(State or country)


10 NAME OF FATHER


11 BIRTHPLACE OF FATHER (city or town) YAchestr (State or country)


12 MAIDEN NAME OF MOTHER Ruth Clark


PARENTS


13 BIRTHPLACE OF MOTHER (city or town).


newton?


(State or country) 2MgAR


mit aus


St.,


.......


Ward


Ward.


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


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 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, Compos- itor, Architcet, 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 statcinent; 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 forin part of the second statement. Never return "Laborer,"


"Foreman," "Manager," "Dealer," etc., without inore 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 spc- 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 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 ("Pncuinonia," 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 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- toins or terminal conditions, such as "Asthenia," "Anemia" (mcrely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," " Debility' (" Con- genital," "Senile," ctc.), " Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all discases 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 HIOMICIDAL, 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 BY


PHYSICIAN.


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


The Commomoralth of Massachusetts STANDARD CERTIFICATE OF DEATH


(City or town)


Registered No.


or Village


or


No.


37%, Ficelhugo


St.,


Ward


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


ichard Stanley Moody


(a) Residence.


No. BY/ Wiecho


Length of residence io city or town where death occurred


years


8


months


25 days.


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, day, and year) 12-9-


19/9


17 I HEREBY CERTIFY, That I attended deceased from


19


19


to bem 9 .1919


that I last saw h


2


alive on


1919.


and that death occurred, on the date stated above, at 6300 m. The CAUSE OF DEATH* was as follows :


(duration)


1


.yrs ....


4


.mos ..


mads.


CONTRIBUTORY


(SECONDARY)


(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 ?.


& Ray Plates


What test confirmed diagnosis ?


2 rueete Elacinsan


(Signed)


M.D.


, 19


(Address)


Wieluof mass


* 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. (Sce reverse side for additional space.)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL


12-11 1919


20 UNDERTAKER


ADDRESS


Withist


Township Cit 2 FULL NAME (Usual place of abode) 3 SEX 4 COLOR OR RACE 5a If married, widowed, or divorced HUSBAND of (or) WIFE of 7 AGE Months 8 1 Years 8 OCCUPATION OF DECEASED (b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer (State or country) 12 MAIDEN NAME OF MOTHER PARENTS Informant 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. 15 Filed Dec. 26, 1919. N. B. - WRITE PLAINLY, WITH ONFADING INK - THIS IS A PERMANENT RECORD. Every item of information should be 9 BIRTHPLACE (city or town) (State or country) Mark


10 NAME OF FATHER Richard C. Morda


11 BIRTHPLACE OF FATHER (city or town).


Bestor


13 BIRTHPLACE OF MOTHER (city or town) Laeken) (State or country) 7.1.0-


14 Richard B. Mr


(Address)


371 milk St


REGISTRAR


.


6 DATE OF BIRTH (month, day, and year) March 15.1918


Days


24


If LESS than 1 day, ........ hrs. or ........ min.


(a) Trade, profession, or


particular kind of work


nous


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Single


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


St., Ward.


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


1 PLACE OF DEATH


County.


Suffolk


State


Mark


[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 cach 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 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 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 "Epidemie ccrebrospinal 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; 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 symnp- 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 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.


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 BY PHYSICIAN.


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


R-302


The Commonwealth of Massachusetts


CERTIFICATE OF DEATH OF NON-RESIDENT


----


( City or town)


10940


County


Suffolk


State


Massachusetts


Registered No.


(Place of death)


City or Town


Boston


No.


ST .ELIZ .HOSPT.


St., Ward


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


2 FULL NAME


CORNELIUS O CALLAGHAN


(If in the AFIRIPENSref the United States, give rank, organization, etc.)


City or Town


No.


28 IRWIN AVE


St.


(a) Residence. 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


MEDICAL CERTIFICATE OF DEATH


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


DEC.10 1919


17


I HEREBY CERTIFY, That I attended deceased from


ост.26


19.19 ....... , to


DEC.10


19 .. 1.9


...


that I last saw h


IM


DEC .10


......


19.19


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


1.30 A m. The CAUSE OF DEATH* was as follows :


* 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.) PYELITIS -- SEPTICAEMIA


(duration).


2'


.. yrs ..


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


CONTRIBUTORY


(SECONDARY)


(duration)


yrs ...


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.A.NORMANDIN


M.D.


, 19 19 (Address)


14 J.J. SULLIVAN. 76 OAK ST


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


BROOKLINE (HOLYHOOD)


DATE OF BURIAL


DEC.12


19 19


Filed


DEC . 12 1919


Registrar of city or town where death occorred


Filed


DEC. 17. 1919


Winthrop


Registrar of city or town where deceased resided


3 SEX


M


7 AGE


63


PARENTS


Informant


(Address)


15


so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions on back


of certificate.


carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,


I. D. WHILE PLAINLY, WITH CITADINO INN TID IN A PERMANENT SECOND. Every Item of information should be


(State or country)


4 COLOR OR RACE



5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


S


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


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


Years


Months


Days


If LESS than


1 day, ........ brs.


Or ....... mic.


If STILLBORN, enter that fact here


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work.


NONE


(b) General nature of industry,


business, or establishment in


which employed (or employer)


(c) Name of employer


IRELAND


9 BIRTHPLACE (city or town)


10 NAME OF FATHER


DENNIS


11 BIRTHPLACE OF FATHER (city or town)


(State or country)


IRELAND


12 MAIDEN NAME OF MOTHER


NOT STATED


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


20 UNDERTAKER


W.J.CASSIDY


ADDRESS


BOSTON


1 PLACE OF DEATH


Registered No.


(Place of residence)


NASS.


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


Statement of occupation. - Prceise 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, c. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial cinployments, 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," cte., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the houschold 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 tlie occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write Nonc.


Statement of cause of death .- Namc, 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 "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar mmcumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, cte., of.


(naine origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, cte. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broneho- mmeumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as " Asthenia." "Ancinia" (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 discases resulting from child- birth or iniscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ctc. State cause for which surgical operation was undertaken. For VIOLENT DEATHIS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to 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 conscquenecs (e. g., sepsis, tetanus) may be stated




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.