Town of Winthrop : Record of Deaths 1910-1912, Part 66

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 66


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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important. See instructions on back of certificate.


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Plympton Mas


12 MAIDEN NAME


OF MOTHER


Sophia . E. Curtis


13 BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant) ..


(Address)


Whichet man


1 &


Filed ... 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


3.1


(Month)


(Day)


, 1912


(Year)


17


I HEREBY CERTIFY that I attended deceased from


(Year)


May 2


1912, to


may 2


, 1912


that | last saw h. ... alive on


may 2


, 19|2,


and that death occurred, on the date stated above, at /2 am.


The CAUSE OF DEATH* was as follows :


Cerebral Harmonlage


9hours(Ducation)


mos. US


Contributory ..


arterio releases


(SECONDARY)


decevaQuestion) .


yrs.


x


mos.


X


.ds.


(Signed)


DEfolman


M.D.


May 4, 1912 (Address)


Winterap


* 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


12 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Elmy S. 1912


.0 UNDERTAKER


ADDRESS


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


wordor


(Write the word)


6 DATE OF BIRTH


(Month) (Day)


7 AGE


53


yrs. mos. ds.


or .... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


at home


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH wochenof .(No .... 60 dea View carl St. ;..


(City or town.)


2 FULL NAME arvilla .


[If married or divorced woman or widow give maiden name, also name of husband.] Widow of albert. T. Bryant @RESIDENCE 60 Lem Veio die


Ward)


If LESS than


I day, ... hrs.


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


9 BIRTHPLACE


(State or country)


Plympton mars


10 NAME OF


FATHER


James. S. Bonney


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, 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 : Meusles (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.


3 SEX 6 DATE OF BIRTH 7 AGE 8 OCCUPATION 9 BIRTHPLACE (State or country) PARENTS important. See instructions on back of certificate. 16 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 17


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH gulhop (No ... 177. Pauline St. ;.. ..


(City or town.)


Ward)


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


Mithan & Bake.


2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 177 Paulina St. Winthrop


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


in


12 (Month)


23


, 1884


,


(Year)


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


5 ms.


11


ds.


of


min. ?


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


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


10 NAME OF


FATHER


arthur L.


11 BIRTHPLACE OF FATHER (State or country) Dux bay mars


12 MAIDEN NAME OF MOTHER Barkley- agnes


13 BIRTHPLACE OF MOTHER (State or country) Louie Doal Eng.


H THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


arthur k. Baker


(Address)


177 Parlics),


Filed 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


1 HEREBY CERTIFY that I attended deceased from


Jan, 31, 1912,


to


, 191.2. that I last saw halive on 4 . 1912 and that death occurred, on the date stated above, at//00 A m. The CAUSE OF DEATH* was as, follows : Exhaustion following Right leren abban Primamin.


.(Duration)


yrs.


mos.


16.


ds.


Contributory ..


(SECONDARY)


(Duration) .


yrs.


mos.


19


ds.


(Signed)


Quando Sille M.D.


f1912 (Address) IS Presenteen St


* 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


DATE OF BURIAL


5- 7- 1912


:0 UNDERTAKER


ADDRESS


IS. Skaggs Skullede


-


1912


(Year)


(Day)


4


4


1 (Month)


Registered No.


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Single


(Day)


may 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 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, 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 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) ; Meusles; 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 dcad, 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.


PARENTS


12 MAIDEN NAME OF MOTHER Exacto H. Kenly


13 BIRTHPLACE OF MOTHER (State or country)


Nova Scotia


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


S. M. Lardan


(Address)


Filed .. ., 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH May 8


(Month)


(Day)


1912


(Year)


I HEREBY CERTIFY that I attended deceased from


191.


., to


., 1912.


IT day . hrs. that I last saw h alive on. , 191


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


1120


m.


The CAUSE OF DEATH* was as follows :


Still Com


medutal to Birth


.(Duration)


yrs.


mos.


ds.


Contributory. (SECONDARY)


(Duration)


mos. . ds.


(Signed)


, M.D.


191- ( Address)


wanthop


* 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


12 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL Munchenof Comedy-May 11. 1912


DO UNDERTAKER


ADDRESS


(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


1


Single


6 DATE OF BIRTH may (Month)


(Day)


(Year)


7 AGE


If LESS than


5 months 2 yrs.


> mos. X 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).


2 BIRTHPLACE


(State or country)


Machento Mars


10 NAME OF


FATHER


Elmer Enfield Stanley


11 BIRTHPLACE OF FATHER (State or country)


Lewiston me


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


(No.


Stanley


2 FULL NAME


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


St. ;...


Ward)


3 SEX


Mali


4 COLOR OR RACE


white


5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (Write the word)


12/C


17


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 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, 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 : Meusles (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 septicemia," " 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.


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Holden Mars


12 MAIDEN NAME OF MOTHER Edith y Coltes


13 BIRTHPLACE OF MOTHER (State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Rocco 19, Kaily


1


(Address)


158 Highlandcom


Filed_ 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


w


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


gle


6 DATE OF BIRTH


5 (Month)


16


1912


17


(Year)


7 AGE


If LESS than I day, ... ... hrs. that | last saw h. alive on


, 191.


or ......


.min. ?


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


m.


The CAUSE OF DEATH* was as follows : Placenta farina Instrumental delivery born deal-


.(Duration)


yrs.


mos. .


ds.


Contributory ... (SECONDARY)


(Signed)


Mary


(Duration)


E. mester


mos.


ds


yrs.


M.D.


may 16


. 1912 (Address)


"The warren" legs


* 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 dlsease contracted,


If not at place of death ?


Former or usual residence


12 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


уме, породии 5-18


, 1912


ADDRESS


50 UNDERTAKER


M.C. Fica490


Ward)


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


2 FULL NAME


Baby Bailey


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


126 38 Highland Diz Huthiop


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


.(Nok


158 Highland Cvs


(City or town.)


16 DATE OF DEATH


5


(Month)


16 (Day)


. 1912


(Year)


I HEREBY CERTIFY that I attended deceased from


Ofer May 6, 1912, to Tway 16


, 1912


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) ,


Fruttuops Mass


10 NAME OF


FATHER


Rosco. B. Bailes


yrs. mos. -- ds.


(Day)


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. 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 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 110 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 "Cronp") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia, Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaoum, 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 cansing 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," " Uremia," "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, Fulls, 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.


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


Winthrop


(No. 332 Pleasant


St. :


....... Ward)


BOSTON


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


2FULL NAME


Leslis Atherton Spinney


[If married or divorced woman or widow give maiden name, also name of husband.] aRESIDENCE 332 Pleasant St. Winthrop Mass,


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


, SEX


May


4 COLOR OR RACE


What


5 SINGLE,


MARRIED,


WIDOWED.




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