Town of Winthrop : Record of Deaths 1919-1921, Part 83

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 83

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

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY

PHYSICIAN.

1 802 1218 50.000

R-302

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

3198

1 PLACE OF DEATH

Registered No.

County

Suffolk

State

Massachusetts

Registered No.

(Place of residence)

St.,

Ward

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

2 FULL NAME

FRANK G. CROWLEY

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

WINTHROP

No ..

33 EDGE HILL ROADSt.

(a) Residence.

State

(Usual place of abode)

Length of resideoce in city or town where death occorred

years

months

days

How loog in U. S., if of foreigo birth?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

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

MAR.5.

1920

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

MABEL H.

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

SEPT.22

Years

Months :

| 2 Days

If LESS than

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

or ........ min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

PRES.MARINE ENGIN

(b) General nature of industry,

business, or establishment in

which employed ( or employer)

EERS

9 BIRTHPLACE (city or town).

ADDI SON

ME"

(SECONDARY)

(duration)

yrs.

mos.

ds.

10 NAME OF FATHER

.HOLMAN G. CROWLEY

11 BIRTHPLACE OF FATHER (city or town)

(State or country)

ME .

12 MAIDEN NAME OF MOTHER FANNIE P.GOOCH

What test confirmed diagnosis?

(Signed)

A.W. REGGIO

M.D.

, 19 20 (Address)

Informant

WIFE

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

CAMBRIDGE (MT.AUBURN)

DATE OF BURIAL

MAR. 8 1920

15 MAR. 1O

19 20

NOM Ilenen

Registrar of city or town where death occurred

20 UNDERTAKER

E.G.BROWN & CO.

ADDRESS

Filed May 1 ....... 19 20 Bessie 1. Dodge

Csak, Registrar of city or town where deceased resided

(duration)

yrs ..

mos.

ds.

CONTRIBUTORY

METASTASES -LIVER ETC.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death?

YES

Date of

FEB.28.20

Was there an autopsy?

LAPAROTOMY

ADDI CON

13 BIRTHPLACE OF MOTHER (city or town)

(State or country)

ME .

I HEREBY CERTIFY, That I attended deceased from

FEB.27

19 20

MAR.5.

19 20

that I last saw h.

alive on

MAR . 5 ., 1920

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

11.55A

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.) CANCER OF STOMACH

3 SEX M 7 AGE 52 PARENTS 14 (Address) carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, 80 that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back of certificate. Filed. N. D. - WHITE PLAINS, WITH UNTADING IN THIS IS A PERMANENT RECORD. Every Hem of Information should be (State or country)

.....

(City or town)

(Place of death)

City or Town

BOSTON

No.

MASS .GEN HOSPT.

MASS ... City or Town

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

MAR

ADDI SO 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 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 DEATHI (the primary affection with respect to time and causation), using always the saine 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, Surcoma, 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," "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 miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," s," 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- 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." (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 303. 6-18 50 000

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

I PLACE OF DEATH Nunchutte (No) -

355° W Wehope St. : Ward)

Sarah. mc neil

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

385 Wucht to Workshop May

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

' COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

1836

(Month)

(Day)

.. , (Year)

7 AGE

.yrs.

mos.

ds.

min. ?

& OCCUPATION

(a) Trade, profession, or

particular kind of work

(b) General nature of industry,

business, or establishment in

which employed (or employer)

mitral monfficiency

(Duration)

yrs.

mos.

.ds.

Contributory.

(SECONDARY)

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

.(Duration)

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

mos. ................ „ds.

(Signed)

M.D.

Mar 85, 1900 (Address) 180 Withurp St

* 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.

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

Former or usual residence

19 PLACE OF BURIAL OR REMOVAL

DATE OF BURIAL

Mar 95

1920

20 UNDERTAKER

ADDRESS

16 Filed Mch. 31. 1080

m. J. draw, ....

ass. t.

REGISTRAR

(City or town.)

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

2 FULL NAME

vidone of frage manière

16 DATE OF DEATH

march

(Month)

(Day)

1920

(Year)

17 I HEREBY CERTIFY that I attended deceased from

1919

mar 104

1920

........

that I last saw her

alive on

Mar.per

1920.

and that death occurred, on the date stated above, at 10 4 m.

The CAUSE OF DEATH* was as follows :

arterio sclerosis

9 BIRTHPLACE

(State or country)

Nalem Man

10 NAME OF

FATHER

unater & ablan

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

12 MAIDEN NAME

OF MOTHER

1ª BIRTHPLACE

OF MOTHER

(State or country)

" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

(Address)

* DATE OF BIRTH

6/4/36

If LESS than I day ......... hrs.

march 6, 1920.

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, Architeet, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," 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 ill 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 faet may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no oceu- pation whatever, write None.

Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-

culosis of lungs, meninges, peritonacum, etc., Careinoma, Sar- eoma, etc., 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 .; Broneho-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," cte.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old agc," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.

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

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

I R-301

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County

Suffolk

State.

Massachusetts

Registered No ..

4.5

City or Town

No ..

200 Lincoln St.

St ... .Ward

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

2 FULL NAME

JOHN PYAN

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

(a) Residence. No ..

200 Lincoln St.

St.,

Ward.

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

Length of residence in city or town where death occurred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

White

Married

Male

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Elizabeth Orpin Ryan

6 DATE OF BIRTH

Cannot be learned

( Month)

(Day)

(Year)

7 AGE

0,5

Years

Months

Days

If STILLBORN, enter that fact here

If STILLBORN, state period of uterogestation

mos.

If LESS than

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

Dr ........ min.

Cardias Cottiman

.. ( duration)

. yrs .......

gmos .....

¿s.

CONTRIBUTORY

(SECONDARY)

(duration)

.. ...

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

18 Where was disease contracted

if not at place of death ?

FOR WHAT?

Did an operation precede death ?

Date of.

Was there an autopsy ?

no.

What test confirmed diagnosis ?

(Signed)

, M.D.

356 Wmthat It

Date

(Month)

( Day) ( Year)

Informant. Elizabeth Ryan

(Address)

200 Lincoln St.

Mch. 31, 1920

Filed (Month) (Day) (Year)

M. G. HEand asst. REGISTRAR

20 UNDERTAKER

ADDRESS

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

Official positiop. Health Officer

-Date of issue Ficar. 11, 1925 No 110

Permit

150,000, 19-XXM.)

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Day)

1920

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

19.

20 to

Musela 9, 1920

that I last saw h

alive on

, 1920

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

m. The CAUSE OF DEATH was as follows:

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work Petired

(b) General nature ofindustry,

business, or establishment in

which employed ( or employer)

Hotel Clerk

9 BIRTHPLACE (City)

(State or country)

Ireland

10 NAME OF

FATHER

James

PARENTS

11 BIRTHPLACE OF

FATHER (City).

Ireland

(State or country)

12 MAIDEN NAME

OF MOTHER

Bridget Costello

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

Ireland

1120

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Holyhoud

Erookline

(Cemetery)

(City or town)

DATE OF BURIAL

3/12/20

( Usual place of abode)

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

.. yrs .......

mar. 9, 1920.

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 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 wili be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. Butin many casos, 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 bo used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesmun, (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 homo, who are engaged in the duties of the house- hold only (not paid Ilousekeepers wilo 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, otc. 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 indicated 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: Cere- brospinal fever (tio only definito synenym is "Epidemic 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 icss definite; avoid use of "Tumor" for malignant neoplasnis); Measles; Whooping cough; Chronic valvular heart discase; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mero symptoms or termiuai conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Cof- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""IIemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Urcmia,""Weakness," etc., when a definito disease can be ascertained as the cause. Aiways qualify ali 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 foliowing diseases, without expianation, as the soie cause of death: Abortion, ceiluiitis, childbirth, convuisions, hemorrhage, gangrene, gastritis, erysipeias, meningitis, miscar- riage, necrosis, peritonitis, phiebitis, pyemia, septicemia, tetanus.

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

A physician shali forthwith, after the death of a person whom he lias attendod 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 classified under the international classification of causes of death], whero contracted, tho duration of his fast illness, when iast scen alive by the physician, and the date of his deatlı. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Aets of 1910, Chap. 322.

No undertaker or other person shali bury a human body . . . untii he has received a permit from the board of heaith 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 shail 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 ... shall 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 thero 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 health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shail upon application make such certificate as is required of the attending physician. If death is caused by vioience, the medical examiner only shall make such certificate. ... The person to whom tho per- mit is so given and the physician who certifics to the cause of death shall thereafter 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 cierk or registrar may require. - Revised Laws, Chap. 78, See. 88.

Medicai examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where tho 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 shail 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, See. 8.

RULES OF PRACTICE

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

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

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

(3) Medical examiners will investigate and certify to ali deaths sup- posably due to injury. These include not only deaths caused dircotly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and cleathe 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 Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City or town

1 PLACE OF DEATH County.

State Massachusetts Registered No. 46

Township

or Village

... or

St.,

Ward

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

Susan

Husten Dansles

(If in the Army oy Navy of the United States, give rauk, organization, etc.)

(a) Residence.

No. 118 Juni Ziele Que

(Usual place of abode) Length of residence in city or town wbere death occurred years months

days.

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

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Town of Winthrop : Record of Deaths 1919-1921, Part 83

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

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