Town of Winthrop : Record of Deaths 1913-1915, Part 87

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 87


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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Filed


_. 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


march


4


(Month)


(Day)


1910


(Year)


17


I HEREBY CERTIFY that I attended deceased from


March 1ch 1955


to.


march 10th,


1913.


that I last saw ball


alive on


195


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


120m. :


The CAUSE OF DEATH* was as follows :


>


mos.


ds.


Contributory: Chronio apatitis


mos.


(Duration)


yrs.


ds.


SECONDARY)


Dr& Paneer


(Signed)


M.D.


Doch 11th10 5


Winthrop


(Address)


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


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


In the


At place


of death ....


....... yrs.


mos.


ds.


State ...


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


mos.


................


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


3/12


1915


· UNDERTAKER


Couchent


(City or town.)


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


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


10 Kowy Road Nurchut Man Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


" DATE OF BIRTH


6 7833


(Month) (Day) (Year)


7 AGE


If LESS than I day ......... hrs.


81 yra. 7


mos.


ds.


or ..... min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry.


business, or establishment in


which employed (or employer).


" BIRTHPLACE


(State or country)


..........


...........


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


I PLACE OF DEATH nunchiof mass (No 1.0 Lowing Road


St. : Ward)


2 FULL NAME


Charles


Edward . Browns


.......


ADDRESS


whichit


(Duration)


... yrs.


10 NAME OF


FATHER


asa Browne


war


7 1915


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- 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, 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) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal minc, 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 rc- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite); Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, ctc., of. ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); 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," "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 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


Winthrop


(No.


30 Jalmira


St. ;........ ...... Ward)


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


Thomas


Richard Donovan


Donovan


? FULL NAME


{If married or divorced woman or widow


give maiden name, also name of husband .!


@RESIDENCE


20 Falmipra it


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


male White


{ COLOR OR RACE


& SINGLE,


MARRIED,


- WIDOWED,


OR DIVORCED


(Write the word)


mania


7


16 DATE OF DEATH


march


10


(Month)


(Day)


(Year)


$ DATE OF BIRTH


(Month)


(Day)


7 AGE 57


59


yrs.


10


mos.


uff


4


& OCCUPATION


(a) Trade, profession, br


particular kind of work


Sitarias Decorator


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


· BIRTHPLACE


(State or country)


It forme J.


PARENTS


12 MAIDEN NAME


OF MOTHER


NOT mark Conlin


18 BIRTHPLACE OF MOTHER (State or country) England.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Elizabeth UT Donovan


(Address)


Lo Talimiva


Filed ... 191


REGISTRAR


(Duration)


15 mo


ds.


Contributory


(SECONDARY)


(Duration)


yrs.


mos. ds.


(Signed)


Bovih


M.D.


Mas 10, 1919 (Address)


2 Cutrin Sh


* 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


yrı.


mos.


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


Former or usual residence


1 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Holy Cross malden Mar 11. 1915


· UNDERTAKEK


John J. Omalley


ADDRESS


Visitlevon,


....... yrs.


10 NAME OF


FATHER


Thomas Donovan


onovan


11 BIRTHPLACE OF FATHER (State or country) veland.


6


1856


17


I HEREBY CERTIFY that I attended deceased from


(Year)


Feb. 18


191.5 ... , to


mar 2


....


If LESS than


! day ......... hrs.


1915


that I last saw hum alive on


Jun 2


1915


ds.


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


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


......


.... m.


The CAUSE OF DEATH* was as follows :


Carcinoma y rectum


(City or town Y


WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.


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) Foreman, (b) Automobilc 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 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, Houscwork, 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, ctc., of. .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- 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 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 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 I, very


important. See Instructions on back of certificate.


16


Filed 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


3 SEX


Female Minite


4 COLOR OR RACE


6 SINGLE;


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Married


16 DATE OF DEATH


march


12


1915


(Month)


(Day)


(Year)


1848


17


I HEREBY CERTIFY that I attended deceased from


(Yeaf)


april 4


191


4, to March 12, 1915,


that I last saw her alive on


and that death occurred, on the date stated above, at. 9.10 Pm. The CAUSE OF DEATH* was as follows :


.(Duration)


.............. yra. ................ mo .. ................


ds.


Contributory. (SECONDARY)


(Duration)


... yrs.


...........


.mos.


ds.


(Signed)


Charles 7 hanhoney


M.D.


march 13, 1915 (Address) 355 Withof


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


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


In the


At place


of death.


.. yrs.


mos.


ds.


Stat ............. yrs. .


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


Where was disease contracted, If not at place of death ?... Former or usual residence


1 PLACE OF BURIAL OR REMOVAL 1


M UNDERTAKER


Toth . mary


ADDRESS


Winthrop


$ DATE OF BIRTH 7 AGE · OCCUPATION PARENTS WHITE PLAINS, WIR UNFADING INA UND A PERMANENT RECORD. (b) General nature of Industry, business, or establishment in which employed (or employer).


The Commonwealth of Massachusetts


1


115


STANDARD CERTIFICATE OF DEATH


PLACE OF DEATH


(City or town.)


(No


22 Adama


Margret Callahan Charles


...


St. ................


Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


(Month)


13


(Day)


67 .


6


mos.


30.


ds .


If LESS than I day ......... hrs.


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


(a) Trade, profession, or


particular kind of work


At Home


& BIRTHPLACE


(State or country)


teland.


10 NAME OF


FATHER


Callahan.


11 BIRTHPLACE


OF FATHER


(State or country)


Avelund.


12 MAIDEN NAME


OF MOTHER


Hanna Harrington


1ª BIRTHPLACE


OF MOTHER


(State or country)


leclancy.


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Million le cause


(Address)


22, adame.


It


DATE OF BURIAL


mar 15, 1915


1913


.....


2 FULL NAME


[if married or divorced woman of widow


give maiden name, also name of Husband.]


@RESIDENCE


22 Adams it


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- 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, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, ete. But in many eases, 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," ete., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, ete. 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 gard 9 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 oceupation 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- CASE CAUSING DEATH (the primary affection with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie eerebro-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., Murcinoma, 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, ete. The contributory (second- ary or intereurrent) affection need not be stated unless im- portant. Example: Measles (disease eausing 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," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease ean be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," ete. 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 violenee, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, ete.


18


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


184


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 eircumstances unknown, as A person found dead, etc.


1913


68


13


1847


N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in piain terms, so that it may be properly classified. Exact statement of OCCUPATION is very


important. See instructions on back of certificate.


Fait Ffert 425


The Commonwealth of Massachusetts win 1305 w STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH winthrop mass. (No. 206 Bathers Road St. :


...... Ward)


2 FULL NAME


Ruthe


Severo Rausing


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


206 Boutlet Road- winthrop-


.... Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


(Month)


(Day)


(Year)


17 I HEREBY CERTIFY that I attended deceased from


(3 195 to march 13 1915 that I last saw her alive on 13 1915. and that death occurred, on the date stated above, at 62% m. The CAUSE OF DEATH* was as follows : Cumplirkia - day to compressione


cord during forcebe operation


(Duration)


yrs.


.............


mos.


ds.


Contributory


(SECONDARY)


(Duration)


yrs.


.. mos.


ds.


(Signed)


, M.D.


March 24, 1915 (Address)


260 Clarana St Bota


....


* 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.


In the


ds.


Stato ...........


yrs.


.mos.


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


3/14


1915


.....


· UNDERTAKER


ADDRESS


Filed 191


REGISTRAR


16 DATE OF DEATH


march


13


1915


3 SEX


Fuente


* DATE OF BIRTH


7 AGE


$ OCCUPATION


(a) Trade, profession, or


particular kind of work


* BIRTHPLACE


(State or country)


PARENTS


WRITE PLAINLT, WITIT UNFADING INK - THIS IS A PERMANENT RECORD.


(b) General nature of industry.


business, or establishment In


which employed (or employer)


COLOR OR RACE


wennte


5 SINGLE


MARRIED,


Single


WIDOWED,


OR DIVORCED


(Write the word)


13


(Month)


(Day)


1915


(Year)


If LESS than


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


mos. ds.


or 15 min. ?


10 NAME OF


FATHER


Johns W . Ramsay


11 BIRTHPLACE


OF FATHER


(State or country)


Sencow - Scotland


12 MAIDEN NAME


OF MOTHER


I. Florence Leave


18 BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


C. R. Bunun


(Address)


Wiechert mars


Winetuch ...... (City or town.)


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


7. 13 , 197


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 eaclı 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 linc is provided for the latter statement; it should be used only when nceded. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.


Statement of cause of death. - Name, first, the DIS- 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, ctc., Carcinoma, Sar- coma, etc., of ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertaincd 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 one supposed to be due to Alcoholism, ctc.


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


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


12 MAIDEN NAME


OF MOTHER


Elizabet Lowclerote


18 BIRTHPLACE


OF MOTHER


(State or country)


Hollowell me


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


C.R. Because


(Address)


wiechert man


16


Filed 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH




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