USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 11
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At place
of death.
......... yrs.
mos.
In the
ds.
State ............ 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
........
20 UNDERTAKER walkaago.
ADDRESS Withiert
....
...... Ward)
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 agc. For many occupations a single word or terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motivc 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 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, etc. Women at home, who are engaged in the duties of the household ouly (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 Nonc.
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, peritonacum, etc., Carcinoma, Sar- coma, etc., of (name origin: "Cancer" is less definite; avoid usc 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: 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," "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, Suieidc, 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.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1916.
CITY OF BOSTON.
FULL NAME
CATHERINE COUGHLIN
Registered No. 3513
Place of Death and Residence S
Boston
INFANT'S HOSP
Date of Death
MAR 27
1916.
Age
years
3
months 27 days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
W
SIN
Maiden Name
Husband's Name
Birthplace WINTHROP MASS
Name of Father
JOHN J COUGHLIN
Birthplace of Father
EAST BOSTON MASS
Contributory . (Duration)
-
GEN SEPTICAEMIA ( 2DS.)
(Signed) J1 GROVER M.D.
MAR 28
1916
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
WOODLAWN CEM. EVERETT
Usual Residence WINTHROP
(8 EDGEHILL RO. )
Filed
MARCH 31 1916.
Undertaker
J F O'MALEY
WINTHROP
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1916, to 1916, that to the best of my knowledge and belief death occurred, on the date stated above, and that the CAUSE OF DEATH was as follows :
RAR'S
UT
Primary ( Duraton
CITY
CTVY
BOSTONIA
COMEITAA
B
OSTO
EGIN
MIME DONATA A
. MASS.
Maiden Name of Mother
FRANCES L SHEFFIELD
Birthplace of Mother ESAT BOSTON MASS
Occupation
Informant
PATRIBIS. SIT D
OFFICE
RETRO-PHARYNGEAL ABSCESS (5 DS. )
TA A. 1822
A true copy.
Attest :
Emblemen
Registrar.
mmar. 27, 1916
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
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop .(No. 220 Woodside CEst. :
William
V. Samuele
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] aRESIDENCE 220 Thoodside Car. Wirdtop
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
m
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1
$ DATE OF BIRTH
8 (Month)
4
185%
(Year)
7 AGE
If LESS than
I day ........ hrs.
58
.... yrs.
V
mos.
24 ds.
or ....... min. ?
$ OCCUPATION
(a) Trade, profession, or
particular kind of work
·Machinist
(b) General nature of industry, business, or establishment in which employed (or employer) ......
Cerebral humanlea
(Duration)
........ yrs.
mos.
21
ds.
Contributory
(SECONDARY)
(Duration)
... yrs.
......
mos. ................
ds.
(Signed)
R. B Parku
M.D.
March 24, 1916 (Address)148 Within of ST.
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
In the
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
of death ..
............ yrs.
mos.
ds.
State ............ yrs. ............ mos.
ds .............
Where was disease contracted, if not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
Winthrop Ceret,
DATE OF BURIAL
3-30, 1916
20 UNDERTAKER W.C Shaggy
ADDRESS
Winthrop
important. See Instructions on back of certificate.
16
Filed 191
REGISTRAR
16 DATE OF DEATH
march.
28
(Month)
(Day)
,
1916
(Year)
17 I HEREBY CERTIFY that I attended deceased from March 9 1916, to. ....
March 28
1916.
that I last saw hw alive or
march 28
1916.
and that death occurred, on the date stated above, at.
130 Am.
The CAUSE OF DEATH* was as follows :
Cutivo Sclerosis
9 BIRTHPLACE
(State or country))
Hartford Com.
10 NAME OF
FATHER
Oliver Daniels
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
graping Corn.
12 MAIDEN NAME
OF MOTHER
Eliza Bus
13 BIRTHPLACE
OF MOTHER
(State or country)
Bloomfield Com.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Ул. Фрун. И. Далее
(Address)
469
......... Ward)
(City or iown.) ..........
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
.... Registered No.
(Day)
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 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 line 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. Tlie 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, 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 domnestie 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 cercbro-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, 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," "Wcakness," 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," ctc. 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.
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
1 PLACE OF DEATH 3 SEX 4 COLOR OR RACE Veniale DATE OF BIRTH mar (Month) 7 AGE 84 yrs. yrs. & OCCUPATION (a) Trade, profession, or particular kind of work (b) General nature of industry, business, or establishment In which employed (or employer) .... PARENTS 13 BIRTHPLACE OF MOTHER (State or country) (Informant) important. See Instructions on back of certificate. (Address) 16 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 ....... ...... mos.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(No. 2: Wheelock SL
St. :
Ward)
marian (Galés)2
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
28
. 196
....
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from 19/1 191 mh 28 to 1916 that I last saw hu alive on mk 2 5 1915 ...... and that death occurred, on the date stated above, at 11.30g The CAUSE OF DEATH* was as follows : apply of
4
(Duration)
......... mos. ......... ds.
Contributory. (SECONDARY)
.(Duration) yts.
mos. ds.
....
(Signed)
mel 3 196 (Address)
wanting
.....
* 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.
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
191
6
ADDRESS
Filed 191
REGISTRAR ....
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
2 2
1832
(Day)
(Year)
If LESS than ( day ......... hrs.
7
ds.
or ........ min. ?
9 BIRTHPLACE
(State or country)
Galés Mountain n.S.
10 NAME OF
FATHER
18 Jacob. Sales
11 BIRTHPLACE OF FATHER (State or country) D)Salió Mountain 4.5
12 MAIDEN NAME
OF MOTHER
May. Brown
M.S.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Margarett- Sherlock
wood Jamb. wheelock
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 2/ wheelche ff winches
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
20 UNDERTAKER C.R. Bemusa-
M.D.
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 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) Salcs- 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 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 Nonc.
Statement of cause of death. - Namc, 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 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 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 discase, 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.
2094
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Newton, Mass. (No ... 61 Central
.St.
4
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Roebuck S. Cordingley
{If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop, Mass.
Registered No.
159
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Male
4'COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (Write the word)
Single
6 DATE OF BIRTH
December 28 (Month)
(Day)
(Year)
7 AGE
If LESS than I day, .. hrs.
51
yrs. 3 mos. 2 ds.
or min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Druggist
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country).
(City or Town)
Boston, Mass.
10 NAME OF
FATHER
Frank Cordingley
PARENTS
11 BIRTHPLACE OF FATHER (State or country) (City or 'Town)
Heckmondwike, England
12 MAIDEN NAME OF MOTHER Maria W. Oddy
13. BIRTHPLACE OF MOTHER (State or country) (City or Town)
Leeds, England
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs. E.E.B. Johnson
61 Central St. , Auburndale, Meds. Newton Cemetery (Address)
16
Filed. Apr. 20 -196 frank haut
REGISTRAR
16 DATE OF DEATH
March
30
1916
(Month)
(Day)
(Year)
1864 17 I HEREBY CERTIFY that I attended deceased from to Mar. 25 , 196 Mar. 30 1916 that | last saw him alive on .. Mar. 30 1916. and that death occurred, on the date stated above, a6. 17 m. The CAUSE OF DEATH* was as follows : Lober Pneumonia
(Duration)
7 or 8 days .. yrs. mos. . ds.
Contributory.Myocarditis - Nephritis (SECONDARY)
(Duration) ..... ) ... yrs. .....
. . mos.
ds.
(Signed)
C. P. Hutchinson
M.D.
Mar. 30
196
(Address).
Auburndale, Mass.
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
.yrs.
mos. ..........
ds.
State
... yrs.
In the
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
Apr .1
6
191
20 UNDERTAKER
Cate
ADDRESS W. Newton, Mass
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.
City of Newton
(City or town.)
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loeo- 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 occupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE 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-
Agent.
cutosis of lungs, meninges, peritoneum, etc., C'arcinoma, Sur- come, etc., of. . (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough ; Chronie valvular heart disease ; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," "Exhaustion," "Heart failure," " Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
. 2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found deud, etc.
1
day of
this
Board of Health, City of Newton. The within return counter-signed and approved 191
TRANS PERMIT Authorized by the State Board of Embalmers
1 PLACE OF DEATH
County of
Van Diero
California State Board of Viralth BUREAU OF VITAL STATISTICS
State Index No.
Town of
or San Diego
City of.
No.
Ifarino Camp Exposition
St.,
1
(Dist.)
[If death occurred in a hospital or institution, give Its NAME instead of street and number. and fill out Nos. 18a and 180.]
PERSONAL AND STATISTICAL PARTICULARS
SEX
+ COLOR OR RACE
White
5 Single
Married
Widowed
or Divorced
(Write the word)
Single
6ª HUSBAND OF
Bb WIFE OF
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