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