USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 107
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St. ;
Ward)
Mintha (City or town.) Elf death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mate White
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
marica
6 DATE OF BIRTH
1845 17
(Month)
(Day)
(Year)
7 AGE
If LESS than
I day ......... hrs.
70 yrs.
yrs ..
mos. ds.
.... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Retired
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Miniland
10 NAME OF FAL Abraham Wilson
11 BIRTHPLACE OF FATHER (State or country)
Finland
12 MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (State or country) Finland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Margaret Hilzon
(Address)
22/6 Main St
Filed 191.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Scht
9
1915
(Year)
(Month)
(Day)
I HEREBY CERTIFY that I attended deceased from
Sept.1
191
5, to Saht9
1915
that I last saw hla alive on
Saft. 7
1915.
and that death occurred, on the date stated above, at
4:30 AN
The CAUSE OF DEATH* was as follows :
Cente lleo = colitis
(Duration)
.... .... yrs.
mos.
10
ds.
arteriosclerosis
Contributory ..
(SECONDARY)
(Duration)
... .... yrs. ...
mos. . ds.
(Signed)
Charles 7 mahoney
M.D.
Siht- 9, 1915
(Address)
355 WmChung
* 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.
12 PLACE OF BURIAL OR REMOVAL
DATE/OF BURIAL
Jeht 11. 1915
20 UNDERTAKER
ADDRESS
PARENTS
In the
Dent. TIYIS
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," " Foreman," "Manager,"" Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never ro- 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 he stated unless im- portant. Example: Measles (disease causing deatlı), 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
(No. 115 Mani
St. :
.......... Ward)
Mary & Muldoon
[If married or divorced woman or widow
give maiden name, also name of husband.1
@RESIDENCE
115 Mam It
Mary E Noonan
Joseple Maddeon
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
( Write the wor
1) Illarice
1
(Year)
If LESS than
Į day ......... hrs.
ds.
... min. ?
· OCCUPATION
(a) Trade, profession, or
particular kind of work
House Wife
9 BIRTHPLACE
(State or country)
* Walthami mars
10 NAME OF
FATHER
Edward & Nevrone
11 BIRTHPLACE OF FATHER (State or country) Trelamid
12 MAIDEN NAME
OF MOTHER
Gatherme Hagerty
13 BIRTHI
OF MOTHER
(State or Country)
Scottona
" THE ABOVE IS TRUE JO THE BEST OF MY KNOWLEDGE
(Informant)
Husband
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Pift.
(Month)
(Đây)
14
191.
(Year)
17 I HEREBY CERTIFY that I attended deceased from March 1912 to Sept. 15, 1915 that i last saw h ......... alive on Salt. 13' , 195. and that death occurred, on the date stated above, at. 8.20m. The CAUSE OF DEATH* was as follows :
Paralipara agitano
(Duration)
5 yrs
yrs.
... mos ..
...... .ds.
Contributory.
(SECONDARY)
.......
.. (Duration)
.. yrs.
mos.
ds.
....
(Signed)
Charles 7. Mahoney
M.D. at 15, 1915 (Addres).
355 Cm
* 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 ............ yra.
In the
......
mos. ...... d .............. Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL Galway Walther
DATE OF BURIAL
Sept 16
1915
20 UNDERTAKER Thomas & Nelson
ADDRESS
Walthour
Filed 191
(City or town.)
{if death occurred in a hospital or institution, give its NAME instead of street and number.]
Welthope
5
1 PLACE OF DEATH
Wenthal
2 FULL NAME
3 SEX
4 COLOR OR RACE
Demate White
· DATE OF BIRTH
(Month)
7 AGE
43
(b) General nature of industry,
business, or establishment in
which employed (or employer).
PARENTS
Important. See Instructions on back of certificate.
(Address)
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should stato
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
.........
yra.
mos.
(Day)
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 cach and every person, irrespective of age. For many occupations a single word or terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loeo- 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 tlie household only (not paid House- who receive a definite salary), may be entered as Housework, or' At home, and children, not gain- fumy 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 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 cercbro-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); Mcasles; 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 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
1 PLACE OF DEATH
Winthrop
...........
(No. 18., Shore Drive. St. :........... .Ward)
Almon Wight
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husoand.] @RESIDENCE
18 Shore Drive Winthrop.
... Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE
white
6 SINGLE,
MARRIED,
WIDOWED, married.
OR DIVORCED
(Write the word)
16 DATE OF DEATH
Seßt 17 1915
(Month)
(Day)
191
(Year)
$ DATE OF BIRTH
Sept 29 1846
(Month)
(Day)
(Year)
7 AGE
68
11
mos.
12
ds.
.. yrs.
or ......... min. ?
$ OCCUPATION
(a) Trade, profession, or
particular kind of work
Turrier
(b) General nature of industry, business, or establishment in which employed (or employer).
Did a surgical operation precede death ?
no
Date
(Duration)
.yrs.
mos. .......
15 de.
Contributory ..
chimie interstitial reflexitis, cardiac
......... yrs.
mos.
ds.
sentite fatty degeneration of myocarduim. Hy bustatic pneumonia.
.. (Duration)
(Signed)
Conrad Wesselhoeft
M.D.
Sept, 18, 1915 (Address).
3-33- Beacon St, Boston
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
16 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS. OR RECENT RESIDENTS).
At place
In the
of death ....
.yrs.
..... mos.
.......
ds.
State ..
........
.yrs.
mos. ds ... .......
Where was disease contracted, If not at place of death ?..
Former or usual residence
" PLACE OF RUPIAL OR REMOVAL
DATE OF BURIAL
28/3.22.
19 .......
20 UNDERTAKER
ADDRESS
Filed ., 191
REGISTRAR
17 1 HEREBY CERTIFY that I attended deceased from april 1. 191.3 ... , to. Sept. 6 1915- .......
If LESS than
day.
.
that I last saw him
alive on
Jeft. 6
1915-
and that death occurred, on the date stated above, at.
.. m.
The CAUSE OF DEATH* was as follows : acute Cardiac dilatation
9 BIRTHPLACE
(State or country Ot isfield Me.
10 NAME OF FATHER Eliphalet Wight
PARENTS
11 BIRTHPLACE OF FATHER (State or con Otisfield Me ..
12 MAIDEN NAME
OF MOTHER
Cordelia unknown
1ª BIRTHPLACE OF MOTHER (State or conntry)
Otisfield Me.
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
) Mrs mabel wight
(Address)
8 Shore drive Winthrop
Wirthof . 37? BOSTON
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
1
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 caclı 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 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 which nceded. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dcaler," 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 domestie 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 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 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) ; Mcasles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (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," "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 ali 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 duc 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
(No.
40 talves
St. : Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1
6 DATE OF BIRTH JEhit 4
(Month)
(Day)
1915
(Year)
7 AGE
If LESS than
day,
„hrs.
or ........ min. ?
8 OCCUPATION (a) Trade, profession, or particular kind of work
(b) General nature of industry, business, or establishment in which employed (or employer)
· BIRTHPLACE
(State or country)
10 NAME OF
FATHER
PARENTS
12 MAIDEN NAME OF MOTHER Curatelle la
13 BIRTHPLACE OF MOTHER (State or country)
Newfoundland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
40 Kratos (1:
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Sept.
(Month)
(Day)
20. .... , 1915 (Year)
I HEREBY CERTIFY that I attended deceased from
Sefo. Get
1913, to
-
Selo. 20 ch
1915
that I last saw her alive on
self 19
1915
and that death occurred, on the date stated above, at
6.a.m.
The CAUSE OF DEATH* was as follows :
Entero Colitis
(Duration)
yrs.
....... mos.
14 ds.
Contributory
(SECONDARY)
(Duration)
.. yrs.
mos. ds.
(Signed)
Villiaux
4.
M.D.
Rep. 20 .. 1915 (Address)
Minetrop
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
IS LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
... yrs.
... mos.
In the
ds.
State
.yrs.
mos.
ds.
Where was disease contracted, if not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Vent 21
191
20 UNDERTAKER ICHal
ADDRESS
Filed 191
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
2 FULL NAME [If married or divoreed woman or widow give maiden name, also name of husband.] @RESIDENCE 40 Date CHied
chiel
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.
11 BIRTHPLACE OF FATHER (State or country)
17
.yrs. mos. 16 de.
2
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 questiou 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 returu " Laborer," " Foreman," " Manager,"" Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Womeu at home, who are engaged iu 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 takeu 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 occupatiou 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 aud causation), using always the same accepted term for the sam disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never ro- 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 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 Examinors:
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.
4
A
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back of certificate.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Winthrop
(No.
Cuestavr.
St.
.....
Ward)
(City or town.)
[If death occurred In a hospital or institution, give its NAME instead of street and number.]
' FULL NAME
Ulice Francplon
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
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