Town of Winthrop : Record of Deaths 1910-1912, Part 70

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 70


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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2 FULL NAME


Weit Prank P.


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


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Mele


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED Widowed


(Write the word)


6 DATE OF BIRTH


November .......


(Month)


18 ..... 844.


(Day) (Year)"


7 AGE


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


67


yrs.


7


mos.


2


ds.


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


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Leson


(b) General nature of industry,


business, or establishment in


which employed (or employar).


9 BIRTHPLACE


(State or country)


Boston Nass.


10 NAME OF


FATHER


Thomas hait


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Lass.


12 MAIDEN NAME


OF MOTHER


Elizabeth Fessenden


18 BIRTHPLACE


OF MOTHER


(State or country)


Mass.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


File June 2.2. 198 5.


REGISTRAR


16 DATE OF DEATH


June 20 1912


(Month)


(Day)


(Year)


17 I HEREBY CERTIFY that I attended deceased from


April ........... , 191 ... 2, to


June.20


191.2.


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


June 20


and that death occurred, on the date stated above, at2 ... 20 m.


The CAUSE OF DEATH* was as follows :


Arterio sclerosis


(Duration)


SeVyrs.


-


mos.


-


ds.


Contributory


-


(SECONDARY)


(Duration)


.yrs.


mos.


ds.


(Signed)


George H Layfield


M.D.


June 20, 1912 (Address)


Chelsea


* 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 7


of daath


2 mos. 19 ds.


In the


State


.. yrs.


mos.


ds.


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


Former or


usual residence.


Tinthrop .....


19 PLACE OF BURIAL OR REMOVAL Forest Hills


DATE OF BURIAL


June 24 . 1912 ...


20 UNDERTAKER


E.B. Douglass & Son


ADDRESS


Chelsea


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.


CHELSEA (City or town.)


1


....


Registered No.


330


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," " Manager,""Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.


Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal 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., C'arcinoma, Sar- coma, etc., of .. .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," " Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


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


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


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


(No. 412 Shirley


St.


Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


41


4 COLOR OR RACE


Ethiopian


5 SINGLE,


MARRIED, L.


WIDOWED,


OR DIVORCED


(Write the word)


laurel


1


(Year)


7 AGE


about 75


yrs.


mos.


ds.


or .. min. ?


(a) Trade, profession, or


particular kind of work


at home


house


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


9 BIRTHPLACE


(State or country)


91. @


10 NAME OF


FATHER


Нашу Вины


PARENTS


12 MAIDEN NAME OF MOTHER


13 BIRTHPLACE


OF MOTHER


(State or country)


1


1


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant).


Samuel Perfino


(Address)


1 6


Filed ... 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


June


26, 92


(Month)


(Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from 7 The 1912 to Mene


Neue


If LESS than


day, .


hrs.


that I last saw het alive on


242


, 1912.


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


4P. m.


The CAUSE OF DEATH* was as follows :


tecreveal itsem a charge


.(Duration)


yrs. .


mos.


ds.


Contributory ..


(SECONDARY)


(Duration)


yrs.


mos. .


ds


(Signed)


. M.D.


2 , 191 .4 (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.


mos.


ds ..


Where was disease contracted,


if not at place of death ?..


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL huit Hope.


DATE OF BURIAL


6-30


1912


0 UNDERTAKER Samuel Pertura


ADDRESS 16 sha -runt CyTT


N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state


(City or town.)


2 FULL NAME


ankary yancey.


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


6 DATE OF BIRTH


(Month)


(Day)


$ OCCUPATION


11 BIRTHPLACE OF FATHER (State or country)


In the


4


June 261912


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 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, peritoneum, etc., Carcinoma, Sar- comu, 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 canse 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.


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


Winthrop (No .... 22 Plummer Street


.St. ;......... .Ward)


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


2 FULL NAME Kate F. Harper


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


Kate F. Henderson wife of Thomas E.


....


@RESIDENCE


22 Plummer St Winthrop.


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX female


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED, married.


OR DIVORCED


(Write the word)


16 DATE OF DEATH


June 29 1912 .


(Month)


(Day)


191


(Year)


6 DATE OF BIRTH


(Month) (Day)


I


(Year)


7 AGE


If LESS than


1 day, ........ hrs.


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


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


Housewife


(b) General nature of industry,


business, or establishment in


which employed (or employer).


Cerebral Harmonlage


(Duration)


......... yrs.


mos.


3


ds.


9 BIRTHPLACE


(State or country)


Carver Mass


10 NAME OF


FATHER


George Henderson


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


unk N.Y.


12 MAIDEN NAME


OF MOTHER


Mary A. unknown


13 BIRTHPLACE


OF MOTHER


(State or country)


unk N.Y.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Grace O. Glidden


(Address)


REGISTRAR


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 Mt. Hope Cem Boston.


DATE OF BURIAL


July 2


.,


191


.....


20 UNDERTAKER,


ADDRESS


Filed 191


Contributory


(SECONDARY)


(Duration) ................ yrs.


mos.


....... .ds.


(Signed)


Edward & Granger


M.D.


July 1


1912 (Address).


Winthrop


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


17


I HEREBY CERTIFY that I attended deceased from


June 26


1912, to


June 29


........


that I last saw her alive on


Jahre 29


1912,


and that death occurred, on the date stated above, at 6 Pm.


about


The CAUSE OF DEATH* was as follows :


1912


55


.. yrs. mos. ............. ds.


......


guns


29, 1912


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 tho business or industry, and therefore an additional line is provided for tho 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 laborcr, 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 Ilousewifc, Houscwork, 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 neod 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 " (mcrely 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 violonce, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violenco, 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


(No .. 31. Protect an


St. ;...


Ward)


[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


Muti


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Marie


6 DATE OF BIRTH


Dec


(Month)


(Day)


(Year)


7 AGE


If LESS than


day ,


hrs.


73


yrs.


6


mos.


13


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)


Compton Quebra


PARENTS


12 MAIDEN NAME OF MOTHER Lucy Leonard


12 BIRTHPLACE


OF MOTHER


(State or country)


Canada


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


June 30


(Month)


(Day)


,1912


(Year)


I HEREBY CERTIFY that I attended deceased from


June 25


1912


Juneso, 1912.


that I last saw her alive on


June 29


., 1912


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


The CAUSE OF DEATH* was as follows :


Branche - pneumonia


(Duration)


yrs. .


(SECONDARY)


mos. .


2 ds.


Contributory a Equipape


(Duration) . .


yrs.


mos.


6


ds.


(Signed)


Tr.J. Varen


M.D.


Jeely 1., 198 (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


DATE OF BURIAL


.


1912


30 UNDERTAKER


ADDRESS


Filed .. . 191.


(City or town.)


2 FULL NAME .. Thomas


Lanard


Buce


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 31 Protect are


17


.838


17


-


10 NAME OF


FATHER


James


11 BIRTHPLACE OF FATHER (State or country) Canadal


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative, healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement ; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," " Foreman," " Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal 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- eoma, etc., of .. .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough ; Chronic 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 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.


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.


1 PLACE OF DEATH


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH (No. 19 Frémont


Winthrop


Ward)


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


2 FULL NAME


[If married or divorced woman or widow give maiden name, also name of busband(1/ Mary Cassidy


@RESIDENCE


19 Fremont ST.


PERSONAL AND STATISTICAL PARTICULARS




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