USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 88
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3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE.
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
Manuel
· DATE OF BIRTH
9 1858
1
(Month) (Day)
(Year)
7 AGE
If LESS than
( day ........ hrs,
56 yrs.
yrs.
mos.
ds.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Luft Sheets
-
(b) General nature of industry.
business, or establishment in
which employed (or employer).
1
' BIRTHPLACE
(State or country)
Hollowell me
(Duration)
............. yrs.
mos.
10 ds.
Contributory
Pacteraemig
(SECONDARY)
(Duration)
mos.
ds.
(Signed)
Mch 15, 1915
(Address)
will be
* 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 pisco
of death
......... yrs.
.... mos.
In the
ds.
Ststo ........
............ yrs.
mos.
ds .............
Where was disease contracted,
If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
3/16
1915-
D UNDERTAKER
ADDRESS
Wuchnot .......
1 PLACE OF DEATH
Wencheof-
(No. 225 Pleasant 81-
St. :
....... Ward)
(City or Lowh.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
alvan, Hall Dean
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
225 Pleasant Ih Wurdeny mary
....
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH
Auch
(Month)
(Day)
14
1915
(Year)
17
I HEREBY CERTIFY that I attended deceased from
5
191
to
much 14 ^
1915
that I last saw him alive on
mich 14
1915
and that death occurred, on the date stated above, at
8 Am. .
The CAUSE OF DEATH* was as follows :
Lobar Pneumonia
10 NAME OF
FATHER
Samuel De am
11 BIRTHPLACE
OF FATHER
(State or country)
Solon me
M.D.
1
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Man. 7 .
1 7 1
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dcaler," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, 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, peritonaeum, 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 discasc; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase 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 ean 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.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Winthrop
(No
187 Show Duri
St. :
Ward)
willing (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Catherine
Elizabet Mc/Kenney
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
widow of John S. Mckennay
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX female
4 COLOR OR RACE
mute
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
16 DATE OF DEATH
Tauch
(Month)
15
(Day)
1915 -
(Year)
$ DATE OF BIRTH
July
25
1843
(Month) (Day)
(Year)
7 AGE
If LESS than I day ......... hrs.
71 yrs. 7 mos. 18 ds.
or ........ min. ?
* OCCUPATION (a) Trade, profession, or particular kind of work
(b) General nature of industry. business, or establishment which employed (or employer)
· BIRTHPLACE
(State or country)
Middleton- mass
10 NAME OF
FATHER
11 BIRTHPLACE
OF FATHER
(State or conntry)
12 MAIDEN NAME
OF MOTHER
Susan . A. Puller
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
C.R. B cuma
(Address)
REGISTRAR
...
17 I HEREBY CERTIFY that I attended deceased from
1915. to March, 6 , 1910. that I last saw he alive on III auch 15, 1914. and that death occurred, on the date stated above, at 17m. The CAUSE OF DEATH* was as follows : Cerebral applied
(Duration)
........
yrs.
3
ds.
Contributory (SECONDARY)
(Duration)
mos. ds.
(Signed)
Hurry all the
M.D.
& luckice, 1915 (Address) 22511 will
-
* If death followed Injury or violence the certificate of death must be made ont 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
y's.
mos.
Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
3,8
1910
........
20 UNDERTAKER
C.R. Beroun
ADDRESS
Filed .. 19!
PARENTS
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
mar. 15, 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, ete. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ete., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestie service for wages, as Servant, Cook, Housemaid, 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, peritonaeum, 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, ete. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-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 ean be ascertained as the eause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State eause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medieal Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homieide, ete.
2. Deaths supposedly eaused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, ete.
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.
1
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) Scotland.
12 MAIDEN NAME
OF MOTHER
Quiz a Miadellam
18 BIRTHPLACE OF MOTHER (State or country)
Lance Eduna Solama
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informent)
hurdignes macdonal d'
(Address)
62 Choes Nite
14
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
1 SEX
male White.
' COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR-DIVORCED
(Write the word)
Dnavira
16 DATE OF DEATH
11 anch
15 1
191
5
............
(Month)
(Day)
(Year)
$ DATE OF BIRTH
(Month) (Day)
1
(Year)
If LESS than
I day ......... hrs.
ds
Or ........ min. ?
* OCCUPATION
(·) Trade, profession, or
perticuler kind of work
Retired
(b) General nature of industry,
business, or establishment in
which employed (or employer) ..
17 I HEREBY CERTIFY that I attended deceased from 11,0ml 13. 191.5 .... , to. 11 1 week 15, 1919. that / last saw h. alive on , and that death occurred, on the date stated above, at ...........?...... m. The CAUSE OF DEATH, was) as follows :
1
(Duration).
............... yrs.
.. mos.
3
..
Contributory (SECONDARY)
.. (Duration) .. yrs.
mos.
ds.
(Signed)
M.D.
Jack 15/1915 (Address) 325 Wwith08
* 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 pisce
of death.
.......
In the
.. yrs.
.mos.
ds.
Stete ............ yrs. ...........
Where was disease contracted, If not at place of death ?. Former or usual residence
M PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Phan 17. 1915
20 UNDERTAKER
ADDRESS
Winthrop
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Alexander Macdonald
2 FULL NAME
..............
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
82 avse St
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH
nathrop
.......
(No ...
82 Cosa
St.
Ward)
.........
....
$ BIRTHPLACE
(State or country)
Sim unic Eduardas Land
Bland
10 NAME OF
FATHER
John Lacclovald.
7 AGE
81
„yrs.
.... mos.
STANDARD CERTIFICATE OF DEATH. 1
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architcet, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, 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- CASE 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 "Epidemie ecrebro-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 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," "Hacmorrhage," "Inanition," "Marasmus," "Old age,". "Shock," "Uracmia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL 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 is very
important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH
Brookline
(No Free Hospital for Women
ST.
.... Ward)=
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME Eliza H Huxley (Eliza H Booth)
[If married or divorced woman or widow give maiden name, also name of husband.]
widow of David G Huxley
@RESIDENCE
#90 Cottage ave Winthrop
Registered No.
76
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
March
1 9 .....
1915
(Month)
(Day)
(Year)
" DATE OF BIRTH
May
(Month)
(Day)
1.85117 (Year)
TAGE
If LESS than
! day, ......... hrs.
57
... yrs.
mos. ds.
or ........ min. ?
& OCCUPATION
(a) Trade, profassion, or
particular kind of work
At home
(b) General nature of Industry.
business, or establishmant in
which employad (or employar)
3 BIRTHPLACE
(State or country)
England
10 NAME OF
FATHER
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
England
12 MAIDEN NAME
OF MOTHER
Harriett
Stanfield
13 BIRTHPLACE
OF MOTHER
(State or country)
England
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs Charles H Whitney
(Address)
Mar 20 Gawardel Saker REGISTRAR
I HEREBY CERTIFY that I attended deceased from
Mar 14
191.5., to
Mar
.. 1.9
191.5 ......
that I last saw h ..... @.X alive on
Mar
19
191.5 .... ,
and that death occurred, on the date stated above, at ... 9 .. 50 pm
The CAUSE OF DEATH* was as follows :
Cystocele, Prolapse of Uterus
Operation for
years ......... (Duration) ........ yrs.
mos. ds.
Contributory
(SECONDARY)
Minutes
(Duration)
.. yrs.
mos. ds.
(Signad)
Frank
A
Pemberton
M.D.
191
Mar 19
5
(Address).
Brookline
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
In the
of death.
yrs.
mos.
ds
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Winthrop Mass
DATE OF BURIAL
Mar 22, 191.5.
16 Filed
20 UNDERTAKER
Chas R Bennison
ADDRESS
Winthrop
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
Brookline
(City or town.)
3 SEX
Female
4 COLOR OR RACE
White
28
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widow
Joseph Booth
Pulmonary Embolism
.......
.. mos.
ds.
Stato ........
... yrs.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive cngincer, 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) 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 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," 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 neoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (mcrely 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 deathis 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 duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
1
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
not Ofnouns
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Zuro, U.S. Barton
(Address)
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