Town of Winthrop : Record of Deaths 1913-1915, Part 51

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 51


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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10 BIRTHPLACE


OF MOTHER


(State or country)


18 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Charles Y. Nurneon -


ADDRESS


" UNDERTAKER 6. G. it herman Low


...


18 NAME OF


FATHER


-


If LESS than


f day .......... hrs.


$ SEX


N. B. - Every Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state


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 agc. 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 lino is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Groecry; (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 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 lungs, meninges, peritonacum, etc., Careinoma, Sar- coma, etc., of .... ... (name origin: "Cancer" is less definite; avoid usc of "Tumor" for malignant ncoplasms); Measles; Whooping cough; Chronie 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," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "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 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 strect, 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


Wmthof Mans ( No. 46200mg Rd


.St.


Ward)


(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


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Manuel


DATE OF BIRTH


(Month)


(Day)


(Year)


" AGE


If LESS than


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


......... yrs.


.......


mos .. ds.


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


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Dentist, infostre,


(b) General nature of industry,


business, or establishment in


which employed (or employer).


9 BIRTHPLACE


(State or country)


B) Shelfum Nova Scotia


PARENTS


11 BIRTHPLACE


OF FATHER


(State or conntry)


Shelbum Nova Scotia


12 MAIDEN NAME


OF MOTHER


thang offofifound


13 BIRTHPLACE


OF MOTHER


(State or conntry)


of helfrom Her Sind.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


16 Filed


.191


......


.......


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


28°


191


(Month)


(Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from


mich 1st


191 ....


to


191


4


.....


that I last saw h hs


alive on


March 28


1914


and that death occurred, on the date stated above, at. 7.30bm.


The CAUSE OF DEATH* was as follows :


Carcinoma of Resending Colon


Operation


1


(Duration).


1


mos.


ds.


Contributory


acute obstruction ? loves


(SECONDARY)


mos.


1


ds.


.(Duration)


31 milcall


.yrs.


M.D.


(Signed)


Jack 31, 1914 (Address)


* If death followed injury or violence the certificate of death must be made out hy the Medical Examiner.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death.


yrs.


mos.


3 de.


In the


State ...


yrs.


... mos.


......


ds ..


Where was disease contracted,


If not at place of death 7.46


tedy boring Road worthing may


Former or


usual residence.


19 PLACE OF BURIAL OR REMOVAL Antes Cemetary


DATE OF BURIAL


19151


ADDRESS


30 UNDERTAKER


Charte Mains


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.


BOSTON .......


James Himfred the


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


46 Joining Rd


1871


10 NAME OF


FATHER


Halter


... yrs.


..........


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 cach 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, cte. 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) Forcman, (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 None.


.


4


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 diseasc. 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, peritonacum, etc., Concarne, Qui coma, etc., of. „(name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Mcasles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (discase 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 discases resulting from childbirth or miscarriage, as "PUER- PERAL scpticacmia," "PUERPERAL peritonitis," etc. Stato 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- posurc, etc.


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


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


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1914. ABRAHAM PERKINS SOUTHARD


CITY OF BOSTON.


3252


FULL NAME


Place of Death } and Residence S


Boston


Date of Death


1914.


Age


45


years


9


months


22


days.


STATISTICAL DETAILS.


SEX.


COLOR.


SINGLE, MARRIED, WID., DIV.


M


W


MAR.


Maiden Name


Husband's Name


KENNEBUNKPORT. ME


Birthplace


Name of Father


GEORGE E SOUTHARD CIVITATIS R


Birthplace


of Father


VASSALBORO.ME.


Contributory : 3 (Duration)


LOBAR PNEUMONIA - 3 DAYS


(Signed)


E.W. WILSON M.D.


APR. 1


1914


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen! Residents.


ADMITTED TO HOSPT. MAR. 30. 1914.


Usual Residence


Filed


1914.


A true copy.


Attest :


WINTHROP (106 CLIFF AV)


APRIL 7


ErMSlenen


Registrar.


0


Place of Burial or removal EVERETT (WOODLAWN ) BROWN & ROLLINS


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from


1914, to


1914, 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'


PATRIB


Primary ( Duration),


CU


NFICE


BOSTOVIA


CONDITAA.


THISF DON TAD


N. MASS.


Maiden Name of Mother


MARTHA E PERKINS


Birthplace of Mother


BIDDEFORD ME.


STEWARD


Occupation


Informant


Undertaker


CITY HOSPT.


Registered No.


MAR . 31


AC. CARDIAC DILA. I DAY


TAD.1822.


mar. 31, 1914


1


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


Hintheok


(No. 40)


Delando vouz


Ward)


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


illie H. Movies-


2FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.].


@RESIDENCE


guillot 40 Orlanda vr Registered No.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE,


WIDOWED,


OR DIVORCED


(Write the word)


· DATE OF BIRTH


5 (Month)


(Day)


.I


(Year)


7 AGE


If LESS than 1 day ......... hrs.


28 yrs. (i) mos


22


ds.


of ......... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


ethome


(b) General nature of industry.


business, or establishment in


which employed (or employer).


9 BIRTHPLACE


(State or country)


I definite


.(Duration) -............ yrs. ................ mos. ...... ds.


Contributory


(SECONDARY)


(Duration)


............. yrs.


mos.


ds.


(Signed)


M.D.


1914


(Address)


218 Main / Brüchen


* 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


„mos.


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


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


Former or usuai residonce.


1 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


4


......


44. 1914


D UNDERTAKER


ADDRESS


Fl!ed


, 191


REGISTRAR


18 DATE OF DEATH


4


(Month)


(Day)


1


, 1914


(Year)


I HEREBY CERTIFY that I attended deceased from


1913


to


191.


that I last saw h.d ..... alive on


March 31


191.7 ...


.......


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


The CAUSE OF DEATH* was as follows :


Ch Myocarditis


10 NAME OF


FATHER


foton Morrer


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


mane


12 MAIDEN NAME


OF MOTHER


bratt


13 BIRTHPLACE


OF MOTHER


(State or country)


Maure


1. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Esivie 3. Moules


(Address)


1841 15


7


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthifulness of various pursuits can be known. The question applies to cach 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, Architcet, 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 None.


Statement of cause of death. - Name, first, the DIS- DASE 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; Broneho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .... .... (name origin: "Cancer" is less definite; avoid usc of "Tumor" for malignant ncoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; 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 .; Broneho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senilc," etc.), "Dropsy," "Exhaustion," "Hcart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Wcakness," etc., wlien a definite discasc can be ascertained as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septieaemia," "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, ctc.


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


3. Sudden deaths of persons not disabled by recognized discase, 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


( psaly)


Scholl


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


41 Cercles di-


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Mate


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


april 2 1914


(Month)


(Day)


1


(Year)


7 AGE


If LESS than


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


mos.


ds.


or ..


.min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer).


2


' BIRTHPLACE


(State or country)


10 NAME OF


FATHER


Edward Scholl


PARENTS


12 MAIDEN NAME


OF MOTHER


Ulga. Liniek


18 BIRTHPLACE


OF MOTHER


(State or country)


AUSTRA


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


REGISTRAR


16 DATE OF DEATH


Ed


1914


...........


(Month)


(Day)


(Year)


17 I HEREBY CERTIFY that I attended deceased from


191


..... , to


191


.. that I last saw hilcie alive on 191 and that death occurred, on the date stated above, at 94m. The CAUSE OF DEATH* was as follows :


Stell Born


(Duration)


........ yrs.


mos.


ds.


Contributory (SECONDARY)


(Duration) ..... yrs.


mos. ds.


(Signed)


N.l. Carter


M.D.


aby. .


191.24


(Address).


Winchuck.


* If death followed injury or violence the certificate of death must be made „ont 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.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


1


18.1.191


20 UNDERTAKER


ADDRESS


Filed 191.


...


Winchof


(City or town.)


Ward)


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


(No. St. :


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.


N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state


-


11 BIRTHPLACE


OF FATHER


(State or country)


yrs.


ups. 2. 1914


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) Automobilefactory. 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 ro- 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


I PLACE OF DEATH


Vinthrop


(No.


52 Chrystal bour


CASTE


Ward)


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


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 12 Chrystal Gove AvE . Vinthron


Registered No.


MEDICAL CERTIFICATE OF DEATH


" DATE OF DEATH


apr


(Month)


(Day)


1950


(Year)


I HEREBY CERTIFY that l; attended deceased from


apr.5


1912, to


apr.5.


that I last saw h ........_ alive on


als.5


19140


...


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


Isq.m.


The CAUSE OF DEATH* was as follows :


Internal Their ownlige.


.. (Duration)


........


de.


Contributory ...


Carcinoma of Intestino


(SECONDA


tudef.


.(Duration)


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


da


(Signed)


HAY Partil


M.D.


0764. 6. 1912 (Address) Vinuetraf Para


* 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 ........... yro.


mos.


de.


State ......


mos.




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