Town of Winthrop : Record of Deaths 1913-1915, Part 21

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 21


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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If LESS than


! day ......... hrs.


54 .yrs. 6 mos. 6 ds.


„min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


et home


(b) General nature of industry,


business, or establishment in


which employed (or employer)


' BIRTHPLACE


(State or country)


E. Boston mans


PARENTS


12 MAIDEN NAME


OF MOTHER


Sarah DieBler


13 BIRTHPLACE


OF MOTHER


(State or country)


Boston Man


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Win. Atlocal.


(Address)


Filed


191


REGISTRAR


16 DATE OF DEATH


I HEREBY CERTIFY that I attended deceased from


man


, 191.3 .. , to


June 29, 19/3.


that I last saw h ... /or alive on


June 29


1913


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


3.300.m.


The CAUSE OF DEATH* was as follows :


Quemment Casciana


Intestines


(Duration)


....


......


... yrs.


mos.


ds.


Chaletichinrio


Contributory


(SECONDARY)


(Duration)


... yrs.


mos. ds.


(Signed)


Charles 7. Mahoney


M.D.


Jums0, 1913 (Address)


355 malahex


* 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.


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


7-1-1913


ADDRESS


20 UNDERTAKER W.c. skaggs


(City or town.)


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


St. :.


Ward)


Month)


29


(Day)


191.3


(Year)


1854/17


(Month)


10 NAME OF


FATHER


Johnathan In Jucken.


11 BIRTHPLACE


OF FATHER


(State or country)-


Ternes bury Mars


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, Arst, 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Wirthnot


(No


37 Pleasant Park Road


St. :


.......


Ward)


amos,


Stuart


-


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Male


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


man


19


(Month)


(Day)


(Year)


7 AGE


83


yra. mos.


ds.


or


min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer).


Clinic Interstitial nephritis


(Duration)


P


.. yrs.


.. mos.


ds.


Contributory.


(SECONDARY)


.(Duration)


... yrs.


mos.


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


ds.


(Signed)


S.A. Moulin


M.D.


191 ........


49 Pleasant Park Road


* 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.


1ª PLACE OF BURIAL OR REMOVAL Winchung- leund, -


DATE OF BURIAL


Jung 592 1913


20 UNDERTAKER


Chiar. A. 1 Bennes.


ADDRESS


Иментор Жал


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


12 MAIDEN NAME


OF MOTHER


Nancy Lombard


1ª BIRTHPLACE


OF MOTHER


(State or country)


"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Rena Stat-Suck


(Address)


37 Pleasant 1/ Ford


14


Filed -. 191 ..


REGISTRAR


16 DATE OF DEATH


(Month)


30 th


191 3


.....


(Day)


(Year)


1830


17


I HEREBY CERTIFY that I attended deceased from


me 23nd


1913 to


30th 1913,


If LESS than han I day ......... hrs." that I last saw h.sdd. alive on


30th 93 and that death occurred, on the date stated above, at 2.30Pm. The CAUSE OF DEATH* was as follows :


· BIRTHPLACE


(State or country)


Harrison me


10 NAME OF


FATHER


Joseph. Stuart


11 BIRTHPLACE


OF FATHER


(State or country)


gorham me


Итени ....


(City or town.)


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


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of 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 Hlousc- 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 , C Carcinoma, Dar-


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 (sccond- 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


(No.


174 Winthrop st


St. :


1


Ward)


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


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


male


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Single


$ DATE OF BIRTH


oct


6


11886 17


(Month)


(Day)


(Year)


7 AGE


26


.yrs.


8


mos.


24


ds.


... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


agrar maker


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


$ BIRTHPLACE


(State or country)


Russia


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


Russia


12 MAIDEN NAME


OF MOTHER


maria Klugman


1ª BIRTHPLACE


OF MOTHER


(State or country)


Russia


"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


n Brother


(Address)


22 West 45 th St. New york


16


Filed 191


REGISTRAR


I HEREBY CERTIFY that I attended deceased from


june 22


1913, to


Am 30


1913


....


that I last saw him


alive on


Ofme 30


1913.


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


1:00 pm


The CAUSE OF DEATH* was as follows :


Cardiac dilatation


ante mitral + )seconfond regurgitate


Chrome Indicarcitid


Contributory.


Rhumatomi


(SECONDARY)


.(Duration)


2


yrs.


mos.


ds.


(Signed)


fry 30, 1913


(Address)


Wathoy


M.D.


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.


8 ds.


State ..


19 yrs.


mos.


ds.


If not at place of death ?...


9 Columbia 81 maplewood


usual residence.


Former or


9 Columbia 21 humphries


1ª PLACE OF BURIAL OR REMOVAL Knight Liberty Cemday


DATE OF BURIAL


July 1, 1913


ADDRESS


20 UNDERTAKER


Jacob Stanetsky


(City or town.)


Joseph Heller


2 FULL NAME


[If married or divorced woman or wiflow


give maiden name, also name of husband.]


@RESIDENCE


9 Columbia st maplewood


Registered No.


16 DATE OF DEATH


June


30


(Month)


(Day)


1913


(Year)


If LESS than


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


10 NAME OF


FATHER


aaron Heller


(Duretion)


3


mos.


ds.


yrs.


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," "Haemorrbage," " Inanition," "Marasmus," " Old age," "Sbock," "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.


PARENTS


12 MAIDEN NAME


OF MOTHER


Surepta Whitcomb,


1ª BIRTHPLACE


OF MOTHER


(State or country)


Swansea TH,


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informent)


(Address)


44 Cheste Cir


Filed 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


9-30 9.2.


7


(Month)


(Day)


J- 1913


(Year)


I HEREBY CERTIFY that I attended deceased from


march


1913


to


1913.


that I last saw him. alive on


30


1913


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


9:30am


m.


The CAUSE OF DEATH* was as follows :


apoplex 1 / Cerebral (newoche.)


.(Duration)


3


mos.


ds.


Contributory


General arterio delensio


(SECONDARY)


(Duration)


yrs. .


mos.


.ds.


(Signed)


M.D.


..... y


* 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 piece


of death.


......


.. yrs.


.......


... mos.


ds.


State


.......


... yrs.


mos.


ds ...


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


Former or usual residence


1ª PLACE OF BURIAL OR REMOVAL LudlowVE


DATE OF BURIAL


7/8, 193


........


20 UNDERTAKER


WC. Skaggs


ADDRESS


Winthrop


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


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


m


4 COLOR OR RACE


W


· SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


mannes


6 DATE OF BIRTH 5 13 (Month) (Day)


(Year)


7 AGE


If LESS than


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


68 yrs. 1 mos


13


ds.


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


& OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) Generel nature of industry,


business, or establishment in


which employed (or employer).


· BIRTHPLACE


(State or country)


" Chester Vt,


10 NAME OF


FATHER


Louis ffiel


11 BIRTHPLACE


OF FATHER


(State or country


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Winthrop


(No. HH, Cheetcetera


Oscar B. ffice


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


Шимвкор пака/


St. : Ward)


(City or town.)


Registered No.


1913 (Address)


yrs.


in the


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: («) 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 ('AUSING 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 usc 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 deatbs 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


I PLACE OF DEATH


Winthrop


(No.


-Sp coule Cottage


St. :


Ward)


annie Buckle (UneConnote)


'FULL NAME


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


widow of Years Buckle.


29 Rue St. Basta.


Registered No.


26008


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX female


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Kordowed


1$ DATE OF DEATH


July 5


191 ....


..........


(Month)


(Day)


(Year)


6 DATE OF BIRTH


26


185 # 17


(Month)


(Day) (Year)


7 AGE


If LESS than


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


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


& OCCUPATION


(a)' Trade, profession, or




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