USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 49
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The CAUSE OF DEATH* was as follows :
natural Causes :
Character in de las.
murate.
presumably
cardiovascular
disease.
(Duration)
.yrs.
.mos.
ds.
Contributory
(SECONDA
"Found dead).
mos. ds.
(Signed)
ury
Burgers Magnets,
M.D.
(Address) ...
MEDICAL EXAMINER
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At placo
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
2-23
.. 1917
20 UNDERTAKER I. C. Skaggs
ADDRESS
Winthrope
20
.... , 191.7
(Month)
(Day)
MEDICAL CERTIFICATE OF DEATH
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE base Witho Artel
8609 Winthrop. (City or town.)
Samu
9
greding
MARRIED DOLCH
1
(Year)
If LESS than
I day ......... hrs.
SI SIHL
PLAINLY, WITH UNFADING INK - WRITE PI
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 occupation ? 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," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- 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 homc. 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. - 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: Cercbro-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) ; Tube»
culosis of lungs, meninges, peritonacum, 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 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," "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. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine 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. g., sepsis tetanus) may be stated under the head of "Contributory."
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 duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
R 16. 7-'16. 5,000.
2 FULL NAME 3 SEX F. " DATE OF BIRTH 7 AGE PARENTS important. See instructions on back of certificate. Filed 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 70
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH Winthrop (No. 369 Winthrop
St. : Ward)
Winthrop (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
amning Churchill
[If married or divorced woman or widow give maiden name, also name of husband.]
Burk Kolm € ......... ....
@RESIDENCE
369 Winthrop St Winthrop
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
10 DATE OF DEATH
Feb 221
1917
(Month)
(Day)
(Year)
Sept
5
1546
(Month)
(Day)
(Year)
If LESS than i day ......... hrs.
.yrs .. 5 mos. 17 ds.
or ..... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
at home
(b) General nature of industry,
business, or establishment In
which employed (or employer).
9 BIRTHPLACE
(State or country)
Magdalen Islands
10 NAME OF
FATHER
William R. Burk
11 BIRTHPLACE
OF FATHER
(State or country)
Prince Edward Island
12 MAIDEN NAME
OF MOTHER
Ann Eulalie Calbeck
13 BIRTHPLACE
OF MOTHER
(State or country)
Magdalen Islands
Canada
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Eulalie Churchill (daughter)
(Address)
369 Winthrop St.
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
1915
191
Feb 22"
.... , to
1917
that I last saw hh
alive on
Feb 212
1917
and that death occurred, on the date stated above, at6 40 Am.
The CAUSE OF DEATH* was as follows :
General arterio devis
Cerebral Somosstage
(Duration)
2
yrs. ........... mos. ............ ds.
Contributory
(SECONDARY)
(Duration)
.yrs.
mos. .......
ds.
(Signed)
Birmalware
M.D.
21-23. 1917
(Address)
....
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
of death
... yrs.
mos.
ds.
State ..........
In the
.yrs. ........
... mos. ............
ds .............
Where was disease contracted, If not at place of death ? Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL north Parsonsfield, The.
DATE OF BURIAL
Heb. 26
1917
.-
20 UNDERTAKER
W. C. Skaggs
ADDRESS
Winthrop
2
4 COLOR OR RACE
2.
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
w.
191
Bay Fortune.
SIH. UNIOVANTY
OHOO3H LNINYWERSY 5
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, 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 ill 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 discase. 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 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 (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," "Hacmorrhage," "Inanition," "Marasmus," "Old age,". "Shock," "Uraemia," "Weakness," etc., when a definite disease ean be ascertaincd as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, 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.
PARENTS
LI BIRTHPLACE
OF FATHER
(State or country)
-
12 MAIDEN NAME
OF MOTHER
~
13 BIRTHPLACE
OF MOTHER
(State or country)
11
14 THE ABOVE IS TRUE TO THE BEST OF, MY KNOWLEDGE
(Informant)
Joseph tt Kinget
(Address) 91 Westrand ave
15
Filed
191
Boston
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
26.
(Month)
(Day)
., 1912
...........
(Year)
17 I HEREBY CERTIFY that I attended deceased from
1
(Year)
Feb. 21.
1917
to
Fil. 26
1912 ......
that I last saw !
Fich. 26
1917
and that death occurred, on the date stated above,
1-300m
.m
The CAUSE OF DEATH* was as follows :
Lohar Precumonia
Did a surgical operation precede death ?
Date
(Duration)
.... yrs.
mos.
5
Contributory
aceite Parenchy. Repheretic
....
(SECONDARY)
(Duration)
mos.
3
ds
(Signed)
....
William S. Parco
M.D
Feb. 26, 1917
Winterof
* 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
ds.
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 Hartford Corn
DATE OF BURIAL
Auf. 28/ 1917
20 UNDERTAKER ADDRESS Boston David tematis 387 Dudleyst
(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
1 SEX
Male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED
OR DIVORCED
(Write the word)
Single
' DATE OF BIRTH
(Month)
(Day)
' AGE
559
If LESS than
! day ......... hrs.
.... yrs.
mos.
ds.
... min ?
· OCCUPATION
(a) Trade, profession, or
particular kind of work
Retired.
(b) General nature of industry. business, or establishment which employed (or employer).
9 BIRTHPLACE
(State or country)
Unknown
10 NAME OF
FATHER
1.
[10-'16-XXM.]
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH
Minthogy Max
Cliff House st .:
Ward)
Andrew & Witch
*FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband ...
@RESIDENCE
Hartford
20mm -
BOSTON ......
... . y's.
Feb. 26, 1917
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Freeise statement of oceu- 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 occupation 3 a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, Loco- motive engineer, Civil engincer, 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," etc., without more precise specification, as Day laborcr, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who reccive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At homc. 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 faet 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 eausation), using always the same accepted term for the same 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 pneunonia; 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, etc. The contributory (second- ary or intereurrent) 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," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or misearriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," ete. 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, Suicidc, 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.
SIHL - XNI ONIOY
ITH UNFA WITH
WRITE PLAINLY, W
-
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
HOLYOKE.
........... (City or town.)
[If death occurred in a hospital or institution, give its NAME Instead of strset and number.]
2 FULL NAME
Many Helen Murphy
[If married or divorced woman or widow give maiden name, aiso name of dusoand.] ........ @RESIDENCE Hanthrop
PERSONAL AND STATISTICAL PARTICULARS
* SEX F
4 COLOR OR RACE
er
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word) Vingle
.
· DATE OF BIRTH
-..
January
31
(Month)
(Day)
, 1914 (Year)
7 AGE
If LESS than
I day ......... hrs.
1 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).
-
Congenital Cardiac Disease
(Duration)
ds.
Contributory
(SECONDARY)
(Duration)
.. yrs.
mos.
ds.
(Signed)
John Hughes
M.D.
mar 6
, 1917
(Address)
243 mayle St.
* 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
State ............ yrs. ............ mos. ...........................
of death,
h ............ yrs.
.......
.. mos.
18 de.
In the
Where was disease contracted, If not at place of death ?.
Former or usual residence
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Sisters of Providence
(Address)
Holyoke
Filed
16 Mar. 8 1917
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
march
6
1917
(Month)
(Day)
(Year)
....
17 I HEREBY CERTIFY that I attended deceased from
Feb.
26
191
7 to March 4, 1917
that I last saw her alive on. march 4 1917 and that death occurred, on the date stated above, at 2-30 A.m. The CAUSE OF DEATH* was as follows :
9 BIRTHPLACE
(State or country)
mars
10 NAME OF
FATHER
Unknown
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
Helen Murphy
18 BIRTHPLACE
OF MOTHER
(State or country)
mase
13 PLACE OF BURIAL OR REMOVAL
Calvary
Chicopee
DATE OF BURIAL
man: 8
1917
20 UNDERTAKER
D. J. Barry
ADDRESS
Chicopee
1 PLACE OF DEATH
APLACE OF DEATH
(No. Brightside Inst.
St. :
3
Ward)
Registered No.
.......... .
............ yrs. ................ mos. ..............
........
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," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - Coal mine, ctc. Women at home, who are engaged in the dutics 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 busincss, that faet 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- LASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. 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 ("Pucunonia," 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 disease; Chronic interstitial nephritis, etc. The contributory (sccond- ary or intercurrent) affection necd 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- acmia" (mcrely 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 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, ete
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.
507 SHIRLEY
(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
MEDICAL CERTIFICATE OF DEATH
3 SEX
MALE
' COLOR OR RACE
WHITE
6 SINGLE,
MARRIED,
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