USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 38
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(Informent)
cattle ....
(Address)
parcelate 220200
Filed
191.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
8 SEX
Male
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Doborcel
6 DATE OF BIRTH
(Month)
7 AGE
43 yrs.
yrs.
3
mos.
27
ds.
& OCCUPATION
(a) Trade, profession, or
Tucker agenta
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer).
Rail Road
$ BIRTHPLACE
(State or country)
Hangar 1ml
(Duration)
yrs.
mos.
4 ds.
Contributory
(SECONDARY)
(Ducation) ... .
..... yrs. .
. mos.
ds.
(Signed)
Hm 18, 1913
(Address)
* 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.
1ª PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
11/19
1913
D UNDERTAKER
ADDRESS
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
19 Saymore than Woche Mods?
Charles. Chandler Lombar.
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
19 Segnare De Wünscht
Wildat
Ward)
(City or town.Y [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered Ner
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH
(Month)
17
. 1913
.....
(Day)
(Year)
21
18.69
17
I HEREBY CERTIFY that I attended deceased from
(Day)
(Year)
Dec 14
1913, to
1913.
-4
If LESS than
I day ......... hrs.
that I last saw h alive on
the
17-
1913,
or ..
min. ?
and that death occurred, on the date stated above, at
5,20pm.
The CAUSE OF DEATH* was as follows :
Pneumonia (Lobar)
10 NAME OF
FATHER
Cehar. S.
M.D.
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 Ilouse- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be 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 neoplasmc) ; 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 Winthrop (No. 18 Cheetos Av
St. : Ward)
Winthrop (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female White
' COLOR OR RACE
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
$ DATE OF BIRTH
(Month) (Day)
1842
(Year)
7 AGE
If LESS than
I day ......... hrs.
or ........ min. ?
$ OCCUPATION
(a) Trade, profession, or
particuler kind of work
At Home
ome
(b) General nature of industry, business, or esteblishment in which employed (or employer)
' BIRTHPLACE
(State or country)
Ireland
10 NAME OF
FATHER
O'Flynn
lynn
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Ireland
12 MAIDEN NAME OF MOTHER
Umberto
IS BIRTHPLACE OF MOTHER (State or country) Ierland
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informent)
William A Fielding
(Address)
18 Chester (Art
.........
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
the
(Month)
19'
(Day)
1913
(Year)
17 I HEREBY CERTIFY that I attended deceased from the 14 >
3
that I last saw ney
alive on
De 16ª
1913
and that death occurred, on the date stated above, at 1045 pm
The CAUSE OF DEATH* was as follows :
mitral and aortic recursitation
chimie Endo cardite
.(Duration)
6
mos.
ds.
Contributory
General arleno selerisis
(SECONDARY)
(Signed)
11 metcalf.
(Duration)
.yrs.
mos.
ds.
M.D.
De 20 1913 (Address)
Wmctrop
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
19 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
.yrs.
.mos.
In the
ds.
Stete
.........
yrs.
......
mos.
ds .............
Where was disease contracted,
If not at place of death ?.
Former or usual residence
1ª PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Holy Grove, Enaldent Dec. 21.
1913
D UNDERTAKER
form & O Unakey
ADDRESS
79. Atlantic It.
Filed 191
Ellen OFhim Driscoll 2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 18 Chester Ave. 0
Wifeof John f. Driscoll
.yrs.
1913, to
De 19
191.
71
yrs.
mos.
-
.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, ctc. Women at home, who are engaged in the duties of the household only (not paid Ilousc- 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 Nonc.
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 pucumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
4
. 1 4
culosis of lungs, meningcs, peritoneum, etc., Carcinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant ncoplasms) ; 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 couditions must be referred to the Medical Examiners:
1. Deaths following iujury 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 onc supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dcad, etc.
3 SEX Female PAGE PARENTS 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 81
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop (No 2 Limerick Park St. :
Winthrop
(City or town.)
[lf death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Lucy Turner Richardson
{If married or divorced woman or widow give maiden name, also name of husband.] Lucy Turner, George L. Richardson
@RESIDENCE
2 Limerick Park
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widowed
16 DATE OF DEATH
December 21 1913.
(Month)
(Day)
.191
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Due 17
1913
to
Du 21
193
that I last saw her alive on
21
191 .-
and that death occurred, on the date stated above, at/2-Pm.
The CAUSE OF DEATH* was as follows : acute Infectionne Chole-
cystitis
(Duration)
X yrs. X
mos.
4
ds.
Contributory.
arterio-sclerose
SECONDARY)
Sinal years
(Duration)
........... yrs.
.. mos.
-
ds.
"(Signed)
Suzz
191.3 .... (Address) ..
M.D.
* If death followed injury or violence the certificate of death must be made out by tho 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.
19 PLACE OF BURIAL OR REMOVAL Mt. Wollaston Cem., Quincy, Mass.
DATE OF BURIAL
12/24/13.
19i
----
(Address)
2 Limerick Park
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
· DATE OF BIRTH
January 27 1837
(Month)
(Day)
1
(Year)
If LESS than
1 day ......... hrs.
.yrs.
10
24
mos.
ds.
or ...
... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Housewife
(b) General nature of industry, business, or establishment i which employed (or employer).
9 BIRTHPLACE
(State or country)
South Scituate, Mass.
10 NAME OF
FATHER
Perez Turner
11 BIRTHPLACE
OF FATHER
(State or country)
Unknown
12 MAIDEN NAME
OF MOTHER
Sally Pinson
13 BIRTHPLACE
OF MOTHER
(State or country) Unknown
14 THE ABOVE IS TRUE TO THE BEST, OF MY KNOWLEDGE
(Informan
Jacob i Deccardraw Son
20 UNDERTAKER
ADDRESS
QUINCY
...... Ward)
STANDARD CERTIFICATE OF DEATH,
Statement of occupation. - Precise statement of oecu- pation 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, c. g., Farmer or Planter, Physician, Compositor, Architeet, 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) Salcs- 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, ete. 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 occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of cul
coma, etc., of ..... ...... ...... ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, ete. The contributory (sceond- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase 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," "Hacmorrhage," "Inanition," "Marasınus,", "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis,", etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deathis 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 discasc, 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.
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
3 SEX
M
· DATE OF BIRTH
' AGE
8 OCCUPATION
10 NAME OF
FATHER
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
PARENTS
WRITE PLAINLT, WITIT ONFADING INA THIS IS A PERMANENT NEVUND.
(b) General nature of industry,
business, or establishment in
which employed (or employer).
4 COLOR OR RACE
5 SINGLE,
MARRIED, Divorced
WIDOWED,
OR DIVORCED
(Write the word)
1
(Year)
39
yrs.
4
.mos.
ds.
...... Or ......... min. ?
(a) Trade, profession, or
particular kind of work
Bookkeeper
9 BIRTHPLACE
(State or country)
Boston
Unknown
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) .I Kovos Hall
(Address)
Filed Dec 20, 103 L. r. Hall
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dec 23 1913
(Month)
(Day)
191
(Year)
17
I HEREBY CERTIFY that I attended deceased from
De ....... 12
191 ..... 3, to .........
Foo 23 191791
........
that i last saw h.
alive on
191. .. and that death occurred, on the date stated above, at .... ............ m. The CAUSE OF DEATH* was as follows : General Syphilis
(Duration)
yrs.
mos.
ds.
Contributory Hepatic cirrhosis. Nocir
(SECONDARY)
ditis. Pericardi to(ation)
.... yrs.
...........
.mos. ..........
ds.
(Signed)
F. Van Nüvs
M.D.
Dec 24, 1913. (Address).
Weston
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
1ª LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
In the
At place
of death ............ yrs.
... mos.
ds.
State
......... yes.
mos.
.........
ds .............
Where was disease contracted,
If not at place of death ?.
Former or
usual residence.
19 PLACE OF BURIAL OR REMOVAL Cedar Grove, Boston
DATE OF BURIAL
........
191
20 UNDERTAKER
J S "itormun º Sons
ADDRESS
Boston
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
"FULL NAME
William F Smith
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop
...........
......... ......
St. :
Ward)
Waltham
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Waltham HospitalNo.
.......
Registered No. 416
PERSONAL AND STATISTICAL PARTICULARS
(Month)
(Day)
If LESS than
! day, ......... hrs.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to 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 occu- pation whatever, write Nonc.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie cerebro-spinal ineningitis") ; 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, peritonacum, etc., Carcinoma, Sar- coma, cte., of ... ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc .. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase 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," "Hacmorrhage," "Inanition," "Marasmus," "Old age,". "Shock," "Uracmia," "Weakness," cte., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or iniscarriage, as "PUER- PERAL septicacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1913.
CITY OF BOSTON. 11522
Registered No.
B. C. H. RELIEF STA.
69
10
16
1913.
Age
years
months
days.
STATISTICAL DETAILS.
SEX.
COLOR
SINGLE, MARRIED, WID., DIV.
W
MAR.
Maiden Name
Husband's Name
Birthplace
BOW N.H.
Name of Father
SCHUYLER WALKER
Birthplace of Father BOW. N. H.
Maiden Name of Mother
MARY GREEN
Birthplace of Mother
BOW N. H.
PROVISION DEALER
Occupation
Informant
PHYSICIAN'S CERTIFICATE.
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