Death certificate — Robert Matthew Davis, Aurora, Illinois, 11 November 1919

The record

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Transcription (as read)

Place of death: Kane County; Aurora, [St. Charles Hospital]. Registration district 44? (not read). Registered no. 507 per the index.

Full name: "Robert Matthew Davis." Residence: "Mooseheart, Ills."

Sex male; color white; single. Date of birth "Feby 22, 1916." Age 3 years 8 months 19 days. Occupation "none."

Birthplace: "[Gries] Mahanoy City, Penn." (two words stacked: "Gries" above "Mahanoy City"; the index took it as "Gries City").

Father: "David F. Davis," born "Mt. Carmel, Penn."

Mother's maiden name: "Harriet Adelaide [Parrish]," with a struck-through entry before "Parrish" that reads like "[Hattie Hadley]". Born "England."

Informant: "Elizabeth D. Hollis," 4702 N. Sacramento Ave., Chicago, Ills.

Date of death: "November 11, 1919." Physician: "I attended deceased from Nov. 11, 1919, to Nov. 11, 1919... death occurred... at 11:40 P.M." Cause: "Hemorrhage following operation for tonsils, adenoids and circumcision, 12 hours 40 min. after operation." Disease contracted at "Mooseheart." Operation "yes," date "Nov. 11-1919"; autopsy "no." Signed "John D. Nichols, M.D., Mooseheart, Ills.," dated Nov. 12, 1919.

Burial: "Mahannoy City, Pa., 12-15-1919." Undertaker "[A. C. Hollister]," Aurora [address not read]. Filed "11/12/19."

Notes. In brief: a three-year-old boy living at Mooseheart (the Moose orphanage school) died at Aurora on the night of 11 November 1919 of bleeding after a tonsil, adenoid and circumcision operation the same day; he was buried at Mahanoy City on 15 December 1919. The middle name (Matthew against the family's George) and the father's "David F." stay open; the family's 12 November is the day of signing and filing. Grade: PROVEN for the death date, place and cause;