USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 190
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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 such 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 Physicians 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 certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), 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.
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.
14 Daniel 1. Cammer dor
Informant
(Address)
15 54 Filed Seph 15, 192%
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) Sept. 7 1921
17 I HEREBY CERTIFY, That I attended deceased from Juli. 19.21, to 19 ... 21
that I last saw him
alive on
Laht 6
19
21
-and that death occurred, on the date stated above, at 1030X m. The CAUSE OF DEATH* was as follows :
inteiro -ecluses.
(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 ?
KO Date of.
Was there an autopsy ?.
no
What test confirmed diagnosis ?
(Signed)
9/7, 19 2\ (Address)
* State the DISEASE CAUSING DEATHI, 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
Old Calvary
DATE OF BURIAL
sep 9.
19
U
ADDRESS
20 UNDERTAKER
Godward learner nomment any
329 Chantal
KM
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town)
1 PLACE OF DEATH
County
' Suffolk
Township
Minthrows
Mass
State
Massachusetts ....
Registered No.
141
City.
BOSTON
No.
or Village
or
St.,. Ward .- , (If death occurred in a hospital or institution, give its NAME instead of street and number)
Michael
Cannes
(a) Residence.
No.
19 Beach
ansavy of the United States, give rank, organization, etc.)
Roud
St ..
Ward.
....
(If non-resident give city or town and State)
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
white
WWW.byMENTIED, WIDOWED, OR-
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Margaret Laney
6 DATE OF BIRTH (month, day, and year) Cannot be learned
7 AGE V Years
Months
2
Days
2
If LESS than 1 day, ........ hrs. or ........ mio.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particolar kind of work.
(b) General nature of industry,
business, or establishment in
which employed (or employer)
(c) Name of employer
geland
9 BIRTHPLACE (city or town)
(State or country)
10 NAME OF FATHER Daniel Carmey
PARENTS
11 BIRTHPLACE OF FATHER (city or town) ..
(State or country) Greland
12 MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (city or town) ..
(State or country)
Ireland
M.D.
1
2 FULL NAME
Winthrop
(Usual place of abode)
Length of residence in city or towo where death occurred
years
mooths
days.
How long io U. S., if of foreign hirth ?
years
1
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 term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engineer, Civil engineer, 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) 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," ete., 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 Housekcepers 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. If the occupation lias been changed or given up on account of the DISEASE CAUSING DEATHI, 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 .- Namne, first, the DISEASE CAUSING DEATH (the primary affeetion 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 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 "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection necd not be stated unless important. Example: Mcasles (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," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting fromn child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ete. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or IIOMICIDAL, or as probably such, if impossible to de- terniine 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." (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, ete.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strcet, 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.
-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH County
Suffolk
State
Massachusetts
Registered No. 142
City or Town
Isabella, S.
..... . Ward (If death ocermed in a hospitalar institution, give its NAME instead of street and number, Frasier
(If in the Army or Navy of the United States, give rank, organization, etc ..
(a) Residence.
No
( Usual place of abode)
Leogth of resideoce in city or town where death occurred
€
years
4
months
days.
How long io U. S., if of foreigo birth ?
years
months days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
white.
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
widow
5a If married, widowed, er divorced
( where of
Daniel, E. France
6 DATE OF BIRTH
Marcelo
( Month)
(Day)
(Year)
7 AGE
81
Years
Months
6
Days
4
1 day ......... his. er ....... min.
If STILLBORN, eoter that fact here 2
8 OCCUPATION OF DECEASED
(a) Trade. professioo, or
particular kind of work
at Home
(b) Name of employer
Dorchester
9 BIRTHPLACE (City)
(State or country)
Mais
PARENTS
11 BIRTHPLACE OF
FATHER (City)
(State or country)
maine
12 MAIDEN NAME
OF MOTHER
almira Naitt
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Man
14
Informant
(Address)
Nunduok Centre, Mais.
15 Sept 15 /199 Bessie & Dodge
(Month) (Day) (Year)
assi REGISTRAR
21 | HEREBY CERTIFY that a satisfactory slan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
F.a. mowry
Official position
Healthofeen
Dale of issoe Cept 9
Permit 930
No ...
21
Cinq
6
, 19 2/, to ...
Left 7
.1.9
that Last saw halive on
Self- 6
21
19
and that death occurred, on the date stated above, at.
If LESS than
The CAUSE OF DEATH was as follows :
Secondary anaemia
por cardenal weer
(duration)
. yrs ...
1
mos .....
ds.
CONTRIBUTORY arterio Sacras
( SECONDARY)
18 Where was disease contracted
if not at place of death? .
FOR WHAT?
yrs.
mos.
ds.
X
Date of
Did an operation precede death ?...
10
no
Was there an autopsy ? ..
What test confirmed diagnosis ?
(Signed)
. M.D.
(Address )
Date ..
Sift
9
(Month)
(Dav)
(Year)
1921
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL Left 10-1921
(Cemetery) Cambada (City or town)
20 UNDERTAKER
C.P. Bennem
ADDRESS
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
STANDARD CERTIFICATE OF DEATH
(City or Town)
. No ...
Beren Villa Wurde St
2 FULL NAME
Beacon Villa Vula
(If non-resident give city or town and State)
MEDICAL CERTIFICATE OF DEATH
Sett
Day,
1921
Year
16 DATE OF DEATH.
Month
17
I HEREBY CERTIFY, That I attended deceased from
3
1840
10 NAME OF
FATHER
Finire Brugeso
Wayne 0
Clinical
1
Also
Sept 7.1991 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise 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 ou the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. Butin many cascs, 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 material worked on may forin 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 house- bold 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, ctc. If the occupation has been changed or given up on account of tho 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: Cere- brospinal fever (the only definite synonyin is "Epidemic cerebrospinal 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, ctc., 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 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atroplıy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," ctc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ctc., when a definite disease can be ascertained as the causc. 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.)
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 discases, 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 deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he dicd [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last scen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Sccs. 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 physician, 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 sball 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, Sec. 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 dicd, 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 to 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 physlclans will certify to such 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 Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have dicd without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or clectrical 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
143
Registered No.
25 Pleasant St Withinthe Ward
No.
City or Town
(If death occurred in a hospital or institution, give its NAME instead of strect and number,
William Henry Johnson
2 FULL NAME
(a) Residence.
No.
25 Pleasant
St.,
Ward.
(If non-resident give city or town and State)
( Usual place of abode)
Length of residence in city or town where death occurred
25 years
months
days.
How long in U. S., if of foreign birth ?
years
mouths days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Hace
4 COLOR OR RACE
5 SINGLE. MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIEL of
Mariah W. Johnson
6 DATE OF BIRTH
(Month)
1838
(Day)
( Year)
7 AGE
Years
-82
Months
H-
Days 9/
22
1 day, ........ h:s. or ....... min.
If STILLBORN, enter that fact herc
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Name of employer
"recuer"
Cambridge
9 BIRTHPLACE (City)
(State or country)
10 NAME OF
FATHER
Thomas
PARENTS
11 BIRTHPLACE OF
FATHER (City).
(State or country)
.n.H
12 MAIDEN NAME
OF MOTHER
E Hannah. Hansa
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
11.74
14 Mariah. W. Johnson
Informant.
(Address)
25 Pleasant St
15
Just 15 1931
(Month) (Day) (Year)
REGISTRAR
21 I 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
on health officer
Date of issue 9/11/21
Permit
No. .. 332
instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See BAU BLE dne funDIDA za DInous
(
Indefinite ... (duration)
.. . mos ....
ds.
CONTRIBUTORY .. ( SECONDARY) several suas (duration)
yrs ...
mos.
ds
18 Where was discose contracted
if not at placo of death ?
FOR WHAT?
Did an operation precede death ?
74 . Date of
Was there an autopsy ?
20.
Clinical
1
What test confirmed diagnosis ?
(Signed)
A.l. Portar
, M.D.
( Address ) ..
Date.
(Month)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
wrecking
DATE OF BURIAL 9/11-21
(Cemetery) Winthrop ( ity or town)
20 UNDERTAKER
ADDRESS
Mig
MEDICAL CERTIFICATE OF DEATH
1901.
16 DATE OF DEATH
Mosthi
Left.
(Day)
Y. ar
17 I HEREBY CERTIFY, That I attended deceased from Jefer. 6., 1921, to Sefet. 9., 19/2/2
that I last saw hacece
alive on
Defit. 9.
, 192 /
and that death occurred, on the date stated above, at 6.00
The CAUSE OF DEATH was as follows :
m
Interstitial nephritis (Chronic)
Chronic.
yrs ... . Cystitis
Dekk.
IC .
1921.
(Yogr)
00. M.
The Commonwealth of Massachusetts
Wir the Army or Navy of the United States, give rank, organization, etc.)
Ceny 18
if LESS than
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupation is very iniportant, 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 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) Croccry; (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 specification, as Day laborer, Farm laborer, Laborer - Coal mine, ete. 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, 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: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoncum, etc., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (discase causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senilc," cte.), "Dropsy,""Exhaustion,""Heart failure,""IIcmorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""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.
(Recommendations on statement of cause of death approved by Com- inittee on Nomeuclature 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.
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