Town of Winthrop : Record of Deaths 1910-1912, Part 36

Author: Winthrop (Mass.)
Publication date: 1910
Publisher:
Number of Pages: 956


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 36


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).


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continuerd


(SECONDARY)


way


(Duration) .. yrs.


.. mos. ds.


(Signed)


Surge Burgers Mangrach.


M.D.


(Address)


MEDICAL EXAMINER ·


* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death


.yrs.


mos.


ds.


State ..


In the


.. yrs.


mos. .


ds.


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL July 8th 191


Filed .. , 191


REGISTRAR


5 SINGLE,


Single


6 DATE OF BIRTH


(Month)


(Day)


(Year)


7 AGE


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


or ....... min. ?


8 OCCUPATION


rather


(a) Trade, profession, or particular kind of work Pulisce Office


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


9 BIRTHPLACE


(State or country)


Cambridge Mass


10 NAME OF


FATHER


Herbert & Gordon


andon


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Cambridge Abass


12 MAIDEN NAME OF MOTHER


13 BIRTHPLACE OF MOTHER (State or country)


Cambrialas Moque


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Hubert & Sunday


(Address) 12/ Park An Withun Mask


30 UNDERTAKER


ADDRESS 116. Hampelpics


imar


WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.


3446 Winthrop (City or town.)


..... Ward)


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


3 SEX


Male


4 COLOR OR RACE


White


MARRIED WIDOWED, OR DIVORCED (With the word)


6h


1 .yrs. 5 .mos. x ds.


191


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The questiou applies to each and evory 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, 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 returu " 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 dutics of the household only (not paid House- keepers who receive a definite salary), may be entered as Ilousewife, 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 iu domestic service for wages, as Servant, Cook, Ilousemaid, 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 frour 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: Cerebro-spinal fever (the only definite synonym is " Epidemic 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, peritonaeum, etc., Carcinoma, Sar- coma, 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 (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-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," etc.), " Dropsy," " Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "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 septicaemia," " PUERPERAL peritonitis," 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 determine definitely. Examples: Accidental drowning; Struck by railway train - accident ; Revolver wound of head -homicide ; Poisoned by carbolic acid - prob- ably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under . the head of " Contributory."


Cases for the Medical Examiners. - Under the provisions 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, 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, ctc.


important. See instructions on back of certificate. .. 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


1 PLACE OF DEATH


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH 281 (No. Main St. ;. ..


Winthroy BOSTON (City or town.)


Ward)


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


'FULL NAME


Helen a. Frederick.


{If married or divorced woman or widow


give ·maiden name, also name of husband.]


Helen a mangun Caheinze Frederick


@RESIDENCE


281 Main at


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


female !brite


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widow


DATE OF BIRTH


(Month)


(Day)


(Year)


7 AGE


80


yrs. - mos. ds.


8 OCCUPATION


(a)' Trade, profession, or particular kind of work ...


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


9 BIRTHPLACE


(State or country


"Bighampton, N.C.


10 NAME OF


FATHER


albor Morgan


PARENTS


11 BIRTHPLACE OF FATHER (State or country


Sighampton N.Y.


12 MAIDEN NAME OF MOTHER Инфлагии


13 BIRTHPLACE OF MOTHER (State or country) Begkunstfor nl


14 THE ABOVE IS TRUE TO THE REST OF MY KNOWLEDGE


(Informant)


Helen B&euro


(Address)


18


Filed .. ... 191. ....


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH July. 9 , 19111 (Year)


(Month)


(Day)


17


I HEREBY CERTIFY that I attended deceased from


to


March


191./ ...


July. 8


1911,


If LESS than


1 day .......


.. hrs.


that I last saw her alive on


191 / .,


or .......


.min. ?


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


The CAUSE OF DEATH* was as follows :


Senility.


. (Duration) ...


.yrs.


ayeara.


mos.


ds.


Contributory


(SECONDARY)


(Signed)


(Duration)


D.L. Jackson


mos.


ds.


M.D.


July 10, 1911 (Address),


5- 6 2 Shirley 80.


If death ffollowed injury or violence the certificate of death must be made out by tho 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.


ds.


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL Winthrop2.


DATE OF BURIAL July 12 1911


20 UNDERTAKER Cell Vallvery


ADDRESSY Bastan


1


..


1


STANDARD CERTIFICATE OF DEATH.


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, Compositor, Architect, 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 Ilouse- keepers who receive a definite salary), may be entered as Hlouscwife, 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 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 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 "Epidemic 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, peritoneum, etc., Carcinoma, Sar- coma, etc., of .. . (name origin: "Cancer " is less definite ; avoid use of " Tumor"> for malignant neoplasms) ; Mcasles ; Whooping cough; Chronic valvular heart discasc; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-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," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," " Marasmus," " Old age," "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 septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions 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, 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.


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


PLACE OF DEATH 1 Wenthigh James Aller 2FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE


Io. 20 Oceano CEur


St.


Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE White


6 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Married


7 AGE


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


49 yrs. 3 mos. 2 .ds.


or .. min. ?


8 OCCUPATION


(a)' Trade, profession, or


particular kind of work


Superintendent


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


Down Laborers


9 BIRTHPLACE


(State or country)


Leland


10 NAME OF FATHER


Solny Alvenu


PARENTS


11 BIRTHPLACE OF FATHER (Stato/or country)


Ireland


12 MAIDEN NAME OF MOTHER Ellent Saving


13 BIRTHPLACE OF MOTHER (State or country) Ireland.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Aux Alice ,Aber


(Address)


20 OVERNU VELUT


16


Filed. 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


IU, 19/1


(Month)


(Day) (Year)


THEREBY CERTIFY that I attended deceased from


1910, to July 1.2. 1911.


that I last saw him alive on 10, 1911. and that death occurred, on the date stated above, at.3.1º @m. The CAUSE OF DEATH* was as follows :


7,


(Duration) . Julenula


y/s.


mos. ds.


Contributory


(SECONDARY)


9


.. (Duration)


.yrs. mos. ..


ds.


(Signed) July 11 1/91) . (Address) 263 Winthing


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. .


ds.


..........


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL Holy Cross, CEMETERY


DATE OF BURIAL


July 13, 1911


20 UNDERTAKER


ADDRESS


79CUlantic It


., M.D.


3 SEX Male 6 DATE OF BIRTH Afval 8 , 1862 17 (Month) (Day) (Year)


STANDARD CERTIFICATE OF DEATH.


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, Compositor, Architect, 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 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 CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal ferer (the only definite synonym is "Epidemic 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, peritonaeum, etc., Carcinoma, Sar- coma, 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 (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-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," etc.), " Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "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 septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical' operation was undertaken.


Cases for the Medical Examiners. - Under the provisions 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, 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.


WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.


important. See instructions on back of certificate. 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


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


( No.


metcalf deslutar


St. :


Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Male


4 COLOR OR RACE


White


& SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


11


1911


1.


(Month)


(Day)


(Year)


7 AGE


.. yrs. mos. ds.


or ........ min. ?


8 OCCUPATION (a) Trade, profession, or particular kind of work.


(b) General nature of industry,


business, or establishment in


which employed (or employer)


Still form


(Duration)


.yrs.


mos.


ds.


Contributory


(SECONDARY)


.(Duration) YES. mos. ds.


(Signed)


M.D.


19 } ......


(Address).


(If death followed injury or violence the certificate of Heath 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.


ds.


State. ..


.yrs.


mos.


ds.


In the


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


Holy Cross Miceldia


DATE OF BURIAL


Jeely 14.


191/


20 UNDERTAKER


ADDRESS voucher


F


191.


(Year)


(Month)


(Day)


?


I HEREBY CERTIFY that I attended deceased from 1


11


, 191.1 ...


19111.


If LESS than


I day,


hrs.


that I last saw him alive on


. 1911.


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


7 m.


The CAUSE OF DEATH* was as follows :.


Incidental to both


) BIRTHPLACE


(State or country)


10 NAME OF FATHERC John Boyer


PARENTS


II BIRTHPLACE OF FATHER (State or country)


2


12 MAIDEN NAME OF MOTHER Eliz abuck E. Daly


13 BIRTHPLACE OF MOTHER (State or country)


Busco


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


Filed ... 191.


REGISTRAR


16 DATE OF DEATH


2 FULL NAME


[If married or divoreed woman or widow


give maiden name, also name of husband.]


@RESIDENCE


Revere mass


BOSTON


(City or town.)


STANDARD CERTIFICATE OF DEATH.


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, Compositor, Architect, Loco- motive engincer, 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 Ilouscwife, 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 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 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 "Epidemic cerebro-spinal meningitis ") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia, Broneho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular hcurt disease; Chronic interstitial nephritis, etc. The contributory (sccond- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," " Collapsc," " Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," " Exhaustion," " Heart failure," "Haemorrhage," " Inanition," "Marasmus," "Old age," "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 septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions 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, Ex- posurc, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholismi, etc.


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


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


(No. 51 Ingleseda Cnt St.


Ward)


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


Registered No.


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


July


Month )


(Day)


11, 191


(Year)


17


I HEREBY CERTIFY that I attended deceased from


1910 ., to


July


"/ .. , 1918,


that | last saw h ....... alive on


July


8, 1911.


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


The CAUSE OF DEATH* was as follows : Fibro- cystic abdominal


about (Duration) ...


3 yrs.


mos.


ds.


Contributory.


(SECONDARY)


.. (Duration)


.. yrs. ..


mos. .


ds.


(Signed)


Que (2, 1911 (Address).


...


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.




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