USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 89
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24 Beal St
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH march 20
(Month)
(Day)
1915
(Year)
I HEREBY CERTIFY that I attended deceased from · Feb. 8 1915 to quando 20, 1915, that I last saw halive on March 15, 1995, and that death occurred, on the date stated above, at.
......... „m. The CAUSE OF DEATH* was as follows : arterio-silenzio
Did a surgical operation precede death ?
Date
(Duration)
yrs.
............
mos.
ds.
Contributory (SECONDARY)
(Duration)
......
.yrs.
mos.
... ds.
(Signed)
Charles ?. Makenay
M.D.
365 Unchamp&
bunch 23 1915 (Address)
* If death followed Injury or vlolence 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.
State
yrs. .........
mos.
Where was disease contracted, if not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL new Calvary
DATE OF BURIAL
Mar 24 1915
O UNDERTAKER
Jos, C, Fallivan
ADDRESS
35-4 91 way
-..
(City or town.) {If death occurred in a hospital or institution, give its NAME instaad of street and number.]
Daniel D Healey
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
24 Beal 87
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
repète
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Medower
$ DATE OF BIRTH
(Month)
(Day)
19 45 17
(Year)
7 AGE
If LESS than
1 day ......... hrs.
72 -
mos ds.
Or ....... min. ?
* OCCUPATION
(a) Trade, profession, or
particular kind of work
.yrs .... Retired
(b) General nature of industry,
business, or establishment In
which employed (or employer) ..
· BIRTHPLACE
(State or country)
10 NAME OF
FATHER
tobuy
11 BIRTHPLACE OF FATHER (State or country)
Filed
191
The Commmuuralth of Massachusetts STANDARD CERTIFICATE OF DEATH
BOSTON .........
1 PLACE OF DEATH Zinflerof (No. 24 Beal St. :
...... Ward)
20
7
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, c. g., Farmer or Planter, Physician, Compositor, Architeet, Loco- motive engineer, Civil engineer, Stationary fireman, ctc. 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 cxamples: (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, ctc. 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, ctc. 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 "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., Careinoma, 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 (sccondary), 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," "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.
7
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
....
..........
(City or town.)
[if death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Muito
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Maril
·DATE OF BIRTH
Tên
1862
1
(Month)
(Day)
(Year)
7 AGE
If LESS than
I day ......... hrs.
53 yrs. yrs.
2 mos. 17 de.
or .. .min. ?
$ OCCUPATION
(a) Trade, profession, or
particular kind of work
Salesman
(b) General nature of industry,
business, or establishment In
which employed (or employer).
$ BIRTHPLACE
(State or country)
Gardener
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Gardner Mars
12 MAIDEN NAME
OF MOTHER
May Femme
1ª BIRTHPLACE
OF MOTHER
(State or country}
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
18
Filed ... 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
march
(Month)
(Day)
.
1915
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Jany
6
191.S., to
march 23, 1915
that I last saw h cwalive on
march 22
1915.
and that death occurred, on the date stated above,.at
850 am.
The CAUSE OF DEATH* was as follows :
Typhoid Fever
(Duration)
2
mos.
yrs.
17 da.
Contributory :.
Septic Primaria and
(SECONDARY)
Endocarditis
.(Duration)
„yrs.
mos.
8 ds
ds.
(Signed)
Corviele 8. Johnson
M.D.
Juan 25. 1015 (Address).
Winthrop. mass.
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
10 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At plece
of death.
.. yrs. ........
In the
... mos. ..........
ds.
State .........
.. yrs.
mos.
Where was disease contracted, If not at place of death ?. Former or usual residence
18 PLACE OF BURIAL OR REMOVAL Gardien Maso
DATE OF BURIAL
1915
........
" UNDERTAKER
ADDRESS
1 PLACE OF DEATH
(No Z
George.
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
>
St. :
Ward)
23
10 NAME OF
FATHER
Lincoln. L.
mar. 2 5 17 ! .
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 cngincer, 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 Housc- 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) ; 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 discasc; 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 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.
278 wunschet
St. :
....... Ward)
2 FULL NAME
Edgar. Weken- Barkas
[If married or divorced woman or widow give maiden name, also name of trusband.] @RESIDENCE
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
Muito
6 SINGLE,
MARRIED.
WIDOWED,
1
(Year)
7 AGE
If LESS than I day ......... hrs.
55 yrs. mos. 3 .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)
9 BIRTHPLACE
(State or country)
Leerling Ya
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
England
12 MAIDEN NAME
OF MOTHER
Susan Rather
13 BIRTHPLACE
OF MOTHER
(State or country)
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
CRISuma
(Address)
REGISTRAR
16 DATE OF DEATH
March
(Day) 24 1915
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Hid. 121
1915, to
Ich. 24
1910
....
that I last saw heure alive on
Meh rych
1915
and that death occurred, on the date stated above, at 3-30
The CAUSE OF DEATH* was as follows :
Interstitial 21 phritis
In def
(Duration)
.yrs.
...........
.. mos.
ds.
Contributory ...
(Duration)
.. yrs.
... mos.
ds.
(Signed)
Dr.J. Parter
M.D.
mch. 2. 1915 (Address)
* 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).
At place
of death
........ yrs.
mos.
ds.
State
... yrs.
In the
mos.
Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL Lesburg Va
DATE OF BURIAL
3/27
195
20 UNDERTAKER
-
ADDRESS
wuch/_
16 Filed .... 191
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
$ DATE OF BIRTH
Feb 21
(Month)
(Day)
1860
(Write the word)
(Month)
....
10 NAME OF
FATHER
thomas. No
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, Loeo- motive engineer, Civil engineer, Stationary fireman, ctc. 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 houschold 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 sehool 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; Broneho- 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 ncoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mcre 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," "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 septieaemia," "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
40 Trident avz
St. :.
.....
Ward)
WINTHROP BOSTON (City or town.) [If death occurred in a hospital or instituticn, give its NAME Instead of street and number.]
2 FULL NAME
Bertha
Hario
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
40 Trident ane W inwhich
George a. Hanis
....
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
married
WIDOWED, -OR DIVORCED (Write the word)
$ DATE OF BIRTH
Sept-
(Month) (Day)
1
(Year)
7 AGE
62
.yrs. 6 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)
Komin Poland
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Konin Poland
12 MAIDEN NAME
OF MOTHER
Juba Koval
18 BIRTHPLACE
OF MOTHER
(State or country)
Yolin Poland
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Henrystanis
(Address)
146 River Rd, Winthrop
18 Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
march
2 1915
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
March 23, 1915, to.
mar. 2 4th
1912 .....
that I last saw h
alive on
march 20 11
1915
and that death occurred, on the date stated above, at
4P.m.
The CAUSE OF DEATH* was as follows :
of steve dich!
Did a surgical operation precede death ? Ho. Date
Indefinito
(Duration)
yrs. ................ mos.
ds.
Contributory.
(SECONDARY)
(Duration)
... yrs.
.........
.mos.
ds.
(Signed)
ml. Para
M.D.
makine.
... 19123 (Address)
.....
....
* If death followed injury or vlolence 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
" PLACE OF BURIAL OR REMOVAL Shahin Sholong
20 UNDERTAKER
C.R Ben
ADDRESS
DATE OF BURIAL
March 2
1915
...........
10 NAME OF
FATHER
Moses ElMann.
If LESS than
! day ........ hrs.
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 enginecr, 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 laborcr, 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 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 necd not be stated unless im- portant. Example: Mcasles (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," "Senilc," 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop (No. 63 Terrace HVE St. : .Ward)
2 FULL NAME
Essa
B. whither
[If married or divorced woman of widow give maiden name, also name of husband.] @RESIDENCE #63 Terrace are
winchent mass
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
white
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Marcel
6 DATE OF BIRTH
may
(Month)
(Day)
1848
(Year)
7 AGE 66
_yrs.
9
mos.
21
ds.
or ........ min. ?
8 OCCUPATION (a) Trade, profession, or particular kind of work
Profese. to-
(b) General nature of industry,
business, or establishment in
which employed (or employer)
Ofici thunder
9 BIRTHPLACE
(State or country)
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