USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 43
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(Month)
23- (Day)
1858
(Year)
7 AGE
If LESS than
1 day ... hrs.
or ... . min. ?
8 OCCUPATION
(a)' Trade, profession, or
particular kind of work.
at home.
(b) General nature of industry, business, or establishment in which employed ( or employer).
9 BIRTHPLACE
(State or country)
Gloucester. Mass.
10 NAME OF
FATHER
andrew Elwell.
PARENTS
12 MAIDEN NAME
OF MOTHER
Mary ann Daniels.
13 BIRTHPLACE OF MOTHER (State or country)
Salem. mass.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
I.S. Stockbridge
(Address)
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Sept
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Sipt ar
191) ., to
Sig125
., 191 ).,
that I last saw h MU alive on
Sagt 25
, 191 )
and that death occurred, on the date stated above, at .
The CAUSE OF DEATH* was as follows : Pneumonia
(Duration) Empyania E operation
.yrs. . . mos. 14 ds.
Contributory ..
(SECONDARY)
3 ds.
(Signed)
Sejt25"
191
1.
(Address)
(Duration) mos. (31 that call , M.D.
* If death followed injury or violence the certificate of death must be made Opat by the Medical Examiner.
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
Rowley, Mass.
DATE OF BURIAL
Jeff. 27, 191/
20 UNDERTAKER U.V. Sanborn.
ADDRESS
Rivers Man
Ward)
a.J. Stockbridge
Registered No.
25 1911
53 yrs. - mos. 2 ds .
11 BIRTHPLACE
OF FATHER
(State or country)
Poucester. Ma
3
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 specifieation, 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 Serrant, 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 ('AUSING 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, peritonacum, etc., Carcinoma, Sur- 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 deud, etc.
3 SEX male 6 DATE OF BIRTH 7 AGE PARENTS 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 (b) General nature of industry business, or establishment in which employed (or employer)
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop (No 97 Locust
Charles To Whittle 2FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband. L @RESIDENCE Prfocust St. Hinttrofe.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
6 (Month)
26
(Day)
182× 17
(Year)
or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
Interior Stora Fixtures
Infar. of Show cased
) BIRTHPLACE
(State or country)
Charlestown Mars
10 NAME OF
FATHER
John Whittle
11 BIRTHPLACE OF FATHER (Stato or country) Iralfsfor NH.
12 MAIDEN NAME
OF MOTHER
ucis Stevens.
13 BIRTHPLACE OF MOTHER (State or conntry) Watertown Mag
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
albert 13, Whittle
12903. Sa Hill St Duates
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH Cet Z
11
(Month)
(Day)
191
(Year)
I HEREBY CERTIFY that I attended deceased from
aug 30
19111
to
191L.,
that I last saw him alive on
6
1911
and that death occurred, on the dato stated above, at.
6.38m.A.M.
The CAUSE OF DEATH* was as follows :
the o carditis
Endocarditis
Endocarditisda yes.
Lattes- 2 (Duration).
.. yrs.
mos.
ds.
Contributory
Old cafe and munition
(SECONDARY)
( Duration )
.yrs,
mos.
.ds.
(Signed)
sexy
1911 (Address).
1084 Boglatin Vor
M.D.
* 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
..........
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
Oct. 10.
191/
ADDRESS
40 UNDERTAKER
I.C. Skad90
1911-10- 1841-6-26
BOSTON 70-3 -11 (City or town.)
St. :
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
If LESS than
I day ......... hrs.
70 yrs.
3 mos.
11 ds
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, irrespectivo 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, Laborcr - 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 tho 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- 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 discases 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 bo referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deathis 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 strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
854801
1
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) P.E.S.
12 MAIDEN NAME OF MOTHER Marguerite Eachen
13 BIRTHPLACE OF MOTHER (State or country) P.S. g.
11 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Hw. H. Livingstone
(Address)
97 Lincalu SR,
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
W
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1963 Gy
(Month)
"Day)
.. ,
(Year)
7 AGE
If LESS than
1 day, ....... hrs.
48 .yrs.
mos. 2/ ds. or ....... min ?
8 OCCUPATION
(a) Trade, profession, or
particuler kind of work
Housewife
(b) General nature of industry. business, or establishment in which employed (or employer)
17
I HEREBY CERTIFY that I attended deceased from
July
1911
.. , to
out ye
1911
that | last saw her
alive on
191 1 ..... ,
and that death occurred, on the date stated above, at
5 pm.
The CAUSE OF DEATH* was as follows :
Splene Leucemia
.(Duration) ..
yrs.
mos.
ds.
Contributory (SECONDARY)
(Signed)
.(Duration)
yrs. .
Bi Motaall
mos.
. ds.
M.D.
ort 8"
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.
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 Hunthrop Cen
DATE OF BURIAL
10 10, 19V
ADDRESS
20 UNDERTAKER
9h. C. Spc a qqs grutheop.
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME annie E. Livingstone
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 92 Lincol
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No.
92 Liucolur
St. :
96-1
Ward)
1911
(Month)
(Day)
191
(Year)
16 DATE OF BIRTH
9
to
16 7
16 DATE OF DEATH
vet 71
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
Filed ., 191
9 BIRTHPLACE
(State or country)
PE.g.
10 NAME OF
FATHER
qual Mcpherson
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 necded. As cxamples: (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- kcepers 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 ('AUSING 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 "'AUSING 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," " All- aemia " (merely symptomatic), " Atrophy," "Collapsc," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," " Inanition," " Marasmus," " Old age," "Shock," " Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirthi 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
Chelsea
(No. Frost Hospital
St. :.
Ward)
CHELSEA (City or town.)
{If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Katherine Agnes Doherty.
[If married or divorced woman or widow give maiden name, also name of husband.] Katherine Agnes Sullivan - Thomas F. Doherty
@RESIDENCE
129 Main St., Winthrop, Mass.
Registered No. 636
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED Widowed
(Write the word)
16 DATE OF DEATH
October
12
(Month)
(Day)
(Year)
6 DATE OF BIRTH
January
28
1878
(Year)
(Month)
(Day)
7 AGE
33
.yrs.
8
mos.
17
ds.
or ........ min. ?
S OCCUPATION
(a) Trade, profession, or
particular kind of work
At Home
(b) General nature of industry, business, or establishment in which employed (or employer)
--
9 BIRTHPLACE
(State or country)
Boston, Mass.
10 NAME OF
FATHER
Patrick Sullivan
PARENTS
12 MAIDEN NAME
OF MOTHER
Mary A. Cotter
13 BIRTHPLACE OF MOTHER (State or country) Boston, Mass.
11 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
--
(Address)
Filed. Oct.13 1 191
REGISTRAR
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
yrs.
mos.
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, Malden
DATE OF BURIAL
Oct.15
191
1
:0 UNDERTAKER
Fred'k A. Magrath
ADDRESS
East Boston
mos.
2
ds.
Contributory
(SECONDARY)
(Duration)
.yrs.
mos. ds.
(Signed)
F. E. Bragdon
1
M.D.
Oct. 12
191
(Address)
East Boston
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
(Duration)
yrs.
19| 1
17
I HEREBY CERTIFY that I attended deceased from
Oct. 9
., 1911 to
Oct. 12
that [ last saw h .... @T alive on.
Oct. 12
1911
and that death occurred, on the date stated above, at.
2 Pm.
If LESS than
I day ......... hrs.
The CAUSE OF DEATH* was as follows : Thrombosis of Pulmonary
Vein following appendicitis
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland
In the
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. Bnt 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 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 ou 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 Nonc.
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: Cercbro-spinal fcver (the only definite synonym is " Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Cronp") ; 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," " All- 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. -
1
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop (No 34 Dalphim .. St. ; Ward)
'FULL NAME
Charlotte M. Scanlon
[If married or divorced woman or widow give maiden name, also name of husband.] Charlotte M. Wilson
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
@RESIDENCE
3 SEX
female
7 AGE
35
10 NAME OF
FATHER
Wm
PARENTS
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
(b) General nature of industry,
business, or establishment in
which employed (or employer)
important. See instructions on back of certificate.
' COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
married
OR DIVORCED
(Write the word)
1
(Year)
If LESS than
| day, .. ... hrs.
yrs. mos.
ds.
or ....... min. ?
8 OCCUPATION
(a)' Trade, profession, or
particular kind of work
Housewife
9 BIRTHPLACE
(State or country)
Boston Mass.
J. Wilson
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