Town of Winthrop : Record of Deaths 1913-1915, Part 71

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 71


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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[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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