USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 106
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BOSTON
(City or town.) {If death occurrad in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Nathaniel Ellendaleon
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
41 Pinchurch cur N.M.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
& SEX
' COLOR OR RACE
cubitte
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
* DATE OF BIRTH
(Month)
(Day)
1
(Year)
If LESS than
( day ......... hrs.
.yrs. ..................... ds.
or ......... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Buyer.
(b) General nature of industry,
business, or astablishment In
which employad (or employer).
· BIRTHPLACE
(State or country)
N. Y.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Formany
12 MAIDEN NAME
OF MOTHER
Roza. Lazbier;
1ª BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
S. M. Jackkeane
(Address)
2446 There Dra Mientras
Filed
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
aleauch
2. 2ª 1915
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
191
Qua, 2nd
5.
to
that I last saw h plc alive on
and 2nd
1915
and that death occurred, on the date stated above, at
... m.
The CAUSE OF DEATH* was as follows :
Ingina Centrais
Did a surgical operation precede death ? no Date
Die deter it
(Duration)
.......
.yrs. ................ mos.
.......
Contributory ....
Pulursupry Cedeuna
(SECONDARY)
.(Duration) ..
1
..... yra. ............... mos.
ds.
(Signad)
Nielira A Ñ Mes
M.D.
luca. vr., 1955 (Address) Venetrop Hinko
* 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 placa
of death ..
.yrs.
... mos.
in tha
ds.
Stata ............ yra.
.mos.
.........
Where was disease contracted, if not at place of death ?.
Former or usual residence
1º PLACE OF BURIAL OR REMOVAL H1 l'un. heret (WE N.Y.
DATE OF BURIAL
191
20 UNDERTAKER
ER JACaro ficastundas Du
ds.
10 NAME OF
FATHER
David FillEndElease
7 AGE 41
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulncss 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 necded. 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 houschold 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 occu- pation whatever, write Nonc.
Statement of cause of death. - Name, first, the D18- EASE 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; Broneho- 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- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions,"" ""Debility" ("Congenital," "Scnilc," 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.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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
Winthrop
(No.
24 Fair View
St. :
Ward)
Winthrop BOSTON (City or town.)
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
Catherine Josephine Hasson
'FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 24 Fair View
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female White
4 COLOR OR RACE
5 SINGLE,
Single
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
· DATE OF BIRTH
(Month)
(Day)
1
(Year)
, AGE
29
... yrs.
- mos. - ds.
or ....... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Home
(b) General nature of industry,
business, or establishment
in
which employed (or employer)
-
9 BIRTHPLACE
(State or country)
East Boston Mask
PARENTS
12 MAIDEN NAME
OF MOTHER
Elizabeth Hasson
18 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
John Hasson
(Address)
24 Stair View
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
5
(Month)
29
(Day)
1913-
....
17
I HEREBY CERTIFY that I attended deceased from
aug 28
1915, to.
am 29'
1910 ...
....
that I last saw ht
alive on
ami29
1915'
....
and that death occurred, on the date stated above, at
6 30 m.
-
The CAUSE OF DEATH* was as follows : Bronchopneumonia Capillary Bron chitin
Did .. a.surgical.operation .. precede .. death.2
.. Date
(Duration)
........ yrs.
...........
... mos.
5
ds .
Contributory
(SECONDARY)
(Duration)
.............. yrs.
mos.
.........
ds.
(Signed)
any za, 191
5
(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 deatn.
. yrs.
mos. .
ds.
State
.yrs.
.mos.
ds .............
Where was disease contracted, If not at place of death ?..
Former or usual residence.
17 PLACE OF BURIAL OR REMOVAL Holy Cross
DATE OF BURIAL
Sept 1, 1915
20 UNDERTAKER
m.g. Kelly
11
ADDRESS
Meridian S.
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.
Filed
191
10 NAME OF
FATHER
John Hasson
....
1
M.D.
I1 BIRTHPLACE
OF FATHER
(State or country)
Ireland
If LESS than
1 day ........ hrs.
(Year)
....
In the
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation 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 houschold 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 occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- EASE 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 rc- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber .
culo losis of tungs, 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 nced 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 provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH In plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important. See Instructions on back of certificate.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
Maria Froya
18 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
$ SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
16 DATE OF DEATH
aug
(Month)
30, 1915
(Day)
.....
(Year)
$ DATE OF BIRTH
10 -1844
(Month)
(Day)
(Year)
7 AGE
70
m.y.s.
.yrs.
10 mos.
MO.
20%
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
al thomas
(b) General nature of industry,
business, or establishment in
which employed (or employer).
Euphrates
Uncertain
.(Duration)
... yrs.
Contributory.
(SECONDARY)
(Duration) ............. yrs. ............ mos. ds.
(Signed)
M.D.
1 lug. 31, 195 (Address)
mittunt
* 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.
In the
mos.
Where was disease contracted, If not at place of death ?.
Former or usual residence
1 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Sift 1t- 1915
20 UNDERTAKER
ADDRESS
L
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
mary
Jana, Flagler
? FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
wils of Allaway. K. flagler
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Kachel Piano (No.
56 Parts and St. ....... Ward)
Wucht
17 I HEREBY CERTIFY that I attended deceased from March 1. 1919, to alex. 31., 19115, that I last saw he alive on
and that death occurred, on the date stated above, at a.m. The CAUSE OF DEATH* was as follows :
Chance Interstitial
9 BIRTHPLACE
(State or country)
medford mars
10 NAME OF
FATHER
- Jagmit
....
mos. ...
ds.
2
3
.
If LESS than
i day ......... hrs.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation 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 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 occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- DASE 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 fcvcr (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); Mcaslcs; 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 septicacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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
' PLACE OF DEATH
Winckrot Man (N.
68 Shower-1PK
St .. ......... Ward)
:
Solomon Harding Barnack
? FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.i
@RESIDENCE
6.8
non- Park
....... Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
$ SEX
Male
' COLOR'OR RACE
White
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Hamid
$ DATE OF BIRTH
...
(Month)
(Day)
1
(Year)
7 AGE
54
yrs.
mos.
ds.
If LESS than
I day ......... hrs.
or ....... min. ?
17
I HEREBY CERTIFY that I attended deceased from
1915
march
Seff 5
191%., to
..........
that I last saw h wwwalive on
Suht 5
1915
and that death occurred, on the date stated above, at
90 m.
m.
The CAUSE OF DEATH* was as follows : Cerebral apohledy
(repeated attached post 1 1/2
quais )
Final one
mos.
ds.
arteriosclerosis
Contributory.
(SECONDARY)
general.
(Duration).
Seguecabos years
(Signed)
Jeff7
1915 (Address).
W inthek
......
* 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 plsca
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
1$ PLACE OF BURIAL OR REMOVAL Well tech !Her
DATE OF BURIAL
9/5
1915
" UNDERTAKER
E.R. Bezum-
ADDRESS
Filed ., 191
REGISTRAR
16 DATE OF DEATH
September 5
(Month)
(Day)
1915 (Year)
· OCCUPATION
Wholesale Merchant
(a) Trade, profession, or
particular kind of work
(b) General natura of Industry,
business, or establishment In
which employad (or employar) ..
9 BIRTHPLACE
(State or country)
Wellfleck Mass
10 NAME OF
FATHER
Solomon H. Barnard, Cr.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or conntry)
Wellfleet Mars
12 MAIDEN NAME
OF MOTHER
Susan . am Stills
1ª BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
C.R. Bem
(Address)
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation 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, c. 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 occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- CASE 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 scpticacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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 ofc 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
PLACE OF DEATH Vonthron (No 226Hain Joseph Abraham Wilson. 2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 26 Main St
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