Town of Winthrop : Record of Deaths 1910-1912, Part 71

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 71


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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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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