Town of Winthrop : Record of Deaths 1922-1924, Part 69

Author: Winthrop (Mass.)
Publication date: 1922
Publisher:
Number of Pages: 1202


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 69


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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 saine disease. Examples: Cerebrospinal fevcr (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_


(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart discasc; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (discase 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," "Sliock," "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. 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 Aincrican 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.


-302


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


Attleboro


(City or town)


1 PLACE OF DEATH


County


Bristol


State ... Ma.ss


Registered No


170


(Place of residence) St. 2 Ward


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


2 FULL NAME


Delia S.Swint


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


(a) Residence.


State


Mass


(Usual place of abode)


City or Town


Winthrop


No


81 Otis


St.


Length of residence in city or town where death occurred


years


9


months


days


How long in 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)


Widowed


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


John W. Swint


6 DATE OF BIRTH (month, day, and year) May 19


1848


7 AGE


74


Years


7 Months


9


Days


If LESS than


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


or ........ min.


If STILLBORN, enter that fact bere


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


At Home


(b) Name of employer


(duration)


yrs


mos.


3


ds.


CONTRIBUTORY


Arterio Sclerosis


(SECONDARY)


(duration)


yrs.


. mos.


3


ds.


10 NAME OF FATHER


Henry Richardson


18 Where was disease contracted


if not at place of death ?


Did an operation precede death ?.


no


Date of


Was there an autopsy?


clinical


12 MAIDEN NAME OF MOTHER Catherine Simmond What test confirmed diagnosis


(Signed)


W.E .Rounseville


M.D.


12/3019 2 2Address)


Attleboro


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


Woodlawn


Attleboro


DATE OF BURIAL


Dec. 31


22


19


15


Filed Dec.30, 19 22 trank 1. 12 aber File QUI S, 197 3. Registrar of city or town where death occurred


Registrar of city or town where deceased resided


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH (month, day, and year)


Dec. 28


19 22


17


I HEREBY CERTIFY, That I attended deceased from


1922


Dec. 28


22


Dec ..


26


to


19


that I last saw h ..


er


alive on


Dec. 28


, 22


19


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


10:30₽


The CAUSE OF DEATH* was as follows :


Cerebral hemorrhage


9 BIRTHPLACE (city or town)


(State or country)


Mass


Melrose


PARENTS


14


Informant


Mrs .... C.M.Robbins


(Address)


Attleboro


20 UNDERTAKER C.F.stone


ADDRESS


Attleboro


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


of certificate.


20,000


Registered No.


265


(Place of death)


City or Town


Attleboro


No ..


218 County


carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,


11 BIRTHPLACE OF FATHER (city or town) Hartford


(State or country)


Conn


no


13 BIRTHPLACE OF MOTHER (city or town) Bristol


(State or country) .


NH


ADDED UNITED SIAIDS STANDARD CERTIFICATE OF DLA AIn


[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 on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive 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 iine 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 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 house- hold only (not paid Housekeepers who receive a definite salary), may be ontered 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, 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, 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), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Lebility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""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- 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 soie cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phiebitis, pyemia, septicemia, tetanus.


4


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


A physician or registered hospital medical officer 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 memberof the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belicf the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . .. - Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shail bury a human body ... . until he has received a permit from the board of health or its agent . . . or .. . from the clerk of the town where the person died; . .. No such permit shall be issued untii there shall have been delivered to such board, agent or cierk ... a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate 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, a physi- cian who is a member of the board of heaith, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by vioience, the medical examiner shali make such certi- ficate. .. . The person to whom the permit is so given and the physi- cian certifying the cause of death shali thereafter furnish 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. - Gen. Laws, Chap. 114, Sec. 45.


Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.


. .. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. . - Gen. Laws, Chap. 38, Sec. 7.


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. J


(3) Medical examiners wili 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 disabied by recognized disease, and those of persons found dead.


R-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


BOSTON (City or town)


County


Suffolk


State Massachusetts


Registered No.


171


City or Town


Boston


No.


26 Beacon


St.,


Ward


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


2 FULL NAME


Samuel Gilman


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


(a) Residence.


No ..


26


Beacon


St.,


.Ward.


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


Length of residence in city or town where death occurred


1


years


6 months


days.


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


40 years


-


mooths


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Male


4 COLOR OR RACE


White


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Mannierd


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


Janny


Gilman


6 AGE


Years


Months


Days


If LESS than


1 day, ........ hrs. or ....... mio.


If STILLBORN, enter that fact bere


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


(b) Name of employer


(State or country


9 NAME OF


FATHER


David Gilman


10 BIRTHPLACE OF


FATHER (City)


(State or country)


Russial


11 MAIDEN NAME


OF MOTHER


thet Sucer


12 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


Date


Wee.


28.


1923


(Month)


(Day)


( Year)


13


Informant


Happy


Galman


(Address)


11 Blancosich Chelsey


14 Jan 2. 1923 Elbert.


Filed ..


(Month) (Day) ( Year)


REGISTRAR


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


Roxbury Wirtual Socity


(Cemetery) Mans male (City of town)


DATE OF BURIAL Dec 29/22


19 UNDERTAKER


Masen SalamancaSon


ADDRESS


580 Blue Will ard


20 I HEREBY CERTIFY that a satisfactory stao- dard certificate of death was filed with me BEFORE the borial or transit permit was issued, albert & Smith


Official position ..


Secretary


Date of Permit issue of permit .. 12/28/22 No. 506


.


M.


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


8 BIRTHPLACE (City).


Russian


(duration)


yrs.


mos.


2


ds.


17 Where was disease contracted


if not at place of death ?


FOR WHAT?


Did an operation precede death ?


no. Date of.


-


Was there an autopsy ?


200.


What test confirmed diagnosis ?


(Signed)


Willigen A Partir


, M.D.


(Address)


Hars.


8.0


...... m.


The CAUSE OF DEATH was as follows :


angina Pectoris.


CONTRIBUTORY


(SECONDARY)


.(duration)


grippe


yrs ...


mos ..


ds.


15 DATE OF DEATH


(Month)


28


1922


Det.


(Day)


(Year)


16


I HEREBY CERTIFY, That I attended deceased from


Dec. 26.


1922


to Dea. 28, 1922,


.


that I last saw h eccalive on


Dece 27.


. 19.7.2


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


60


MEDICAL CERTIFICATE OF DEATH


(Usual place of abode)


should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH


000.


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 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 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 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 house- hold 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, es 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 (retircd, 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 discase. 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, 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 (disease 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,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""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- mittco 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, celiuiitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipeias, 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 or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertakeror 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 died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . . - Gen. Laws, Chap. 46, Sec. 9.


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 town where the person died; . . . No such permit shall be issued until thereshall have been delivered to such board, agent or clerk .. . a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate 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, a physi- cian who is a member of the board of heaith, or employed by it or by the selectmen for the purpose, shail upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shail make such certi- ficate. .. . The person to whom the permit is so given and the physi- cian certifying 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 cause of the death, which the clerk or registrar may require. - Gen. Laws, Chap. 114, Sec. 45.


Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.


. . . He shall in all cases certify to the town clerk or registrar in the place where the deceased dicd his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. - Gen. Laws, Chap. 38, Sec. 7.


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 medieal 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- posabiy 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 disabied by recognized disease, and those of persons found dead.


302


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


(City or town)


1 PLACE OF DEATH


County


SUFFOLK


State


MASS.


Registered No.


178


(Place of residence)


St ..


Ward


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


2 FULL NAME


GRACE C. SHOREY


MASS.


City or Town


WINTHROP


No.


12 COTTAGE AVE . - st .-


(a) Residence.


State


(Usual place of abode)


Length of residence in city or town where death occurred


years


months


days.


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


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


F


4 COLOR OR RACE


W


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


MAR.


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


RALPH W.


6 AGE


Years


Months


Days


If LESS than


1 day ........ brs.


46


4


20


or ....... min.


If STILLBORN, enter that fact bere


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


AT HOME


(h) Name of employer


8 BIRTHPLACE (city or town)


WORCESTER


(State or country)


9 NAME OF


FATHER


THOMAS L. BRAMORE


PARENTS


10 BIRTHPLACE OF


FATHER (city or town)


(State or country)


11 MAIDEN NAME


OF MOTHER


GRACE L.FERCHARD


12 BIRTHPLACE OF


PAXTON


MOTHER (city or town)


(State or country)


CONN.


13


Informant


HUSBAND


(Address)


14 Filed .....


Filed


DEC. 30


19


Registrar of city or town where deceased resided


MEDICAL CERTIFICATE OF DEATH


DEC.28


1922


15 DATE OF DEATH


(Month)


(Day)


(Year)


16


I HEREBY CERTIFY, That I attended deceased from


19


... , to


,19


...


that I last saw h


.alive on


, 19


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


The CAUSE OF DEATH was as follows :


m.


BURNS OF FACE, BODY & EXTREMETIES


CAUSED BY APPLICATION BY HERSELF


OF KEROSENE TO A FIRE OF SOFT


COAL IN A HEATING FURNACE


(duration)


yrs ..


mos.


.ds.


CONTRIBUTORY


(SECONDARY)


(duration)


yrs ..


.mos.


ds.


17 Where was disease contracted


if not at place of death ?.


Did an operation precede death ?


Date of




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