Town of Winthrop : Record of Deaths 1910-1912, Part 42

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 42


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culosis of lungs, meninges, peritoneum, etc., Carcinoma, Sar- coma, 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 .; Broncho-pneumonia (secondary), 10 ds. Never report mero 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 septicacmia," " 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 tho 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.


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1911.


CITY OF BOSTON.


FULL NAME


Ruth Daily


Registered No .. 9678


Place of Death }


Boston


and Residence S


Date of Death


.. 1911.


Age


6


years


10


months


16


days.


STATISTICAL DETAILS.


SEX


COLOR


F


W


SINGLE, MARRIED, WID., DIV. S


Maiden Name


STRAR'S


PATRIBUN, SIT DEL Primary (Duration)


Burns(accidental hot water


Birthplace ..


Waterbury, Conn


Name of


Father


Charles H. Daily 1830.


ISREGIMI!


Birthplace


of Father


Waterbury, Conn.


Contributory : (


Nephritis - 45 days


(Duration)


Maiden Name of Mother .. Nellie Cody


Birthplace Waterbury, Conn.


of Mother.


(Signed)


J.W.J.Marion


M.D.


Occupation


School girl


1911


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Informant


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from


1911, to.


1911, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows:


Husband's Name


CITY


EFFICE


burnsł 47 days


BOSTONIA CONDITA A.


A A. 1822.


DONATA A


ST


O


N. MASS.


In hospital 47 days


Place of Burial or removal ...


Winthrop"Winthrop. Cem Usual Residence


Winthrop(537 Shirley st)


Oct. 23


Undertaker


C R Bennison


Filed


1911


A true copy .


Attest


ErMSlenen


Registrar.


Childrens Hospt.


Sept.2nd.


CIVITATISRE


Sept. 2, 191


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.


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


England


12 MAIDEN NAME


OF MOTHER


Mary Sohlire Bell


13 BIRTHPLACE


OF MOTHER


(State or country)


England


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Willemi E. Roberta


(Address)


Filed 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


3 SEX


female


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Linjer


6 DATE OF BIRTH


(Month)


27 (Day)


1897


(Year)


7 AGE


14.


yrs.


8


mos.


19


.ds.


... min .?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


The CAUSE OF DEATH* was as follows : Perforated appendix operation


Streptococcus infection


(Duration)


yrs.


mos.


98


.ds.


Contributory.


(SECONDARY)


(Duration)


Birmetcalf


yrs.


mos.


ds.


M.D.


Sujet 18'


19| 1


... (Address)


* 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.


96 ds.


In the


b


„yrs.


mos.


ds ...


Where was disease contracted,


If not at place of death ?


29 mermaid are Worthof


usual residence


29


Former or


monnaie med wanted


19 PLACE OF BURIAL OR REMOVAL Wurchent- Quick-


DATE OF BURIAL


1911


ADDRESS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Metcalf Hospital (No.


St. ;....


Ward)


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


May Robili Isabel


2 FULL NAME .. [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 29 mmmural avez Wucheng Registered No.


PERSONAL AND STATISTICAL PARTICULARS


16 DATE OF DEATH


Sept


15


(Month)


(Day)


191.1


(Year)


17


I HEREBY CERTIFY that I attended deceased from


If LESS than


June


12


. 191.L., to


Sept 15th


1911


I day,


hrs.


that I last saw her


alive on


Sept 15


, 1917


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


7309m.


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


9 BIRTHPLACE


(State or country)


Belfast Ireland


10 NAME OF


FATHER


William Edward


Roberts


(Signed)


-DOSTUN


(City or town.)


20 UNDERTAKER


C.R. Bana.


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) Forcman, (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 minc, 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 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 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) ; 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: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- acmia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," " Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," " Heart failure," " Haemorrhage," " Inanition," " Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," ctc. 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.


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1911.


CITY OF BOSTON.


FULL NAME


Peter Costello


Registered No ... 8870


Place of Death )


Boston


Hotel Venice, Hanover st.


and Residence


Sept.18


45


Date of Death


1911.


Age


years


2


months


14


. .. days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


M


M


Maiden Name.


ST


RAR'S


Husband's Name


CITY.


3019


( suicidal)


Name of John Costello


Father.


Birthplace Ireland


of Father.


Maiden Name


Bridget Concannon


of Mother.


Birthplace Ireland


of Mother


Occupation. Musician


Sept.20 1911


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Place of Burial or removal.


Winthrop"Winthrop Cem. "


Winthrop(Fort Banks)


Usual Residence


Sept.26 1911


Undertaker


Filed ..


Winthrop


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from 1911, to .. .1911, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows:


DATR


BUS. SIT DE Primary (Duration)


Poisoning by ill. gas


Birthplace. Quincy


LVJ.LAIJ BOSTONIA" CONDITA AL.


A).182


1830.


DONATA A.


.55.


TO


N. MA


Contributory : ( (Duration)


(Signed)


G.B.Magrath, Med. Ex.


M.D.


Informant.


17 C Skaggs


A true copy.


Attest .


EMMYlenen


Registrar.


80 REGI


Depl. 18, 1919


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


1 PLACE OF DEATH Wintheok (No. 35 Waldirman


Wundert (City or town.)


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


'FULL NAME Harriet anne Kenworthy


[If married or divorced woman or widow give maiden name, also name of husband.]


Harriet anne. Hangon Wife of Hubert


@RESIDENCE


35 Mulderman avenue


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


female


4 COLOR OR RACE


White


5 SINGLE


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


manil


6 DATE OF BIRTH


och


30


(Month)


(Day)


1870 (Year)


7 AGE


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


40


yrs.


11 mos. 12 ds.


or .min. ?


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


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


at home


9 BIRTHPLACE


(State or country)


Huddersfield England


10 NAME OF


FATHER


11 BIRTHPLACE OF FATHER (State or country)


12 MAIDEN NAME


OF MOTHER


13 BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Hubert Kenworthy


(Address) 35 Walderman Cie


REGISTRAR


16 DATE OF DEATH


Seff


/ (Month) 18 (Day)


191. (Year)


17


I HEREBY CERTIFY that I attended deceased from


191 .... . , to


Fely


Sett 18


1911 .


that | last saw h .........


alive on


Sift 18


. ,


191(.,


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


The CAUSE OF DEATH* was as follows :


acute Cardiac Dilatatieri


aufrationale yrs.


mos. ds.


Service labor


Contributory


(SECONDARY)


8 hours(duration)


(Signed)


Soft 20, 1911 (Address)


* 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.


ds.


State .


.. yrs.


In the


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


Left 20


191


1


....


20 UNDERTAKER


ADDRESS


mos


PARENTS


Filed .. 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 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 luborer, 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 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 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, 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 deathis 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.


:


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1911.


CITY OF BOSTON.


FULL NAME


Evelyn Ginepra


Registered No. 8896


Nass. Char. E.& E.Inf.


Place of Death ) Boston


and Residence S


Date of Death


1911.


Age


18


years


9


months.


27


days.


STATISTICAL DETAILS.


SEX F


COLOR W


SINGLE, MARRIED, WID., DIV.


S


Maiden Name


Husband's Name


Boston


CIT


Birthplace


Name of


Charles S. Ginepro 1830.


Father


ST


ONI MASS.


abscess ? Brain abscess, pur. Meningitis - 10 days


Birthplace


of Father.


Maiden Name Lyda Varney


of Mother .


Boston


Birthplace of Mother.


Occupation


Stenographer


Informant.


Place of Burial or removal.


Calvary


Undertaker


Porcella & Granara


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


1911,


from 1911, to that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows:


TRAR'S


PATRI


Rt. Otitis Media, supp.with


polypi-mastoiditis, etra-dural


CONDITA AL


1 .A. 182


Italy


Contributory : ) (Duration)


F.P.Emerson


(Signed) M.D.


.. 1911 ..


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Winthrop(135 Main st)


Usual Residence.


Sept.27


Filed


A true copy.


Attest :


ErMSlenen


1911


Registrar.


...


Sept.21


RIBUS SIT DEN Primary (Duration) RICE


CIVITA BOSTONIA"


-


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


(No .. 175 Somerset AM


Annie Kahier Gribbon


2 FULL NAME


Annie Napier Milne - James Gribbon


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 175 Somerset Avenue


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


white


Female


6 DATE OF BIRTH


7 AGE


8 OCCUPATION


PARENTS


WITTE PLAINLT, WITHT ONTAUING INK THIS IS A PERMANENT NECONU.


(b) General nature of industry,


business, or establishment


În


which employed (or employer)


-


(Month)


(Day)


1


(Year)


If LESS than


1


day ..... ... hrs.


84


„.yrs.


-


mos.


... ds.


or min. ?


(a) Trade, profession, or


particular kind of work


Home


9 BIRTHPLACE


(State or country)


Scotland


10 NAME OF


FATHER


Alexander Milne


11 BIRTHPLACE


OF FATHER


(State or country)


Scotland


12 MAIDEN NAME


OF MOTHER


Annie bowie


13 BIRTHPLACE


OF MOTHER


(State or country)


Scotland


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Mrs Edna M. Metcalf


(Address)


175 Somerset Avenue


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Sept


(Month)


(Day)


22 1911 (Year)


17


I HEREBY CERTIFY that I attended deceased from


Left. 20, 1911, to


191


that I fast saw her alive on


20, 1911.


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


79.m.


The CAUSE OF DEATH* was as follows :


Central Hervorhogy


1


(Duration)


yrs.


mos.


3


ds.


Contributory.


(SECONDARY)


Senility


(Duration) ..


.. yrs. ...


. mos.


ds.


M.D.


(Signed)


Lek. 2.2/191


(Address).


Minitrope


* if death followed injury or violence the certificate of death must be made gut 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


DATE OF BURIAL


19 PLACE OF BURIAL OR REMOVAL


St. Peters Hudson City Syd.


..


191


:0 UNDERTAKER


M.D. Kelly


ADDRESS


49 Maverick Sy


Ward)


..... ..


Winthrop BOSTON


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


Registered No.


Filed 191


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


medora


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: («) 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- Coul 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 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 neoplasmns) ; 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 bo 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


1 PLACE OF DEATH


Tinttrofo


(No. 55 Somerset Com.


268


(City or town.)


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


'FULL NAME. Rata Blake Stockbridge


[If married or divorced woman or widow give maiden name, also name of husband.] Kate B. Elwell.


@RESIDENCE


Heuttrop mass.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


married


6 DATE OF BIRTH Sept.




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