USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 69
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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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