Town of Winthrop : Record of Deaths 1913-1915, Part 11

Author: Winthrop (Mass.)
Publication date: 1913
Publisher:
Number of Pages: 1094


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 11


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 one supposed to be due to Alcoholism, etc.


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


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


asenich & Hunt


.Registered No.


Date of Į


March 21


1963 .


Death *


Residence 260 Bowdoin St Wanting Age


84


.years.


7


months.


1


.days


STATISTICAL DETAILS


SEX


Female


COLOR


SINGLE, MARRIED, WIDOWED, OR DIVORCED


Widowed


MAIDEN NAME +


Ellis


HUSBAND'S NAME t


alfred


Date of Birth


aug 20 1828.


BIRTHPLACE #


Harwich Mass


NAME OF


FATHER


aruna Elles


BIRTHPLACE


OF FATHER$


Harwich Mass,


MAIDEN NAME


OF MOTHER


Unknown - Bassett


BIRTHPLACE


OF MOTHER


Harwich Mase


OCCUPATION


at Home


INFORMANT § Me N. J. Gorham


PLACE OF BURIAL OR REMOVAL II


South Harwich Mars


DATE OF BURIAL


......


190.


UNDERTAKER


E.G. Brown flow


ADDRESS


286 merchan SA


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from July 29 19.2 ... to March 21 19/03, 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 : antero Salumi


(DURATION).


DAY9


Contributory :


Basilar and Orbital Hammlys,


(DURATION) .. DAYS


(Signed).


M.D.


190.3 ... (Address).


218 Manit Duchef


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


.190


Clerk


* 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 dotails. ][ Name of cemetery.


FILL OUT WITH INK. - THIS IS A PERMANENT RECORD


ALL NAMES TO BE IN FULL


Place of


260 Howdoin St


Death


S


Mar. 21, 1913


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


Chelsea


(No .....


Frost Hospital


St. ;...... .Ward)


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


'FULL NAME


Eliza A. Morse


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


@RESIDENCE


155 Fleasant St. Winthrop


Registered No. 204


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


March


22


3


Female


6 DATE OF BIRTH


(Month)


(Day)


1 (Year)


7 AGE


If LESS than


[ day .......... hrs.


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)


Rockland, Me.


10 NAME OF


FATHER


Unknown


11 BIRTHPLACE


OF FATHER


(State or country)


12 MAIDEN NAME


OF MOTHER


13 BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Albert II. Nute


(Address)


155 Xleasant St.


1% Mar.22 Filed 191 3.120. 1.


REGISTRAR


18 DATE OF DEATH


17 I HEREBY CERTIFY that I attended deceased from Jan. 1 1913 .,


to


Mar. 22


191 3.


that ! last saw he.r .... alive on


Mar. 21


1913.


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


.. m.


The CAUSE OF DEATH# was as follows : Gangrene of Foot


(Duration)


yrs 2% - ds.


Contributory


Chronic .... Interstitial


(SECONDARY)


Nephritis (Duration)


?


... .yrs. - - ds.


(Signed)


Edward J. Grainger


M.D.


far.22


1913


.........


(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).


In the


At place


of death


.. yrs.


........... mos.


ds.


State


******.... yrs.


... mos.


...........


ds .............


Where was disease contracted,


If not at place of death ?.. Former cr usual residonce


1 PLACE OF BURIAL OR REMOVAL


Winthrop


26


DATE OF BURIAL


Mar. 25 or 1913


" UNDERTAKER


C.R. Benner


ADDRESS


Winthrop


¿ SEX


4 COLOR OR RACE


White


6 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED idowed


(Write the word)


(Month)


(Day)


191


(Year)


68 yrs. - mos. - _ds.


PARENTS


mos.


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 tho 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 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. Caro 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, stato occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who havo no occupation whatever, write None.


Statement of cause of death. - Name, first, tho 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 rc- port "Typhoid pneumonia") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) : Tuber-


Mar. 22, 1913


culosis of lungs, meninges, peritoneum, etc., Careinoma, 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


...


August peterson


%FULL NAME


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


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


W


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Jung


6 DATE OF BIRTH


3 24


(Month)


(Day)


1913


(Year)


or .......


.min. ?


8 OCCUPATION


(a) Trede, profession, or


particular kind of work


framers nule


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


9 BIRTHPLACE


(State or country)


10 NAME OF


FATHER


PARENTS


11 BIRTHPLACE OF FATHER (State or country} " Buaceder


12 MAIDEN NAME


OF MOTHER


13 BIRTHPLACE


OF MOTHER


(State or country)


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Nella Beler Low


(Address) /8 Ccextintos


16


Filed 191


.......


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


1ª DATE OF DEATH


Mar


24. 191


3


(Month)


(Day)


(Year)


17 I HEREBY CERTIFY that I attended deceased from Mar 19 1913, to. Mar 24 193 that I last saw him alive on 1913 and that death occurred, on the date stated above, at pm. 1800 The CAUSE OF DEATH* was as follows :


Acute Cobar neumonitis


.. (Duretion) ................ yrs. ............


.. mos.


Contributory ..


nothing


(SECONDARY)


(Duration) ............. yrs.


.......... mos.


ds.


M.D.


(Signed)


Mar. 25 1913


(Address) .!


318 Shawment Com


* 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


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.


1º PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


3-27


.....


191.


3


20 UNDERTAKER


W. Sarayyo


ADDRESS


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.


(City or town.)


(No. 18 atlantis 9


St. : Ward)


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


Registered No.


7 AGE


If LESS than


I day .......... hrs.


60 yrs. 5 mos 1


ds.


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 re- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


mar. 24, 1913


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 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.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1913.


CITY OF BOSTON.


FULL NAME Catherine Rodes


Registered No


2980


Place of Death l


Boston


Infants' Hospt.


and Residence


Date of Death


Mar. 24


1913.


Age


years.


4


months.


15


.days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


F


S


Maiden Name


IS


Husband's Name


IT


Primary; (Duration)-


Tub.Meningitis


ETICE!


16 da.


BOSTONIA


Name of


Treantos Rodes


BOSTO


Birthplace of Father


Greece


Maiden Name


of Mother ...


Helen Llathopoulone


Birthplace of Mother.


Greece


Occupation


Informant


Place of Burial St.Michael's Cemt.


or removal


Undertaker Joseph A. Langone


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


1913, from 1913, to 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:


RAR


S. SIT.


R


PATRU


Birthplace Winthrop


TUTTATIS REGO


CONDITAA.


A 0.1822


YE DONATA A.


N. MASS


Contributory : 2 (Duration)


(Signed)


C. H. Dunn


M.D.


Mar. 24 1913


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Usual Residence ..


Winthrop, 195 Lincoln St.


Filed . .


Mar. 27 1913.


A true copy.


Attest :


ErMSlenen


Registrar.


Father


Mar. 24, 1913


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1913.


CITY OF BOSTON.


FULL NAME


---


Kidd


Registered No


3138


Place of Death ¿ and Residence


Boston


Boston Lying-in Hospt.


Mar. 26


11


Date of Death


1913.


Age


years


months. days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


M


W


S


Maiden Name


Husband's Name


Boston


Birthplace


Name of


Harry E.Kidd


Father


Birthplace Baltimore Md.


of Father


Maiden Name of Mother ....


Rina Borsky


Birthplace of Mother.


Boston


Occupation


None


Informant .


Place of Burial


Tewksbury


or removal.


Undertaker J. S. Watorman & Sons


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from 1913, to.


1913, 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:


RAR


S. SITA


Primary (Duration )-


Umbilical Hemorrhage


PICE


1 dy.


BOSTONIA


TTAT


TISREAD


11 30.


E DONATA A


N. MASS. Contributory : - Anaemia 6 ds.


(Duration)


(Signed)


Somers Fraser


M.D.


Mar. 26


1913


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Usual Residence


Winthrop, 117 Revere St.


Filed .


Apr. 1 1913.


A true copy. Attest :


Registrar.


IS


T PATRIJ


CITY'


CONDITAA


TA A 182


BOSTO


mar. 26, 1913


1 PLACE OF DEATH [If married or divorced woman or widow give maiden name, also name of husband.] 3 SEX 4 COLOR OR RACE Female $ DATE OF BIRTH (Month) (Day) 7 AGE 8 OCCUPATION (a) Trade, profession, or At home particular kind of work. (b) General nature of industry, business, or establishment in which employed (or employer) 10 NAME OF FATHER 12 MAIDEN NAME OF MOTHER PARENTS ( Unknown ) important. See instructions on back of certificate. 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 46 0 mos. 0 ds.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


Cambridge (No 350 Charles River Rdg ...


Charlesgate Hospital,


Ward)


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


2 FULL NAME


HELEN DOUGLAS CARR


MacCullum,


J. Stewart Carr


@RESIDENCE


Winthrop, Mass.


Registered No.


442


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


IS DATE OF DEATH


March 28 ,1913.


(Month)


(Day)


191


(Year)


17 I HEREBY CERTIFY that I attended deceased from Mar . 21, 19131., to Mar.28 1913 that | last saw h ..... (2º alive on and that death occurred, on the date stated above, at .. A . Max.27 1913 191 1 m. The CAUSE OF DEATH* was as follows : Myoma ..... of ..... Uterus.


(Duration) .


........ yrs. .


--


...... ds.


Contributory.


Operation- Ileus


(SECONDARY)


(Duration)


os ..


ds.


(Signed)


H. H. Germain,


M.D.


Ifar . 28,1913.


416 Marlboro.St


., 191.


(Address)


Boston


* 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).


In the


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


19 PLACE OF BURIAL OR REMOVAL


Winthrop, Mass.


DATE OF BURIAL


Har . 30,1913


191


....


20 UNDERTAKER A. C. Skaggs,


ADDRESS


Winthrop, Mass.


WHITE PLAINST, WITH UNFADING INN THIS IS A PERMANENT RECORD.


9 BIRTHPLACE


(State or country)


Pr. Edwd. Island


Douglas MacCullum


11 BIRTHPLACE


OF FATHER


(State or country)


Pr. Edwd. Island


13 BIRTHPLACE


OF MOTHER


(State or country)


Pr. Edwa. Island


11 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


J. Stewart Carr,


(Address) - Winthrop , Mass.


Filed. Mar. 29,1915 .....


REGISTRAR


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Married


1


(Year)


If LESS than


I day, ....... hrs.


Or ........ min. ?


Cambridge (City or town.)


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 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 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-


mar. 28, 191.


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 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


XX


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


(No. 83 Loving Road


St. ;.. ...... Ward)


2 5 Withrap (City or town, [If death occurred in a hospital or institution, give its NAME instead of street and number.]


2 FULL NAME Charles an Slivel [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE


83 Living Road


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX Man


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


manuel


6 DATE OF BIRTH


(Month)


(Day)


18.66


(Year)


7 AGE


If LESS than I day, .. hrs.


or ........ min. ?


8 OCCUPATION


(a) Trade, profession, or particular kind of work


Gravely Salesman


Shoes


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


9 BIRTHPLACE


(State or country)


10 NAME OF FATHER Cehas. F.


PARENTS


11 BIRTHPLACE OF FATHER (State or country)




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