Town of Winthrop : Record of Deaths 1913-1915, Part 69

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 69


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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2FULL NAME


Jan A. Moulton


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


North Randolph Ut.


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


1 SEX


M


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widowad


1ª DATE OF DEATH


10-


(Month)


(Day)


27


... 1914


(Year)


6 DATE OF BIRTH


4


(Month)


(Day)


18


1832


(Year)


7 AGE


If LESS than


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


82 yrs.


.... mos.


..... 9 da.


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


8 OCCUPATION


(a) Trade, profession, or


particular kind of work.


Retired


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


acute Nephritis


$ BIRTHPLACE


(State or country)


Tunbridge Ut.


(Duration) ............... yrs.


.mos.


20.00.


Contributory ...


Organic Htearh


(SECONDARY)


Diefree


.. (Duration)


........ yra.


sudet.


.mos. da


(Signed)


Och, 28 , 10/ (Address)


M.D.


Winthrop


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


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


At place


in the


of death ............ yrs.


mos.


da


State ........... y ... ......... moa.


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


Where was disease contracted,


If not at place of death ?.


Former or


usual residence


1º PLACE OF BURIAL OR REMOVAL Randolph Ut


DATE OF BURIAL


10-30, 1914


ADDRESS


Filed


191


REGISTRAR


-


I HEREBY CERTIFY that I attended deceased from


Och noth 1914, to


Oct 27


1915


. that I last saw he zalive on Oct. 18. 19156 and that death occurred, on the date stated above, at 11a.m. The CAUSE OF DEATH* was as follows :


Important. See Instructions on back of certificate.


PARENTS


12 MAIDEN NAME


OF MOTHER


1ª BIRTHPLACE


OF MOTHER


(State or country)


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(informant)


Clyde D. Moulton


(Address)


27 Pleasant Ps. Rd.


1&


" UNDERTAKER


HC. Skaggs


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


:


10 NAME OF


FATHER


Jude Moulton


11 BIRTHPLACE


OF FATHER


(State or country)


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, 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 tho 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," "Dcaler," etc., without more precise specification, as Day laborer, Farm laborcr, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- 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- BASE 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 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 in- portant. Example: Measles (disease causing death), 29 ds .; Broneho-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," "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 septicemia," "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 discasc, 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, Mass


(No.


11


Court Road


St. :


..................... Ward)


...


BOSTON (City or town.)


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


Mary A Agnew


2 FULL NAME


[If married or divorced woman or widow give maiden name, also name of /husband 12 @RESIDENCE 11 leary Road Winthrop Maso


.... Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


:


4 COLOR OR RACE


& SINGLE.


MARRIED


WIDOWED


Married


OR DIVORCED (Write the word)


16 DATE OF DEATH


Cect 30


(Month)


(Day)


4


191.


(Year)


$ DATE OF BIRTH


(Month) (Day)


1


(Year)


7 AGE 81


.yrs.


....... ... 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).


9 BIRTHPLACE


(State or country)


Ireland


PARENTS


11 BIRTHPLACE


OF RATHER


(State or country)


Ireland


12 MAIDEN NAME


OF MOTHER


Margaret


13 BIRTHPLACE


OF MOTHER


(State or country)


Ireland


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Daughter.


(Address)


16 Filed ., 191


REGISTRAR


17 I HEREBY CERTIFY that I attended deceased from


Oct


3 0


1914, to


Oct 30


191


4.


If LESS than


1 day ........


hrs.


that / last saw h.e.l .... alive on


Oct .30


1914,


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


2º p.m.


The CAUSE OF DEATH* was as follows :


Pulmonar Oedema


Did a surgical operation precede death ?


Date


Cento Exacerbada of


.(Duration)


... yrs.


.. mos.


3


.ds.


Contributory.


Chir PassachamaTus hepferitio asteño


Setemiss This Muncarchten Epitheturiu of nost?


rs.


ds


.mos 27


(Signed)


Oct 31


1914 (Address)


East Bastien Mars


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


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR


RECENT RESIDENTS).


At place


In the


of death.


.yrs.


.mos.


ds.


State.


.. yrs.


mos.


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


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Malden Holy Cross Nov 2


1914


20 UNDERTAKER


ADDRESS


Richard G. Nerby 15.11 Bennington


M.D.


10 NAME OF


FATHER


JohnM & learn


:


3 SEX


Female White


Widow


Francis.


50


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, Arehiteet, Loeo- motive cngincer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is neeessary 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, ctc. 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; Broneho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Careinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); 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 (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report merc 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," etc., when a definite disease can bo ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "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 due to Aleoholism, etc.


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


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 Wintheof (No. 52 Locust)


St. : Ward)


Elizabeth Budget Dors


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


52 Locust St.


Elizabeth B.MC Gowan widow of Charles St. TEL.


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Female White


4 COLOR OR RACE


5 SINGLE,


MARRIED.


WIDOWED,


OR DIVORCED


(Write the word)


Shadow


$ DATE OF BIRTH


June


(Month)


(Day)


8, 1842 17


(Year)


7 AGE


If LESS than


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


72


4


.mos.


24 ds.


or ...


.... min. ?


OCCUPATION


(a) Trade, profession, or


particular kind of work


Automa


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


9 BIRTHPLACE


(State or country)


Ireland


PARENTS


12 MAIDEN NAME


OF MOTHER


Bridget Deigman


1ª BIRTHPLACE


OF MOTHER


(State or country)


Dicland


" THE ABOVE IS TRUE TO THE BEST, OF MY KNOWLEDGE


(Informant).


Albert St, 20 cEst


(Address)


52, Locust It.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


10 DATE OF DEATH


(Month)


14


(Day)


1917


(Year)


1 HEREBY CERTIFY that I attended deceased from


out 30"


1917


........ , to


1914


that I last saw her


alive on


191%


oct 314


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


8300m.


The CAUSE OF DEATH* was as follows :


rente obstruction of bowels are to


hernia allowing Laparotomy 10 yrs


a80


(Duration).


.yrs.


mos.


-3


ds.


Contributory


(SECONDARY)


(Signed)


(Duration)


..... yrs.


mos.


.........


ds.


3/ Mul call


M.D.


INv 2ª, 1914 (Address)


134002 pullup Sit ..


* 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 ..


d ............


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


Former or usual residence


1 PLACE OF BURIAL OR REMOVAL Holy HardCom (Bucks)


DATE OF BURIAL


191 !...


20 LINDESTAKER


John J: Q' Haley


ADDRESS


Filed 191


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


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


.....


:


10 NAME OF


FATHER


Ower & Mº Gran


11 BIRTHPLACE


OF FATHER


(State or country)


Proland


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of oceu- pation is very important, so that the relative healthfulness of various pursuits ean 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, Architcet, Loco- motive engineer, Civil engineer, Stationary fireman, ete. 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," "Dcaler," 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 domestie service for wages, as Servant, Cook, Housemaid, ete. 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., Carcinoma, Sar- coma, ete., of .(name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart discase; Chronie interstitial nephritis, etc. The contributory (second- ary or intereurrent) 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," "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 septicacmia," "PUERPERAL peritonitis," etc. State eause 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 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.


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


Wentluch


(No.


47 Birch Roads


'St. :


Ward)


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


Anno Callahan france widow


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


47 Birch Rar)


of fameutones


....


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


:


3 SEX


' COLOR OR RACE


Female White


& SINGLE;


MARRIED,-


WIDOWED,


OR DIVORCED


(Write the word)


el Hadow


$ DATE OF BIRTH


mar


(Month)


10


1


(Year)


7 AGE


61


yrs ..


7


mos.


22


ds.


If LESS than


day.


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


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


At Home


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


9 BIRTHPLACE


(State or country)


Ireland


10 NAME OF


FATHER


Amex Callahan


PARENTS


11 BIRTHPLACE


OF FATHER


(Stater country)


Ireland


12 MAIDEN NAME OF MOTHER Anne Hanley


13 BIRTHPLACE


OF MOTHER


(State or country)


roland


14 THE ABOVE 15 TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


47 Burch Board


REGISTRAR


.. (Duration)


...... yrs.


mos.


ds.


Contributory.


Cerebral Salle


(SECONDARY)


(Signed)


(Duration)


E Chenany


mos.


.ds.


M.D.


1914


(Address)


222 Handel Son


* 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.


19 PLACE OF BURIAL OR REMOVAL It Fechles Com.


DATE OF BURIAL


Nov. 5.


4


20 UNDERTAKER


Holmt. O Malley


ADDRESS


(Winther


Filed 191


16 DATE OF DEATH


Self


(Month)


(Day)


(Year)


(Day)


17 I HEREBY CERTIFY that I attended deceased from Self-


191.6. to.


hoy L


1914.


that I last saw her alive on


nov 2


1911,


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


3 m.


The CAUSE OF DEATH* was as, follows ;


Chrome Inleshal


-


....


Vantuch


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, Laborcr - 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 (retircd, 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 discase. Examples: Ccrebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typheid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonacum, 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 discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report merc symptoms or te. minal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "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 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 onc supposed to be due to Alcoholism, etc.


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


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


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