Town of Winthrop : Record of Deaths 1913-1915, Part 20

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 20


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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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, (3) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The matorial 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- kecpers 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- neumonia (" 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. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident ; Revolver wound of head-homicide ; Poisoned by carbolic acid - prob- ably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of " Contributory."


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.


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


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Millbury, Mass.


(No.


Orchard


St. :


Ward)


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


(Home of Mrs C.H.Smith)


FULL NAME


Adelina May White


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


Adelina May Smith


wife of William E.White


Registered No. 41


@RESIDENCE


Winthrop, Mass.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


June


20


3


(Month)


(Day)


191


(Year)


6 DATE OF BIRTH


May


9


1875


(Month)


(Day)


7 AGE


If LESS than


day ...


38


.yrs.


1


mos.


11


ds.


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


& OCCUPATION


(a) Trade, profession, or


particular kind of work


At home


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


(Duration)


5


yrs.


mos. ds.


Contributory.


(SECONDARY)


(Duration)


.yrs.


.mos. ds.


(Signed)


Albert G.Hurd


M.D.


une 21


191


(Address)


Millbury, Mass.


* 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


Central Cemetery


DATE OF BURIAL


June 23.


1913


(Address)


M: 11bury , Mass.


Filed July 8


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


10 NAME OF


FATHER


Charles H.Smith


11 BIRTHPLACE


OF FATHER


(State or country)


Burlville, R.I.


12 MAIDEN NAME


OF MOTHER


Lillia P. Putnam


18 BIRTHPLACE


OF MOTHER


(State or country)


Millbury, Mass.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Mrs Lillia P.Smith


REGISTRAR


@UNDERTAKER


Herbert A.Ryan


ADDRESS


Millbury, Mass.


3 SEX female


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


married


17 I HEREBY CERTIFY that I attended deceased from


(Year)


Apr.29


1913


to


June 20


191


3


....


that I last saw h


.... eralive on


June 20


3


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


12. 30


.. m.


The CAUSE OF DEATH* was as follows :


Pulmonary Tuberculosis


-


9 BIRTHPLACE


(State or country)


Millbury, Mass.


Millbury


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Procise 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 nceded. 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-


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.


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


YPLACE OF DEATH


2/


(No.


Shriley


Retia hi :. Donald


C FULL NAME


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


17 Summer Road learnibuduc mass


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


8 SEX


7


4 COLOR OR RACE


W.


6 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


1ª DATE OF DEATH


June 21


(Month)


(Day)


(Year)


6 DATE OF BIRTH


4


191


(Year)


7 AGE


...


4 yrs.


7


mos.


17


da.


....


„.min. ?


$ OCCUPATION


(a)' Trade, profession, or


particuler kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer) ..


.(Duration).


5 mos. 20


ds.


.. yrs.


Креманом


Contributory.


(SECONDARY)


(Duration)


...........


... yrs.


mos.


ds.


......


M.D.


191 .....


(Address).


Cambridge


* 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.


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


Where was disease contracted,


If not at place of death ?...


Former or usual residence.


" PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


It Paule Galinaton firme 22, 1993


" UNDERTAKER


8. 8. le overran


1


ADDRESS


Filed 191


REGISTRAR


17 I HEREBY CERTIFY that I attended deceased from


191.3 ... , to


that I last saw h_ alive on Que 10 191 .... 3. and that death occurred, on the date stated above, at 4 &m.


The CAUSE OF DEATH* was as follows :


9 BIRTHPLACE


(State or country)


Cambridge


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country}


Prince Edward Island.


12 MAIDEN NAME


OF MOTHER


Mary Jane Hogan


13 BIRTHPLACE


OF MOTHER


(State or country)


Orange mars.


"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant) A LO


Lio mi Donald


(Address)


17 Summer Rd. Cenabudy


16


St. ;... Ward)


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


191-3


(Month)


(Day)


If LESS than


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


18 NAME OF


Lio. In: Dowald.


(Signed)


Georg & Flla facture


0


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statemont of occupa- tion is very important, so that tho relative hcalthfulness of various pursuits cau be known. The question applies to each and every person, irrespectivo of age. For many occupations a single word or torm 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 iu 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 definito salary), may be entered as Ilousewife, 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 DEATII, stato 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 diseasc. Examples:" Cerebro-spinal fever (the only definite synonym is " Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid usc of "Croup ") ; Typhoid fever (never re- port "Typhoid pneumonia") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualificd, 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," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," otc., when a dofinite 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 provisions of chapter 24 of the Revised Laws deaths under the following conditious must be referred to tho Medical Examiners:


1. Deaths following injury or violenco, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


8. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or onc supposed to be due to Alcoholism, etc.


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


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1913. WALTER L LORD


CITY OF BOSTON.


FULL NAME


185 ST. BOTOLPH ST.


Place of Death


Boston


and Residence S


JUNE 23


Date of Death


1913.


Age


44


years


months days.


STATISTICAL DETAILS.


SEX


COLOR


M


SINGLE, MARRIED, WID., DIV. MAR.


Maiden Name


Husband's Name


IPSWICH


Birthplace


Name of


Father ROBERT LORD


Birthplace of Father


Maiden Name


of Mother


Birthplace of Mother ..


Occupation SALESMAN


Informant


Place of Burial


WINTHROP (WINTHROP CEM)


or removal


Undertaker. W. C.SKAGGS


Filed


JUNE 26


1913.


A true copy. Attest :


WINTHROP


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


.S


ASPHYXIATION ( ILL GAS ) SUICIDAL -


Primary (Duration}


FFICI


BO3TONIA


TON HITAA


13D.


HE .PONATA A


N. MASS


Contributory · ? ( Duration) 1


(Signed)


W. H. WATTERS


M.D.


JUNE 239|3


...... . .....


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


WINTHROP (223 LINCOLN ST) Usual Residence


Registrar.


IS


T PATRILA


CITY :R


Inais


TA A 1822


ITIS REGIMIN


BOSTON


Registered No .. 6043


1


-


-


June 23-1913


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 Winthrop


(No.


27 Pleasant PK. RSt. ;


Ward)


Martha a. Moulton,


2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] a RESIDENCE Wielkiof Mars- 27, Pleasant Ph Od Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


marked


6 DATE OF BIRTH


10 (Month)


28


(Day)


(Year)


7 AGE


If LESS than


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


74 yrs


8


mos.


28 ds.


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


$ OCCUPATION


(a) Trade, profession, or


particular kind of work


ethome


(b) General nature of industry,


business, or establishment in


which employed (or employer)


Valvular Heart Deseas


Indefinido


(Duration)


yrs.


mos. ds.


Contributory.


aceite nephritis


(SECONDARY)


.(Duration)


yrs. ....


mos. ds.


(Şıgned)


my Parten


M.D.


ene 29, 199 (Address).


Nunchuoto Mano.


* 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.


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


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


Former or usual residence.


1$ PLACE OF BURIAL OR REMOVAL & Raudacht Vit


DATE OF BURIAL


7-1-


1913.


ADDRESS


Filed


191


REGISTRAR


16 DATE OF DEATH


1838


17


I HEREBY CERTIFY that I attended deceased from


nov. 1ch


19123., to ...


Veen 2800


1913,


.......


that I last saw het alive on


Aucune 27,


191.2.


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


5.a.m.


The CAUSE OF DEATH* was as follows :


' BIRTHPLACE


(State or conntry)


Eden V.t.


10 NAME OF


FATHER


Food Plundy


PARENTS


11 BIRTHPLACE OF FATHER (State or conntry)


12 MAIDEN NAME


OF MOTHER


Surah Dudley


18 BIRTHPLACE


OF MOTHER


(State or conntry)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informsnt)


Clyche Di Moulton


(Address)


(City or town.)


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


1913.


(Month)


28


(Day)


(Year)


20 UNDERTAKER


we. skaggs Wirlium.


June 28-1913.


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-


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.


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


Metcalf Hospital No. 176 Wiecchio


Hettie


Martha Jucken Floyd.


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


36 Center St Winthrop


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


w


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


married


6 DATE OF BIRTH


13


(Day)


(Year)


7 AGE




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