Town of Winthrop : Record of Deaths 1910-1912, Part 8

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 8


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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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 onc supposed to be due to Alcoholism, etc.


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


THE COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


Registered No.


Date of ¿


Death S


Jul 3


19/0


Death *


Residence 11


€ 1


Age 67 years


months .. 2/ .days


STATISTICAL DETAILS


SEX Female


COLOR Perfeita


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME t


HUSBAND'S NAME t


BIRTHPLACE # Dorchester illard


NAME OF FATHER


BIRTHPLACE


OF FATHER $


MAIDEN NAME OF MOTHER


BIRTHPLACE OF MOTHER $


OCCUPATION


INFORMANT §


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from 190 Y to.


July 3 .. 19/0 , that to the best of my knowledge and behef death occurred on the date stated above, and that the CAUSE OF DEATH was as follows:


Primary :


several weeks)


(DURATION).


Contributory :


yra


(DURATION) .. ... DAYS


(Signed)


M.D.


July 4.1900 (Address)


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


How long at Place of Death ? . years.


.months.


....... . days


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


Filed


.... 19


Clerk


PLACE OF BURIAL OR REMOVAL 1


Forest Hills


Concation


DATE OF BURIAL


7-4


19 0


UNDERTAKER


-


4


ADDRESS


Coinentra MI


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.


t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.


§ Name and address of person giving statistical details. il Name of cemetery.


ALL NAMES TO BE IN FULL


FULL NAME


Place of l


59 Sarah Elizabeth Hood July 3, 1910


THE COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME


Warner. a. march


Registered No.


Date of l


June 10th


19 / 0


Death S


Residence


109 Johnson an


Age.


69


.. years


.. months ..


22 .days


STATISTICAL DETAILS


SEX


mali


COLOR


White


SINGLE, MARRIED, WIDOWED, OR DIVORCED


marked


MAIDEN NAME Ť


HUSBAND'S NAME Ť


BIRTHPLACE $


Gotrain Maso


NAME OF FATHER Philo March


BIRTHPLACE OF FATHER $ Roue Mass


MAIDEN NAME


OF MOTHER


Cumin nelson


BIRTHPLACE


OF MOTHER $


Rowe Mais


OCCUPATION


INFORMANT §


Son &


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from to .. Jen 2 19/ 0 nl 10 .19 /0, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :


Primary :


acute suppression of wine


uraemia


(DURATION)


3


DAYS


Contributory :


fracture of hip (accidental)


slipped and fell out tile / floor .


(DURATION).


7


DAY8


(Signed)


M.D.


2 1910 (Address)


worthof mass


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


How long at Place of Death ? .. years ... .................... months. ....


........ days


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


Filed


19


Clerk


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


7/12 1916


11


UNDERTAKER B . R Némuson


ADDRESS 1 Wundert


* Clty or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give its NAME instead of street and number.


t In case of married or divorced woman, or widow.


# State or country; also city, town or county, If known.


§ Name and address of person giving statistical detalls. Il Name of cemetery.


ALL NAMES TO BE IN FULL


Warthnot (


(CITY OR TOWN.)


Place of l


101 Johnson Com


Death *


60 Warner 9. March July 10 , 1910


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 of country)


Ireland


12 MAIDEN NAME MEJarah Gilman


13 BIRTHPLACE


OF MOTHER


(State or country)


Ireland


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Margaret, Cochran


(Address) 437 Winttrofe St. 12 intlunch


16


Filed. 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


3 SEX


Female


4 COLOR OR RACE


White


6 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widow


6 DATE OF BIRTH


(Month)


(Day)


(Year)


7 AGE


If LESS than


I day ........


hrs.


79 yrs. mos. ds.


or


min. ?


8 OCCUPATION


Home


(a) Trede, profession, or


particular kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer)


9 BIRTHPLACE


(State or country)


Ireland


(Duretion)


.yrs.


mos.


ds.


Contributory


(SECONDARY)


(Duration) yrs.


mos. ds.


315 miliard


.,


M.D.


(Signed)


July 13, 1910 (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


In the


yrs.


mos.


ds.


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


Former or usual residence.


1 PLACE OF BURIAL OR REMOVAL St. John N.B.


DATE OF BURIAL


time 14.


1910


20 UNDERTAKER


This. I. Lame


ADDRESS


120 Havre Lt


E. Bustina


1


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


I PLACE OF DEATH Winthrop Mass (No 437. Winthrop -


St. ;


Ward)


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


'FULL NAME


Catherine


Minchan


[If married or divorced woman or widow give maiden name, also name of husband.] Widow of michael new Hurley aRESIDENCE 437 Winthrop St. Winthrop Maso.


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


16 DATE OF DEATH


(Month)


(Day)


July


12-


1910


191.


(Year)


17


I HEREBY CERTIFY that I attended deceased from


1908


191


., to


July 12


., 191.0.


that l last saw h


alive on


Que 30


191. 0,


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


m. The CAUSE OF DEATH* was as follows : oldage General debility


10 NAME OF


FATHER


Randall Hurley


Winthrop BOSTON (City or town.)


July 12, 1910


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 evory 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 usc of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonacum, etc., Carcinoma, 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.


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


Mathoh BOSTON (City or town.)


1 PLACE OF DEATH. Minthof (No 95 Beach Rd St. :


Jack Joseph Hennessy. 'FULL NAME


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Inale


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH abril 28


(Month)


(Day)


(Year)


7 AGE


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


yrs. 2 mos. . 16 ds.


or


min. ?


8 OCCUPATION


(a)' Trade, profession, or


particular kind of work


General Contractor


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


9 BIRTHPLACE


(State or country)


10 NAME OF


FATHER


William Hennessy


11 BIRTHPLACE OF FATHER (State or country)


New York


12 MAIDEN NAME OF MOTHER Blanche In Green


13 BIRTHPLACE OF MOTHER (State or country)


Boston Mass


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


16


Filed .. 191.


REGISTRAR


16 DATE OF DEATH


Jeely


14, 1910


(Month)


(Day)


(Year)"


1910


17


I HEREBY CERTIFY that I attended deceased from


July 14


, 1910, to


Perly 14, 199,


that I last saw he alive on


-


genety 14 , 191,0 and that death occurred, on the date stated above, at - m. The CAUSE OF DEATH* was as follows : Manasmine


.(Duretion) . -


yrs.


1


mos.


ds.


Contributory


(SECONDARY)


(Duration)


. . yrs. .


mos. . .ds.


(Signed) .


July 14, 1910 (Address).


Minitrop Tard,


* 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 deeth


.. 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 Dorchester


DATE OF BURIAL


July 12, 1910


20 UNDERTAKER


John & Omaley


ADDRESS


79 Atlantic St


M.D.


PARENTS


Ward)


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


July 14, 1:10


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 laborcr, 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, 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 discasc; 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, 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.


THE COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Henry hoal Frotter


Registered No.


Place of


173 Pauline St Hintheo


Date of


Death


July 16 .19/0


Residence


Age


... years ..


F.months.


... days


STATISTICAL DETAILS


SEX


COLOR


SINGLE, MARRIED, WIDOWED, OR - DIVORCED


MAIDEN NAME +


HUSBAND'S NAME t


BIRTHPLACE $


NAME OF FATHER


Atury Trotter


BIRTHPLACE


OF FATHER $


Liverpool Oug.


MAIDEN NAME


OF MOTHER


Ida Ray-


BIRTHPLACE OF MOTHER $ Staffordshire Eng.


OCCUPATION


INFORMANT §


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from. June 22 19/0 to July 16 1910, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Patent Foramen Quale


(DURATION).


2.5.DAYS


Contributory :


(DURATION) .......... DAY8


(Signed).


DEjahuran


M.D.


July 17 1910


(Address)


SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.


How long at Place of Death ? .. years ...


... months. ...... days


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


Filed


.19


Clerk


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


Warsthofer. Com


July 17-1910


ADDRESS


UNDERTAKER I. C. Slag.go


Columbia A7


* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclai Information." If in a Hospital or Institution, give Its NAME instead of street and number.


t In case of married or divorced woman, or widow.


# State or country; also city, town or county, If known.


§ Name and address of person giving statistical detalls. Il Name of cemetery.


ALL NAMES TO BE IN FULL


Death *


S


0


July 16, 1910


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Dedham


wir Charles River


St. :


Ward)


Dedham


(City or town.)


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


2 FULL NAME


walter Wade Battis Ir


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


95 Herman St Winthrop mass


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


male


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Singles


16 DATE OF DEATH


July 1%


(Month)


(Day)


(Year)


6 DATE OF BIRTH


november


18


(Month)


(Day)


(Year)


7 AGE


If LESS than


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


22


yrs.


7.


.mos.


29


or ... ... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


million any salesman


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


(Duration)


.. yrs.


mos.


ds.


Contributory (SECONDARY)


(Duration)


.. yrs.


mos.


ds.


Jolie Pratt


M.D.


examiner


Delleam mass


* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or GHOMICIDAL.


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 Cemetery Wintherof mass 20 UNDERTAKER Smitte + Haiggnie 89 multon Str. ADDRESS


DATE OF BURIAL Admiral July 17. 1910


Declam man


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) East Boston mass Suffolk


12 MAIDEN NAME OF MOTHER mary Elizabeth Dunbar


13 BIRTHPLACE OF MOTHER (State or country}


East Bostin mass Suffolk,


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


C. R. Bennison


(Address)


Wiritlerof mars


15


Filed July 27, 1910


REGISTRAR


17 HEREBY CERTIFY that I have investigated the death of the deceased.


The CAUSE OF DEATH* was as follows :


Drowning accident


9 BIRTHPLACE


(State or country)


East Boston maso Suffolk Of


10 NAME OF


FATHER


Walter Wade Battis Si


(Signed)


July19


191.0 ......


(Address)


MEDICAL EXAMINER


191.0


1887


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) Salcs- 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 Housc- 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, meningcs, peritonacum, 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 septicaemia," " 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.


THE COMMONWEALTH OF MASSACHUSETTS


winchat


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Mollie Schiff


Registered No ..


Place of ¿


makeall Hospital


Death *


5


Residence


Age


33




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