Town of Winthrop : Record of Deaths 1928-1930, Part 82

Author: Winthrop (Mass.)
Publication date: 1928
Publisher:
Number of Pages: 1296


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 82


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379" Pleasant


St.,


Ward,


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


Length of residence in city or town where death occurred


14 years


months


days.


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


years


months


days.


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


1


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Niclow


5 a If married, widowed or divorced


HUSBAND of


(or) WIFE of


John Barbour


IF LESS than


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


or ........ min.


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


(Month)


(Day)


8


1838


(Year)


16 I HEREBY CERTIFY , That I attended deceased from January 20, 1929 to February 8 1929


that ! last saw


ber alive on


Feb. 8


29


19


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


The CAUSE OF DEATH was as follows: (State fully)


Chronic Interstitial heplantes


CONTRIBUTORY


(Secondary)


Senility


(dagation).


(duration)


_yrs.


.mos.


ds.


17 Where was disease contracted


if not at place of death


Did an operation precede death


no


For what.


Date of operation


Was there an autopsy


no


What test confirmed diagnosis


clinical & laboratory.


always M.D., M.D.


(Signed)


962 Sauley Street, Withup


(Add


Date


february 8/29


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


north rendal


Prov. R. J.


(Cemetery)


( City cr town)


DATE OF BURIAL teb 11/28 2


ADDRESS 591 - 1guay JO. Bolton


20 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me or transit perm it was iss


WWW. Childress


4


Official position agent


Date of issue _of permit. 2/11/29


Permit No. 1574 -


7


1 PLACE OF DEATH


Suffolk


County.


City or Town


Winthrop


200.000. 9-26. NO. 6373


(Usual place of abode)


3 SEX


Female


While


6 AGE


Years


Months


Days


75


IF STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


(b) Name of employer


8 BIRTHPLACE (City)


Salem


1 O BIRTHPLACE OF


FATHER (City)


Ireland


(State cr country)


Ulice Savage


1 1 MAIDEN NAME


OF MOTHER


12 BIRTHPLACE OF


PARENTS


MOTHER (City)


Ireland


(State or country)


13


(Address)


329ª Pleasant St


Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.


plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified-


14


N. D. - WARTE PLAINLY, WITH ONEADING BLACK INAS THIS TO A PERMANENT ALGUND. Every Bit of Information Should be carefully sup-


9 NAME OF


FATHER


Richard Welch


(State or country)


Mayachapter


Informant


vouulice moriarty


Filed


(Month) (Day) (Year)"


REGISTRAR


19 UNDERTAKER William T. Bulger Inc


Maw


yrs


_. mos.


ds.


200 Pm.


No.


339a Pleasant


Winthrop (City or town


REVISED UNITED STATESSTANDARD 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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, 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 "Laborer," "Fore- man," "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 onty (not paid Housekeepers who receive a definite salary), may be entered as House- wife, Housework, or At home, and children, not gainfully employed, as At school or At home. 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 occupa- tion 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. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, 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, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symp- tomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL 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 ""primary"; if secondary, give primary cause.


Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, menin- gitis, miscarriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.


EXTRACTS


FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS


GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forth- with, 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 registra- tion a standard certificate of death, stating to the best of his knowl- edge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ..... Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, or from one cemetery to another, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be ob- tained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certi- ficate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying 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 clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.


Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .-- Gen. Laws, Chap. 38, Sec. 6.


He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.


No undertaker or other person shall bury a human body or the ashes thercof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 40, G. L., as amended.


-


-


-


-


M R-301


DIVISION OF VITAL STATISTICS


The Commonwealth of Massachuset s


Winthrop


BOSTØN


1 PLACE OF DEATH


County


Suffolk


State


Massachusetts


Registered


2019


37


City or Town.


Boston


Winthrop


No.


248 thisby


St.,


Ward


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


Francesca Madonna


KM U. S. War Veteran, specify WAR)


(a) Residence.


No.


(Usual place of abode)


Length of residence in city or town where death occurred


yrs


.St.,


.Ward,


(If non-resident, give city or town and state)


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


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX Frmala


4 COLOR OR RACE


White


5 SINGLE, MARRIED. WIDOWED, or DIVORCED (write the word) Single


5a If married, widowed, or divorced HUSBAND of (or) WIFE of


6 AGE


Years 2


Months


Days


11


IF LESS than 1 day . ....... hrs. or .......... min.


IF STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work. (b) Name of employer


S BIRTHPLACE (City)


(State or country)


9 NAME OF FATHER


Pasquale Madonna


10 BIRTHPLACE OF FATHER (City) Italy (State or country)


11 MAIDEN NAME OF MOTHER


Lucia Ontorci


12 BIRTHPLACE OF MOTHER (City) (State or. country) Italy


13 Pasquale Madonna (Father Informant (Address) 248 Hirlay It. Winthrop


14 Feb 11/2-1 Filed (Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


Feb


1929


( Year )


16 I HEREBY /CERTIFY, That I attended deceased from to tel 11 Feb 339 29


19 29


that I last saw her


alive on


Feb11


2kg


19


2.30 PM


m.


and that death occurred, on the date stated above, at The CAUSE OF DEATH was as follows: (State fully)


Heute Johan neum Permond


(duration)


.yrs.


mos. .


8


.ds.


CONTRIBUTORY


(Secondary)


(duration)


.yrs.


mos ..


ds.


17 Where was disease contracted


if not at place of death


Did an operation precede death to For what


Date of operation


Was there an autopsy If under one year, was infant Breast Fed ?. What test confirmed diagnosis.


(Signed) 4. I Maronald


(Address)


26 anality


a M castro, con


Date


Feb 11-1/29


PLACE OF BURIAL, CREMATION, OR REMOVAL It Michael Emstory ForestHill)


DATE OF BURIAL


( Cemetery ) AÇity or town ) 1/26.131929


19 UNDERTAKER Patry Dapino


achilora ff DRESS & Bostore


20 I HEREBY CERTIFY that a satisfactory stand- ard certificate of death was filed with me BEFORE the burial or transit permit was issued


Official


health officer Date of issue 2/12/29 Permit 15. 70 Permit


20M.


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.


PARENTS


Winthrop Mars


200M 7-'28 No. 2787-c


2 FULL NAME


2H8 Thirty


mos.


STANDARD CERTIFICATE OF DEATH


(City or town)


, M. D.


15 DATE OF DEATH


( Month)


( Day)


-


Feb. 11, 1929 Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Ass'n.)


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, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, es- pecially 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 ex- amples : (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 re- turn "Laborer," "Foreman," "Manager," "Dealer," etc., with- out 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, House- work, or At home, and children, not gainfully employed, as At school or At home. 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 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 meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never report "Typhoid pneumonia") ; Lobar pneumonia; Bronchopneumonia ("Pneu- monia," unqualified, is indefinite) ; Tuberculosis of lunga, 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, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example : Measles (disease causing death), 29 da .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthe- nia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile." etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock." "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peri- tonitis," etc.


State cause for which surgical operation was undertaken.


(Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Associa- tion.)


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


Certificates will be returned for additional information which give any of the following diseases, without explanation, as the nole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.


EXTRACTS


FROM THE LAWS OF THE


COMMONWEALTH OF MASSACHUSETTS


GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forth- with, 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 de- ceased, 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 as required by section one, where same was contracted, the dura- tion of his last illness, when last seen alive by the physician or officer and the date of his death .- Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall ex- hume a human body and remove it from a town, or from one cemetery to another, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement con- taining the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for suffi- cient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a mem- ber of the board of health, or employed by it or by the select- men for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by vio- lence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and trans- mit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying 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 clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.


Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .- Gen. Laws, Chap. 38, Sec. 6.


.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the common- wealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46 G. L., as amended.


2


1 PLACE OF DEATH


County


City or town


. 2 FULL NAME


(a) Residence.


Sta


(Usual place of &


Length of residence in city or town wher


PERSONAL AND ST


3 SEX


4 COLOR OR


5a If married, widowed, or divorc Name of


6 AGE


Years


If STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) Name of employer


8 BIRTHPLACE (city or town) (State or country)


. 9 NAME OF FATHER


10 BIRTHPLACE OF FATHER (city or town) (State or country)


11 MAIDEN NAME OF MOTHER


12 BIRTHPLACE OF MOTHER (city or town) (State or country)


13


Informant (Address)


14


Filed


. 19


Filed , 19


. 4312


58 COPY


Grant Percy Veale Feb. 11.1929 Grant Percy Veale Name,


Place of Death,


Portsmouth, N. H.


No.


Ward,


Village,


How long a resident,


5 days


Previous residence,


Winthrop, Mass.


If death occurred at an institution give name of same


Portsmouth Hospital


How long an inmate,


5 days


19


Where from,


North Hampton,N. H.


1


Date of Death: Year


1929


Month


Feb .Day,


11th.


Age: Years,


35


Months,.


11


Days,


8


Place of Birth,


Chicago, Il1.


Date of Birth: Year,


1893


Month,


Mar


"Day,


3rd.


Married, Single


Divorced


Sex,


M


Color,


Widowed or


Divorced.


Occupation,


Salesman


Cause of Death,


Traumatic Shock


Duration,


Contributing Cause,


Fracture of Hip.


Dilated Stomach. Automobile Accident DurationNO. Hampton, N. H.


Name of Father,


Ernest A. Veale


Maiden Name of Mother,


Mary L. Ainge


Birthplace of Father,


England


Birthplace of Mother,


England


Occupation fo Father,


Salesman


TH


(City or town)


Registered No.


(Place of death)


38,


Registered No.


(Place of residence)


St.,


Ward


Street n, give its NAME instead of street and number)


le United States, give rank, organization, etc.) No. St.


eign birth?


years


months


days


¿TIFICATE OF DEATH


(Month)


(Day) (Year)


! TIFY,


That I attended deceased from


, to


19


ate stated above, at. m.


ollows:


(State fully)


(duration) yrs ..


mos. de.


(duration)


yrs ..


mos.


de.


For what


M. D.


OR REMOVAL


DATE OF BURIAL


(City or town)


, 19


ADDRESS


may be properly classified. Exact statement of OCCUPATION is very important. PARENTS


§ HUSBAND ? (or) WIFE


R-301


DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


Winthrop


1 PLACE OF DEATH


County


Suffolk


State


Ma. ss


Registered No. 30


City or Town


Winthrop


No.


6 Jefferson St.


St.,


Ward


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


2 FULL NAME


Matie D.Brown


(If U. S. War Veteran, specify WAR)


6 Jefferson St.,


St.,


.Ward,


Winthrop, Mass


(a) Residence.


No.


(Usual place of abode)


Length of residence in city or town where death occurred. 4 yrs.


mos.


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


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Female


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


Horace R.


6 AGE


Years


51


Months


11


Days


6


IF LESS than


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


or .......... min.


IF STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


At home


(b) Name of employer


Hamilton


8 BIRTHPLACE (City)


(State or country)


Ontario


9 NAME OF


FATHER


John B. Dayfoot


10 BIRTHPLACE OF


FATHER (City)


(State or country)


Ontario


11 MAIDEN NAME


OF MOTHER


Fanny (Unknown)


12 BIRTHPLACE OF


MOTHER (City)


(State or country)


Canada


13 Herbert W. Brown


Informant


( Address)


165 Court Rd., Winthrop


Filed Teb 13. 1929


(Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


Fsb


11


1929


(Month)


(Day)


( Year)


16 I HEREBY CERTIFY, That I attended deceased from.


9


15


to


26


11


1929


that I last saw h&.A.w ... alive on


11


19


29


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


3:15 Am.


The CAUSE OF DEATH was as follows: (State fully)


angina pectoris


.yrs ..


(duration)


6


mos


.ds.


Chronic my scanditi


CONTRIBUTORY


(Secondary)


mos ..


.ds.


(duration) 10 yrs.


.


17 Where was disease contracted if not at place of death


Did an operation precede death


no


For what


Date of operation


Was there an autopsy


10


What test confirmed diagnosis.


Purmal Observation.


(Signed)


Raymond 3 Parker


., M. D.


(Address)


GIVE White & St Wanted Man


Date


18 PLACE OF BURIAL, CREMATION, OR REMOVAL Mt. Auburn


Cambridge


DATE OF BURIAL


2/13/29


(Cemetery)


(City or town)




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