Town of Winthrop : Record of Deaths 1919-1921, Part 162

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 162


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions on back


(State or country)


of certificate.


4 COLOR OR RACE


W


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


WID.


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


6 DATE OF BIRTH (month, day, and year)


---- 1845


Years


Months


Days


750


If LESS than


I day, ........ hrs.


or ....... min.


If STILLBORN, enter that fact here


8 OCCUPATION OF DECEASED


RETIRED


(a) Trade, profession, or


particular kind of work


9 BIRTHPLACE (city or town).


CAVADA


10 NAME OF FATHER


JOHN


11 BIRTHPLACE OF FATHER (eity or town)


(State or country)


IRELAND


12 MAIDEN NAME OF MOTHER


AUN GALLAGHER


13 BIRTHPLACE OF MOTHER (eity REEDA.N.D (State or country)


-


15


20 UNDERTAKER


J . L . MULDOON


ADDRESS


City or Town


Boston


No.


LONG ISLAND HOSET.


JOHN H. KELLY


(If in the Army or Nayy of the United States, give rank, organization, etc.)


(a) Residence.


State


(Usual place of abode)


Length of residence in city or town where death occurred


years


months


WINTHROP


No.


24 QUINCY AVE. - SE


may 2, 1921


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 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, Compos- itor, 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) Foreman, (b) Automobile factory. The ma- terial worked on inay form part of the second statement. Never return "Laborer.""


"Foreman," "Manager," "Dealer," ctc., 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 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 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 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 "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, meningcs, peri- toneum, etc., Carcinoma, Sarcoma, etc., of.


(namne 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 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms 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- mus," "Old age," "Shock," "Uremia," "Wcakness," 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.


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 diseasc, 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.


2-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


(City or Town)


1 PLACE OF DEATH


County


Suffolk


State.


Massachusetts


Registered No ..


68


City or Town


No.


St ...


.Ward


(If death occurred in a hospital or institution, give its NAME instead of street and number)


[thee Dorothy Brumby


(a) Residence.


No.


0. 56 Lincoln PL


(Usual place of ahode)


Length of resideoce in city or town where death occurred


2


years


months


days.


How loog io U. S., if of foreign birth ?


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Temal


4 COLOR OR RACE


white


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Single


5a If married. widowed, or divorced


HUSBAND of


(or) WIFE of


6 DATE OF BIRTH


( Month)


"(Day)


(Year)


7 AGE


Years


20


Months


10


Day's


13


1 day, ........ hrs. or ....... min.


If STILLBORN, eoter that fact here


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


(b) Name of employer


9 BIRTHPLACE (City)


(State or country)


10 NAME OF


FATHER


Francis 9. Brumby


11 BIRTHPLACE OF


FATHER (City).


England.


(State or country)


What test confirmed diagnosis ?


(Signed)


M.D.


(Address) ......


174 undhowl


Date


In


1


1921


( Month)


(Lav)


Year)


14


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL


(Cemetery)


(City or town)


.....


15


led May20 191


(Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


may 3


1921.


(Year)


17 I HEREBY CERTIFY, That I attended deceased from


July 1919, to.


7


that I last saw her alive on may 14 19.29.


756 9 m. and that death occurred, on the date stated above, at


If LESS thao The CAUSE OF DEATH was as follows :


of both Lungo


0


(duration)



.yrs ..............


mos.


ds.


....


CONTRIBUTORY ( SECONDARY)


(duration)


.yrs ...


........


mos ...............


ds.


18 Where was disease contracted


if not at place of death ?


FOR WHAT?


Did an operation precede death ?


Date of


Was there an autopsy ?


12 MAIDEN NAME


OF MOTHER


What. S. Williamin


13 BIRTHPLACE OF


MOTHER (City)


(State or country)


Informant


(Address)


20 UNDERTAKER


ADDRESS


wucht.


21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued S.a. Maury


Official position.


Healtho Officer


Date of of permit 5/5/21.


Permit No. 2.68


2 FULL NAME


(If in the Army or Navy of the United States, give fank, organization, etc.)


St., Ward.


(If non-resident give city or town and State)


16 DATE OF DEATH.


(Month)


(Day)


umN 14 -1900


PARENTS


in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.


The Commonwealth of Massachusetts


J. 101


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH


[Approved by U. S. Census and American Public Health Association]


.


Statement of occupation. - Preciso statement of occupation 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, Locomotive engincer, Civilengineer, Stationary fireman, etc. Butin many eascs, 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 material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specifieation, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold 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, ete. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state oceupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who liave 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 tho same disease. Examples: Cere- brospinal fever (the only definito synonym is "Epidemic ecrebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, 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, ete. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (discase causing death), 29 ds .; Bronchopneumonia (sccondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," cte.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., when a definite discase 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 operatlon was undertaken.


(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)


Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.


Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH


A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deccased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccascd, his supposed agc, the disease of which he died [defined so that it can be classified under the international elassification of causes of death], where contractcd, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 822.


No undertaker or other person shall bury a human body . .. until he has received a permit from the board of health or its agent, . . . or . . from the clerk of the city or town in which the person died; . . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physiclan, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . .. The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or eause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Scc. 88.


Medical examiners shall, in all cases, certify to the city or town clerk or to the eity registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed te have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.


RULES OF PRACTICE


The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians will certify to sueh deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.


(2) Board of Health Physlclans will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical examiners will investigate and ecrtify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septieemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


.


-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


(City or Town)


1 PLACE OF DEATH


County.


Suffolk


State


Massachusetts


Registered No. 69


City or Town


No ...


466 Plement St


St ..


.Ward


(If death occurred in a hospital or institution, give its NAME instead of street and number) William Ernest Medhold-


2 FULL NAME


..... 466 Plement & L


(a) Residence. No ..


(Usual place of abode)


Length of resideoce in city or town where death occurred


>


years


mooths


days.


How loog in U. S., if of foreign birth ?


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


thale


4 COLOR OR RACE


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Inger


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


6 DATE OF BIRTH


7 1898


( Month)


(Day)


(Year)


7 AGE


Years


Months


Days


246


If LESS thao


12


If STILLBORN, enter that fact bere


8 OCCUPATION OF DECEASED


(a) Trade, professioo, or


particular kind of work


(b) Name of employer Woods Machen. Co Gratin


9 BIRTHPLACE (City)


(State or country)


10 NAME OF


FATHER


Louis. T.


11 BIRTHPLACE OF


FATHER (City)


(State or country)


12 MAIDEN NAME


OF MOTHER


Many, Bruce


13 BIRTHPLACE OF


MOTHER (City)


(State or country)


Tia -


What test confirmed diagnosis ?


Pritin Sputum


(Signed)


Raymond B Pull


M.D.


(Address)


Winchamp


4


1921


(Month)


(Day)


(Year)


14


Informant


Miche Many Medholdt


(Address)


466 Clemensdit Which


15


Filed : 1/ 20,1971


(Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


3


1921


(Day)


,


(Year)


17


I HEREBY CERTIFY, That I attended deceased from


to.


may 3


19 2 1


......


July


1920


that I last saw h.


alive on


march 17


192/


and that death occurred, on the date stated above, at


4:10 A


.m


day .... .... hrs. The CAUSE OF DEATH was as follows:


or ....... min. Pulmonary Inhumains


(duration)


.yrs.


10


mos. ds.


CONTRIBUTORY (SECONDARY)


(duration)


yrs.


mos ................ ds.


18 Where was disease contracted


if not at place of death ?


FOR WHAT?


Did an operation precede death ?......


Date of


Was there an autopsy ?


no


Date ..


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


.....


(Cemetery) Winner


(City or town)


DATE OF BURIAL


May 5# 192,


ADDRESS


20 UNDERTAKER


CRB.


21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued S. a. maury.


Official .position,


Health Officier


Date of issue of permit 5/5/21.


Permit


No.


269


in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.


PARENTS


Queflamen


Wilmington-


16 DATE OF DEATH


(Month


(If non-resident give city or town and State)


(If in the Army or Navy of the United States, give rank, organization, etc.)


St.,


.....


Ward.


The Commonwealth of Massachusetts


In auf 3, 19 71


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH


[Approved by U. S. Census and American Public Health Association]


Statement of occupation. - Precise statement of occupatiou 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. F'or many occupations a singlo word or term on tho first line will be sufficient, e. g., Farmer or Planter, Physician, Compasitor, Architect, Locomative engineer, Civilengineer, 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) Cottan mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automabile 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, Laborcr - Coal minc, ete. Women at home, who are engaged in the duties of the house- hold only (not paid Hausckcepers who receive a definite salary), may be entored as Hausewife, Hausewark, or At home, and children, not gainfully employed, as At school or At hame. Care should be taken to report spe- cifically the occupations of persons engaged in domestic servico for wages, as Servant, Cook, Hausemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, stato occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who liavo no occupation whatever, write Nane.


Statement of cause of death. - Name, first, tho DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemio cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumania; Bronchapneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis af lungs, nicn- inges, peritaneum, etc., Curcinama, Sarcoma, etc., of .... . (nawie origin; "Cancer" is less definite; avoid uso of "Tumor" for malignant neoplasms); Measles; Whoaping cough; Chranic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Mcasles (disease causing death), 29 ds .; Bronchapneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (ineroly symptomatic), "Atrophy," "Col- lapso,""Coma,""Convulsions," "Dehility" ("Congenital," " Senile," etc.). "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia, ""Weakness," etc., when a definito disease can bo ascertained as tho 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.


(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)


Bronchopneumonla: If primary cause, write the word "pri- mary " ; If secondary, give primary cause.


Certificates will be returned for additional Information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH


A physician shall forthwith, after the deatlı of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of lis knowledge and belief the name of the deceased, his supposed age, the discase of which he died [defined so that it can bo classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Reviscd Laws, Chap. 29, Secs. 10 and 1, as amended by Acts af 1910, Chap. 822.


No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent, . . . or . . from the clerk of the city or town in which the person dicd; . . . no such permit shall be issued until there shall have boen dellverod to such board, agent or clerk, . . . a satisfactory written statement con- talning the facts required by law to be returned and recorded, which . . . shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in licu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficlent reasons, his certificate cannot be obtained early enough for the purpose, or Is Insufficient, the chairman of the board of health, if a physician, or any physician employed by sald board or by the selectmen for the purpose, shall upon application mako such certificate as is required of the attending physician. If death Is caused by violence, the medical examiner only shall make such certificate. . .. The person to whom tho per- mit is so given and the physician who certifies to the cause of death shall thereafterfurnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Scc. 38.


Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if kuown, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to havo come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.


RULES OF PRACTICE


Tho fulfilment of the purpose of these laws calls for the observance of tho following rules of practice:




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