USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 71
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MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
Widow
OR DIVORCED
(Write the word)
6 DATE OF BIRTH
Seht
15
(Month)
(Day)
(Year)
7 AGE
If LESS than I day, ....... hrs.
78 yrs. .yrs.
7
mos.
16
ds.
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)
County Fermanagh tre
10 NAME OF
FATHER
Janus Cassidy
PARENTS
11 BIRTHPLACE OF FATHER (State or country)
tre
12 MAIDEN NAME OF MOTHER Mary Mc Gragh
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs. Manzo Loggins
(Address)
19 Freshour .It
REGISTRAR
16 DATE OF DEATH
July
Monthy
(Day) 1 192 (Year)
1833 17 I HEREBY CERTIFY that I attended deceased from
1912
to
July 12
1912
thatI last saw her alive on 1912 and that death occurred, on the date stated above, at . m.
The CAUSE OF DEATH* was as follows : -
General arba Lebasis
ambul Homorrhage.
(Duration)
2 yrs ..
... mos. ..
ds.
Contributory ... (SECONDARY)
(Duration) . yrs.
mos. .ds.
(Signed)
La 2ª
191 w (Address).
If doath 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
Holy Cross Cemetery
Malden
DATE OF BURIAL
July
3.
1912
TO UNDERTAKER
T & Goudey + Sou
ADDRESS
459 75 ding
Everett
Filed 191
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
St. ;....
Mary Mullen
Jeremiah Mullen
Registered No.
M. D.
July 1, 1912
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative hcalthfulness of various pursuits can be known. The question applies to each and overy person, irrespective of age. For many occupations a single word or term on tho first line will bo sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engincer, 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 wlien 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 sccond 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 ongaged in domestic servico 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 ('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-
I
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: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mcre 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 septicacmiu," " PUERPERAL peritonitis," etc. Stato cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under tho 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 PLACE OF DEATH 3 SEX 6 DATE OF BIRTH 7 AGE & OCCUPATION (a) Trade, profession, or particular kind of work PARENTS 13 BIRTHPLACE OF MOTHER (State or country) important. See instructions on back of certificate. 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
(No.
Emma.
Cordelia Harro
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
4 Metales el.
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Manuel
(Month)
(Day)
If LESS than i day, .. . hrs.
65 , 9 mos. . 久子 ds.
or ....... min. ?
9 BIRTHPLACE
(State or country)
Chelsea Macer
2
10 NAME OF
FATHER
Was R. Parman
11 BIRTHPLACE OF FATHER (State or country) Budge Work Such
12 MAIDEN NAME OF MOTHER Cordelia M. Som
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) ...
S.B. Para
388 Bincon EL dolor- Wurdemaria
(Address)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
July 2
(Month)
(Day)
(Year)
I HEREBY CERTIFY that I attended deceased from
2M
1912, to.
, 191.2.0
that | last saw h
alive on
, 191. 2
1. 3 0mai
and that death occurred, on the date stated above, at.
The CAUSE OF DEATH* was as follows :
General antonio Delevazio
(Ducation)
yrs. .
/ .. mos. .
ds.
Contributory.
Cerebral Jaumontial
(SECONDARY)
( Duration) yrs.
mos. .
2 de
Biroul call
, 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 REGENT RESIDENTS).
St place
of death ..
yrs. .
mos.
In the
Where was disease contracted,
If not at place of death ?.
Cutting PL Hotel
mos.
ds .... .
Former or
usual residence
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
6
, 191
2
ADDRESS
20 UNDERTAKER
GR. Bennem
Filed 191
6 1846 (Year)
(City or town.)
(Signed)
July 4, 1912
(Address)
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 1 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 "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia, Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, otc., 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- nemia " (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, ctc.
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 PARENTS important. See instructions on back of certificate.
N. B. - Every item of Information should be carefuly supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
11
6 DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE
54 yrs. 11
mos. .
3℃
ds.
or ....... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
At Home
Home
(b) General nature of industry. business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country)
1
10 NAME OF
FATHER
ila
11 BIRTHPLACE OF FATHER (State or country)
1? MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
16
Filed.
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
2
. 19|
(Day) ,
(Year)
I HEREBY CERTIFY that I attended deceased from mch 1912, to 191.2,
If LESS than I day, . hrs. that | last saw h 4 alive on. .
7
, 1912
and that death occurred, on the date stated above, at. 610am
The CAUSE OF DEATH* was as follows :
Cerebral Humourhage
. (Duration)
yrs. .
2
mos. .
ds.
Contributory.
(SECONDARY)
. (Dyration) yrs.
mos ..
„ds.
(Signed)
318mi/call
191 ... 2 (Address)
winthrop
*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.
DATE OF BURIAL
191
20 UNDERTAKER
ADDRESS
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
St. ;..
Ward)
eld.
(City or town.)
1 PLACE OF DEATH
... .....
(No.
149
(
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 149 tocut
4 COLOR OR RACE
5 SINGLE,
MARRIED
WIDOWED
OR DIVORCED
(Write the word)
15 DATE OF DEATH
Jul
(Month)
8
17
1
M.D.
In the
19 PLACE OF BURIAL OR REMOVAL / Winthrop DEmetaux.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
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, Architeet, 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, peritonaeum, etc., Carcinoma, Sar- coma, etc., of ..... .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," " Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," " Exhaustion," "Heart failure," " Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," " Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septieaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident ; Revolver wound of head-homicide ; Poisoned by carbolic acid - prob- ably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."
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.
I PLACE OF DEATH Chelsea 3 SEX Male 6 DATE OF BIRTH 7 AGE 78 & OCCUPATION particular kind of work 9 BIRTHPLACE (State or country) 10 NAME OF FATHER 12 MAIDEN NAME OF MOTHER PARENTS 18 BIRTHPLACE OF MOTHER (State or country) (Address) 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. Filed N B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state which employed (or employer)
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(No ....... Frost Hospital
.St.
........
.Ward)
2 FULL NAME
Byram.
Edward R.
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop, 90 Atlantic St.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
Aug.
26 .......
1863 ...
(Month)
(Day) (Year)
If LESS than
(a) Trade, profession, or
Retired Dramatic
Editor
(b) General nature of industry,
business, or establishment
n Theatre L'anager
Boston, Mess.
Henry
11 BIRTHPLACE OF FATHER (State or country) Portland, Mo.
Lucretia Loring
Last Yarmouth, L'e.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
C .R.Bennison
Winthrop,
Lass.
July 13 191 ......
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
191.
, to.
191
I day ....... hrs. that I last saw ha alive on 191 and that death occurred, on the date stated above, at. .. m. The CAUSE OF DEATH* was as follows : Multiple injuries following.
accidental fall down stairs
(Duration) ...
yrs. .......
mos.
.ds.
Contributory (SECONDARY)
(Duration)
.. yrs.
mos. ds.
(Signed)
W.H.Watters
M.D.
July 12, 192 (Address) Medical Examiner
....
* If death followed injury or violence tho certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
.. yrs.
.. mos.
ds.
State.
.yrs.
In the
mos. ..
ds .............
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL Winthrop, Mass.
DATE OF BURIAL
July 14
191
2
........
20 UNDERTAKER
C.R.Bennison
ADDRESS
Winthrop
CHELSEA (City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No. 373
16 DATE OF DEATH
(Month)
July
11 ,., 1912
(Year)
(Day)
yrs.
11
mos.
14
ds.
or ........ min. ?
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 taborer, 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.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH 119 Rever SI ... (No ...
Samuel
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Com
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Mala
4 COLOR OR RACE
white
¿ SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Manuel
6 DATE OF BIRTH
(Month)
(Day)
(Year)
If LESS than I day, hrs.
yrs. . . mos.
ds.
or ..... .min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Retireat
(b) General nature of industry, business, or establishment in which employed (or employer)
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