USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 150
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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: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, etc., of.
(name origin; "Cancer" is less definite; avoid use of "Tuinor" for malignant neoplasms); Measles; Whooping cough; Chronie valvular heart disease; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broneho- pneumonia (secondary), 10 ds. Never report mere symp- tonis or terminal conditions, such as "Asthenia," "Ancmia" (merely symptomatic), "Atrophy," "Col- lapse," "Comna," "Convulsions," "Debility" (“Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birtli or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolie acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions 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, Exposure, 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.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY PHYSICIAN.
R 15. 1-'18. 100,000.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH Winthrop
(No
30
Bellevue Chip
...
St. :.
.. Ward)
Come
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] "RESIDENCE 30 Bellevue Ar IN anthrote Masc
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
( Write the word)
6 DATE OF BIRTH
Dec (Month)
4 (Day)
1918
17
( Year)
7 AGE
If LESS than
yrs. mos ... ds.
Of .min. ?
8 OCCUPATION (a) Trade, profession of Matter what Many
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE (State or country ) Winthrop Masa
10 NAME OF
FATHER
Quaseel Cone
PARENTS
11 BIRTHPLACE OF FATHER (State or country )
Beverly Marad
12 MAIDEN NAME OF MOTHER
Bertha Cobus
J
13 BIRTHPLACE OF MOTHER (State or country)
Chelsea Mass
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
In Buccell Comp
(Address)
15
Filed
Dec. 14, 1918. Enlatis Churchil,
assy. REGISTRAR
MEDICAL CERTIFICATE OF DEATH
IG DATE OF DEATH
(Month)
4 (Day)
, 191
( Year)
I HEREBY CERTIFY that I attended deceased from
, 191.
18
to
Der 4
, 1910,
191. and that death occurred, on the date stated above, at 94070
The CAUSE OF DEATH* was as follows :
20 hours
(Duration)
. ..
. yrs.
Contributory
(SECONDARY)
mos.
ds.
(Signed)
, M.D.
. 1.
2
(Address).
* If death followed injury or violeuee 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
Woodlawn Everett.
1918
,
20 UNDERTAKER
ADDRESS
٢
East Boston
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
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 or town.)
[If death occurred in a hospital or institution. give its NAME instead of street and number.]
Registered No.
8
day, hrs. that I last saw hm alive on
Dec. 4, 1918
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthifulness 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, 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," "Dealer," etc., without more precise specification, as Day laborer, Farne 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 oecu- 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 clefinite; avoid use of "Tumor" for malignant neoplasms) ; Measles, Whooping cough, Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intereurrent) affection need not be stated unless in- portant. Example: Measles (diseaso causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility." ("Congenital," "Senile," ete.), "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 septicemia," "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, Starration, Suffocation, Exposure, 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.
R. 15. 7-'17. 100,000.
The Comumwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(No.
57 Ocean Vai
St. : ....... .Ward)
Jefferson
Beichen
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
54,00can
Veci
.... Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
1918
....
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from
191
........ j to
191
that I last saw his
......
alive on
,
1918
and that death occurred, on the date stated above, at
2,00
m.
The CAUSE OF DEATH# was as follows :
arteriosclerosis
Hypertrophy + delatation of heart-
(9)
.(Duration)
.. yrs. ..
.............. mos.
.........
ds.
Contributory
Qualora
(SECONDARY)
.. (Duration).
mos. ............... d ..
(Signed)
Horace Sauce
...
M.D.
Dec 78, 1918
(Address).
Winthrop, 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).
In the
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
DATE OF BURIAL
12/9
....
20 UNDERTAKER
ADDRESS
Filed. Dec. It, 1918 Eulalie Churchill Quit REGISTRAR
(City or town.)
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
1 PLACE OF DEATH
2 FULL NAME
3 SEX
male
$ DATE OF BIRTH
7 AGE
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer).
PARENTS
18 BIRTHPLACE
OF MOTHER
(State or country)
CAUSE OF DEATH in plain terms, so that it may be properly classifled. Exact statement of OCCUPATION is very
important. See instructions on back of certificate.
16
N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
....
4 COLOR OR RACE
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
(Month)
(Day)
61837
1
(Year)
If LESS than 1 day ......... hrs.
80
.yrs.
11
mos.
1
ds.
or .... min. ?
9 BIRTHPLACE
(State or country)
Chelsea (not)
10 NAME OF
FATHER
Jambe Welchen
11 BIRTHPLACE OF FATHER (State or country) Chelsea (Moret)
12 MAIDEN NAME
OF MOTHER
mary Whitting
Whilenão me
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address) vecchio
16 DATE OF DEATH
Dec. 7, 1918
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oceu- 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, Architeet, 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) Groecry; (a) Foreman, (b) Automobile factory. The inatcrial 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 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 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 saine disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie 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., 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 imn- 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," "Haeinorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all discases 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, ete.
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-1918.
CITY OF BOSTON
FULL NAME
MYRA CROCKETT
Registered No. 16146
ST.ELIZABETHS HOSPT.
Place of Death
Boston
Date of Death
DEC.9
1918.
Age
54 years
months days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
F
W
S
Maiden Name
Husband's Name
oATHIon& Primary li (DurationO
SOBIS
OFFICE
Name of Father
SELDON L.CROCKETT
Birthplace
of Father
MEREDITH.N.H.
Maiden Name
of Mother
LUCY L.STAPLES
Birthplace of Mother
TAMWORTH.N.H.
(Signed) J . J . WARD M.D.
DEC . 9TH
1918
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal WILMINGTON
Usual Residence WINTHROP (77 PLUMMER AVE)
Filed
1918.
A true copy.
Attest :
DEC -14
Date of Burial
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness 1918, from 1918, to 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:
AR
CEREBRAL HEMORRHAGE -19 DYS
Birthplace
BOSTONIA
TVIT
CONDITAA.
B
TMINE DONATA
STON.
MASS.
Contributory: { MYOCARDITIS -ENDOCARDITIS
(Duration )
Occupation
AT HOME
Informant
CITY R
CANAAN.N.H.
0. 1822.
Undertaker
W. H . THOMAS
Registrar.
Dec 9, 1918
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1918.
CITY OF BOSTON 16396
FULL NAME
EDWIN J.EVANS
Registered No.
Place of Death
Boston
52 FULTON ST.
Date of Death
DEC.16
1918.
Age 62
years 3
months
13
days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
M
Maiden Name
Husband's Name
Birthplace
- -N.F.
Name of Father
JOHN EVANS
Birthplace of Father
ENGLAND
Maiden Name of Mother
MAGDALENE POOL
Birthplace of Mother
ENGLAND
Occupation
SHIPPER
DEC.17 SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
WINTHROP (WINTHROP CEM)
Undertaker C.R.BENNISON
WINTHROP
Usual Residence WINTHROP (44 LOCUST ST)
Filed DEC .20 1918.
A true copy.
Attest :
Date of Burial
PHYSICIAN'S CERTIFICATE.
1918, I HEREBY CERTIFY that I attended deceased during last illness from 1918, to 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:
TRAR'S ONTRIBUS Primary
CITY
DaFFICE
BOSTONIA
CONDITAALL
D. 1822.
SREOIMINE DONATA D 1630. STON MASS.
COMPOUND FRACT. (CRUSH) OF SKULL CAUSED BY AN ACCIDENTAL FALL INTO AN ELEVATOR WELL
Contributory : { (Duration)
(Signed)
G.B.MAGRATH MED-EX-
M.D.
1918
Informant
Registrar.
Dec. 16, 1918
carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classifled. Exact statement of OCCUPATION is very important. See instructions on back
of certificate.
14
Informant
(Address) , Spielen 3t
15
Filed Lice 26, 19 18
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) 12-21- 19/ Y
17
I HEREBY CERTIFY, That I attended deceased from
Seteh.
30
18
Dea. 21.
,19.
18.
19
to.
that [ last saw
helle alive on
Dec 19.
., 19.
and that death occurred, on the date stated above, at
6.4.
m.
The CAUSE OF DEATH* was as follows :
Intestinal Carcinoma
(duration)
2
yrs. (2)
.mos.
ds.
CONTRIBUTORY
nephriter
(SECONDARY)
(duration)
yrs. ~ 3
.. mos.
ds.
18 Where was disease contracted
if not at place of death?
Did an operation precede death?
Date of-
-Was there an autopsy ?
no.
What test confirmed diagnosis ?
(Signed)
1/21918 (Address)
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
U
20 UNDERTAKER
ADDRESS
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
m
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED, (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year) .
185$
7 AGE
Years 63
Months
Days
If LESS than 1 day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(h) General natare of industry, business, or establishment in which employed (or employer) (c) Name of employer
9 BIRTHPLACE (city or town). (State or country) maria
10 NAME OF FATHER Fohn Alanaja
PARENTS
11 BIRTHPLACE OF FATHER (city or town)
(State or country)
Ireland
12 MAIDEN NAME OF MOTHER Elizabeth Horas
13 BIRTHPLACE OF MOTHER (city or town).
(State or country)
Ireland
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE OF DEATH
County.
Suffolk
State
mark
Registered No ...
Township
or Village?
or
City
Winthrop
410.
Shirley
St.,. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
William n. Hlavaga
(If in the Army or Naty of the United
e United States,give rank, organization, etc.) St., .Ward.
(a) Residence.
No. 410 Show
(Usual place of abode) Length of residence in city or town where death occurred 63 years months
(If non-resident give eity or town and State)
days.
How long in U. S., if of foreign birth ?
years
months
,
4. Partes
M.D.
1000 -
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]
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 terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- ilor, Architect, Locomotive 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) Salesman, (b) Grocery; (a) Forcman, (b) Automobile factory. The ma- terial 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 Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. It 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 indi- cated 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: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal inenin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 Gs .; Broncho- pneumonia (secondary), 10 ds. Never report inere symp- toins or terminal conditions, such as "Asthenia." "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" (“Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e a sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations - on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions 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, Exposure, 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.
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE OF DEATH
County.
uffock
State
mass
Registered No.
Township
Whentrop
or Village.
............. . or
Sam
mes Que
St., ............
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
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