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James Henry DeCoursey
(1883 - 1955)
1. PLACE OF DEATH a. County Wyandotte b. Township 1052 c. Length of Stay (in this place) 50 Years 1 d. City or Town Kansas City Is place of death within city limits? Yes XX No ___ e. Full Name of Hospital or Institution Providence Hopital (If not in hospital or institution, give street address or location) 2. Usual Residence (Where deceased lived. If institution: residence before admission). a. State Kansas b. County Wyandotte 1052 c. City or Town Kansas City Is place of res. within city limits? Yes No ___ d. Street Address (If rural, give location) 408 North 17th. Street 3. NAME OF DECEASED a. (First) James b. (Middle) H. c. (Last) DeCoursey 4. Date of Death (Month, Day, Year) January 19, 1955 5. SEX Male 6. COLOR OR RACE White 7. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED (Specify) Married 8. DATE OF BIRTH July 29, 1883 9. Age (In years last birthday) 71-5-20 10 a. Usual Occupation (Give kind of work done during most of working life, even if retired) Manufacturer b. Kind of Business or Industry Ice-Cream Co. 11. BIRTHPLACE (State or foreign country) Alma, Colorado 12. Citizen of What Country? U.S.A. 13. FATHER�S NAME Edwin E. DeCoursey 14. MOTHER�S MAIDEN NAME Mary Mc Cormick 15. Was Deceased Ever in U.S. Armed Forces? (Yes, no, or unknown) None (If yes, give war or dates of service) ______ 16. Social Security No. 510-07-1392 17. INFORMANT Edwin DeCoursey, (Son) K.C.K. MEDICAL CERTIFICATION 18. Cause of Death Enter only one cause per line for (a), (b), and (c) I. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH * * This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury, or complication which caused death. (a) Hypostatic Pneumonia 2 INTERVAL BETWEEN ONSET AND DEATH 3 days ANTECEDENT CAUSES Morbid conditions, if any, giving rise to the above cause (a) stating the underlying cause last. DUE TO (b) Hypertension Left Hemoplegia 3 INTERVAL BETWEEN ONSET AND DEATH 20 years DUE TO (c) Carcinoma Bladder INTERVAL BETWEEN ONSET AND DEATH 4 year II. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition causing death. Asthenia 4 INTERVAL BETWEEN ONSET AND DEATH 6 mo 19 a. Date of Operation ________ b. MAJOR FINDINGS OF OPERATION none 20. AUTOPSY? Yes ___ No XX 21 a. ACCIDENT, SUICIDE, HOMICIDE (Specify) no b. Place of Injury (e.g., in or about home, farm, factory, street, office bldg., etc.) _____ c. (CITY, TOWN, OR TOWNSHIP) none (COUNTY) ________ (STATE) ________ d. Time of Injury (Month, Day, Year, hour) no e. Injury Occurred while at work ___ while not at work ___ f. HOW DID INJURY OCCURR? none 22. I hereby certify that I attended the deceased from Jan , 19 26 , to Jan 19 , 19 54 that I last saw the deceased alive on Jan. 19 , 19 55 , and that death occurred at 1:58P m., from the causes and on the date stated above. 23 a. SIGNATURE L. Lafe Bresette (Degree or title) MD b. ADDRESS Kansas City, Kansas c. Date Signed 1/21/1955 24 a. Burial, Cremation, Removal (Specify) Burial b. Date Jan. 22 1955 c. Name of Cemetery or Crematory Mt. Calvary Cemetery d. Location (City, town, or country, state) Kansas City 2, Kansas 25. FUNERAL DIRECTOR Jos. A. Butler�s Sons ADDRESS Kansas City, Kansas Date Rec�d by Local Reg. 1/21/55 REGISTRAR�S SIGNATURE Howard Payne 1 50 years in Kansas City would mean he moved there from Leavenworth about 1905, which is supported by other sources. 2 Hypostatic pneumonia is linked to elderly or weak persons, and occurs when an immobile person lies in the same position for such long periods of time that fluid builds up in the lungs, increasing the risk of infection. It is a very serious complication which can be prevented by pulmonary physical therapy and changing the patient's position in bed regularly. 3 Hypertension is defined as high blood pressure. Hemiplegia is the total paralysis of the arm, leg, and trunk on the same side of the body (in this case the left side). It is most often caused by stroke, but can also be caused by a variety of other things. 4 Asthenia is defined as weakness or lack of energy and strength. It can be mental as well as physical.
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