Town of Winthrop : Record of Deaths 1910-1912, Part 43

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 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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