USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 87
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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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