USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 71
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[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
104 Highland Ave. Winthrop, Mass.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
' COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
single
$ DATE OF BIRTH
April 5, 1994
(Month)
(Day)
1
(Year)
7 AGE
If LESS than
[ day ......... hrs.
20
... yrs. 7 mos. .. ds.
min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
none
(b) General nature of industry,
business, or establishment in
which employed (or employer).
17
I HEREBY CERTIFY that I attended deceased from
Nw. 1st
1914
to
Nov. 6th
1914 .....
that I last saw he alive on
Nw. 6th
1914
and that death occurred, on the date stated above, at.
IP
m.
The CAUSE OF DEATH* was as follows :
Pericar Sitio+ Cu do car Sitro
Did a surgical operation precede death NO Date
(Duration)
.. yrs.
mos.
ds
Contributor Cardiac Hypertrophy with
(SECONDARY)
dilaterrighethecut (Duration) 7
.. yrs.
.. mor ....
ds.
(Signed)
BrainandaluSiens
M.D.
Nwych
, 1914 (Address 68) Wirtuofare
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner. Levere
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
In the
At place
of death.
.yrs.
... mos.
ds.
State ............ yrs.
.. mos.
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL Nashua
DATE OF BURIAL
191
» UNDERTAKER
fred! L. Bugga
ADDRESS
Boston
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back of certificate.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Derry N. H.
12 MAIDEN NAME
OF MOTHER
Elizabeth J Thompson
13 BIRTHPLACE
OF MOTHER
(State or country) Li'ast
Ireland
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
other
(Address)
I@4Highland Av -.
16
Filed 191
...... REGISTRAR
C
16 DATE OF DEATH
November
6 th
(Month)
(Day)
1915
(Year)
6
10 NAME OF
FATHER
Hobert IT.
9 BIRTHPLACE
(State or country)
Nashua N. H.
-
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 fircman, 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) 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 laborcr, Laborer - Coal minc, etc. Women at home, who are engaged in the duties of the household only (not paid House- kccpers 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) ; Tubcr-
culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of .. ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcaslcs; 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 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 dead, etc.
N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important. See instructions on back of certificate.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Philadelphia Per
12 MAIDEN NAME
OF MOTHER
Sarah Cooler
18 BIRTHPLACE
OF MOTHER
(State or country)
Philadelphia
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Wallace 6 .William
Filed
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH
non.
(Month)
(Day)
1918 (Year)
17
I HEREBY CERTIFY that
1
attended deceased from
Self.
191
nov. 8.
1914
to
that I last saw heer alive on
nos. 7.
1915
and that death occurred, on the date stated above, at.
3.9.
10-30 m.
1
The CAUSE OF DEATH* was as follows :
Diabetic
Indy
.(Duration)
yrs. .......
mos.
ds.
Contributory
Gangren of Hast
(SECONDARY)
(Duration)
2
mos.
ds.
(Signed)
Mal. Parter
M.D
Nov. 81, 1914 (Address)
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
of death.
.. yrs.
.... mos.
ds.
1
In the
State
Myrs.
mos.
ds .............
Where was disease contracted,
If not at place of death ?.
105 jours und
usual residence
Former or
105 groun we Were
IS PLACE OF BURIAL OR REMOVALU
DATE OF BURIAL
(Address)
65 bread de Would Said till Philo 11/10/11/2016
Central (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
1415
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
COLOR OR RACE
20
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
6 DATE OF BIRTH
march
(Month)
(Day)
1
(Year)
7 AGE
If LESS than
I day ......... hrs.
73
... yrs.
6
mos.
ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Relived
(b) General nature of industry,
business, or establishment
In
which employed (or employer).
· BIRTHPLACE
(State or country)
Philadelphia Pene
10 NAME OF
FATHER
Charles 13
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Withaf
(No. 17H Wenthub
St. : ....... .Ward)
metall Nr ... aliation & Williams
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Registered No.
....
A UNDERTAKER ADDRESS Eugen Garden Lowell
yrs. ...
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement ; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Lahorer," " 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 ('AUSING 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, 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 he 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 childhirth 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 ....
203 main.
St. : ...... Ward)
Winthrop (City or lownh) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Charles St Keen
" FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
203 main St Nw
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
· SEX
male.
4 COLOR OR RACE
White
' SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single.
$ DATE OF BIRTH
June 11
(Month) (Day)
1856
(Year)
7 AGE
If LESS than
I day ......... hrs.
or ......... min. ?
· OCCUPATION
(a) Trade, profession, or
particular kind of work.
Tollman
(b) General nature of industry,
business, or establishment in
which employed (or employer)
@ Boston Ferry
S BIRTHPLACE
(State or country)
East Boston
PARENTS
12 MAIDEN NAME
OF MOTHER
mary & Lower
1ª BIRTHPLACE
OF MOTHER
(State or country?
to Cambridge for Amass
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informan
mrs Strive
(Address) 203 main SV Mr
REGISTRAR
10 DATE OF DEATH
irro
(Month)
8
(Day)
1914
(Year)
17
I HEREBY CERTIFY that I attended deceased from
angy
1914, to
AW 8'
1914
.
that I last saw h ...
alive on
1914
and that death occurred, on the date stated above, at 2-15 Am.
The CAUSE OF DEATH* was as follows :
Sarcoma Oliver +
right arm
1
(Duration)
.............. yrs. ...
4
mos.
ds.
Contributory
(SECONDARY)
.. (Duration) .
yrs.
mos.
ds.
(Signed)
31 med calf
M.D.
......
, 1914 (Address)
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
of death
yrs.
In the
. mos.
ds.
State ..........
.. yrs.
mos.
ds .............
Where was disease contracted, If not at place of death ?.
Former or usual residence
IS PLACE OF BURIAL OR REMOVAL Winthropwas
DATE OF BURIAL
1914
.......
10 UNDERTAKER ett Fannie
ADDRESS
Chelsea
Filed 191
...
10 NAME OF
FATHER
Williamt Been
11 BIRTHPLACE
OF FATHER
(State or country)
Boston mass
2H
58 yrs. 4 mos 27 ds.
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) Groccry; (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- kecpers 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," unqualificd, 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 ncoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ctc. 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," "Haemorrhagc," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, 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 due to Alcoholism, etc
4. Deaths under circumstances unknown, as A person found dead, etc.
N. B. - Every Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No.
65 Bral
St. :
Ward)
(City or town.) {If death occurred la a hospital or institution, give its NAME Instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
4 COLOR OR RACE
W
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widowed
6 DATE OF BIRTH
10
5, 1836
(Month)
(Day)
(Year)
7 AGE
If LESS than
( day, ........ hrs.
78 yrs.
..........
1 mot
4 de.
Of ......... min. ?
OCCUPATION
(a) Trade, profession, or
particular kind of work
Retirez entes
(b) General nature of Industry,
business, or establishment in
which employed (or employer)
9 BIRTHPLACE
(State or country)
1
10 NAME OF
FATHER
thomas stra cona
PARENTS
11 BIRTHPLACE
OF FATHER
(State or conntry)
Engiana
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or conntry)
Engined
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
( Informant
(Address)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH
1 HEREBY CERTIFY that I attended deceased from
July
1914, to
Av 9
1914
that I last saw h
alive on
1914
and that death occurred, on the date stated above, at.
9 A .m.
The CAUSE OF DEATH* was as follows :
Chronic interstitial nephritis
(Duration)
............ da.
Contributory. (SECONDARY)
(Duration)
yrs.
mos. .
.............. ds.
(Signed)
M.D.
191 .... 4 (Address).
winstrol 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
of death,
........ yrs.
in the
da
Stato .......... yra.
........... mos.
Where was disease contracted, If not at place of death ?. Former or usual residence
1 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
11-11-1914
2 UNDERTAKER
Ha skugga
ADDRESS
Filed 191
Stidstone
2FULL NAME
[If married or divgreed woman or widow
give maiden name, also name of husband.]
@RESIDENCE
65 Beal St, Wiethe of
Registered No.
(Month)
(Day)
9. 1914
(Year)
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 ncecssary 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," "Forcman," "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., Carcinoma, 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 mere 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 be ascertained as the cause. Always qualify all discases resulting from childbirth or miscarriage, 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 onc supposed. to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dcad, etc.
N. B .- Every item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See Instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No
94 Jomerech are
St. :
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
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