USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 12
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Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: 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, 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 intercurrent) affection need not bo statei 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 " ("(ongenital," "Senile," ctc.), " Dropsy," "Exhaustion," " Heart failure," "Haemorrhage," "Inanition," " Marasmu;," " 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 septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of tho Revised Laws deaths under the following conditions must be referred to tho 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.
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH 540 Only S
(No.
Menthon Mask
St .; .Ward)
[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
$SEX
famule
4 COLOR OR RACE
Coloud
5 SINGLE,
MARRIED,
WIDOWED,
OA DIVORCED
(Write the word)
Single
DATE OF BIRTH
8
25
1889
(Month)
(Day)
7 AGE
21
-
.yrs.
19
mos.
ds.
or ........ min .?
8 OCCUPATION
(a) Trade, profession, or particular kind of work,
(b) General nature of Industry, business or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
Charleston, Ce
10 NAME OF
FATHER
Anthony Frank
11 BIRTHPLACE OF FATHER (State or country) Charlielors le
12 MAIDEN NAME OF MOTHER Mary Combineon ,
13 BIRTHPLACE OF MOTHER (State of country)
Charleston Sle
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) ..
Uroxaza le fones
(Address) 590 Shelly St Formwhich
Filed
191
REGISTRAR
..
(Day)
1910
(Year)
(Year March 12h 1910, to 1910.
If LESS than 1 day, ........ hrs. that I last saw her alive on Afkh. 10 1910 ... and that death occured, on the date stated above, at 109.m. The CAUSE OF DEATH* was as follows :
......
(Duration)
1
yrs. .............. mos.
ds.
Contributory
(SECONDARY)
(Duration) .. yrs. ........
.......
mos. ........... ds.
(Signed) ..
Lepo. 13. (19)C . (Address).
Minister of Many
* If death followed injury or violence the certificate of death must be made ouf by the Medical Examiner.
1ª LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
In the
of death
.yrs.
mos
ds.
State
......... yrs. ...
.. mos. ........ ds .....
Where was disease contracted, If not at place of death ?
Former or usual residence
LO PLACE OF BURIAL OR REMOVAL Mount Hope
DATE OF BURIAL Super 15 1910
......
20 UNDERTAKER
ADDRESS Using + Jones 639 Showmal auch Josh >
instructions on back of certificate. OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See 16 N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE PARENTS
winthrop. BOSTON
Trubach Frank 2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.]
16 DATE OF DEATH
depot.
(Month)
19.
17
I HEREBY CERTIFY, That I attended deceased from
M. D.
Sept. 13, 1910
Standard Certificate of Death.
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, Compositor, Architeet, 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 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 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 specifically the oceupations 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 begin- ning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no oceupation 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: Cerebro-spinal fever (the only definite synonym is " Epidemic cerebro-spinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia;
Broncho-pneumonia ("Pneumonia," unqualified, is indefi- nite); Tuberculosis of lungs, meninges, peritonaeum, etc., Careinoma, 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 intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (second- ary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anaemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Con- vulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemor- rhage," "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 miscarriage, as " PUERPERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Exam- iners :
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suieidc, 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 discase, 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.
(Informant)
(Address)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Sept 13"
(Month)
(Day)
, 1916
(Year)
17
1 HEREBY CERTIFY that I attended deceased from
19%, to
1905
Sist, 3
1910
Sift 13"
.
that I last saw ha
alive on.
1910
and that death occurred, on the date stated above, at
1pm The CAUSE OF DEATH* was as follows :
(Duration)
yrs.
mos.
Contributory
(SECONDARY)
(Duration)
yrs.
mos. ...
ds.
(Signed)
M.D.
Saft 14. 1910 (Address)
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
yrs.
mos.
ds.
State
In the
yrs.
mos.
ds.
1 Where was disease contracted, If not at place of death ?
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL Winchnot Comelit
DATE OF BURIAL
Jeff. 5. 1910
ADDRESS
20 UNDERTAKER
C. R. Person
SE. ......
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Elizabet Willen abbott
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.]
Widow of Thomas. L. abbott a RESIDENCE #94 Bellever ate
winthert-
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Mute
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
(Month)
(Day)
1
(Year)
If LESS than
1 day, .. .. hrs.
yrs.
mos.
ds
or min. ?
(a) Trade, profession, or
particular kind of work
at home
9 BIRTHPLACE
(State or country)
England
11 BIRTHPLACE OF FATHER (State or country) Unknown ( " )
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Filed 191
3 SEX femme 6 DATE OF BIRTH 7 AGE about 60 8 OCCUPATION 10 NAME OF FATHER 12 MAIDEN NAME OF MOTHER PARENTS WHITE PLAINLY, WITH UNFADING INN THIS IS A PERMANENT NEVOND. (b) General nature of industry, business, or establishment in which employed (or employer)
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Muntlig Masa 94 Bellevivi ave
STANDARD CERTIFICATE OF DEATH.
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, Compositor, Architect, Loeo- 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 fuetory. 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 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: 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, peritonaeum, etc., Carcinoma, Sar- coma, etc., of. .. (name origin : "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasmns) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be state? 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," " Marasmu.," " 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 septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to le due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(No.
20 Woodside Park
St. ;
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Mary Corbett.
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
20 Woodside Park Withich.
Mary Wahar wife Thomas Corbett.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
15 (Day)
, 19!0 ( Year)
, 1910. , to
17
I HEREBY CERTIFY that I attended deceased from
July
September, 1910
that I last saw he . alive on
Sep. 15th
,1910
and that death occurred, on the date stated above, at 4. 9
m.
The CAUSE OF DEATH* was as follows :
arteriosclerosis with
Cerebral henvorlage
(Duration) Inhrysense
mos. ..
ds.
Contributory.
(SECONDARY)
(Duration) 7 yrs,
mos. .
ds.
(Signed)
Borg. Fr Campbell
M.D.
1910 .... (Address)
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
16 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death,
yrs ..
mos.
In the
ds.
State
yrs.
mos.
ds.
Where was dlsease contracted, If not at place of death ?.. . Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL
Forest Hills
DATE OF BURIAL
Jeff. 12
1910
16 Filed 191
REGISTRAR
20 UNDERTAKER
¿ Waterman 8ans.
1
ADDRESS
Boston
1 PLACE OF DEATH 3 SEX fornals 6 DATE OF BIRTH 7 AGE 8 OCCUPATION (a) Trade, profession, or particular kind of work (b) General nature of industry, business, or establishment in which employed (or employer) 9 BIRTHPLACE (State or country) 10 NAME OF FATHER 11 BIRTHPLACE OF FATHER (State or country) 12 MAIDEN NAME OF MOTHER PARENTS (Informant) important. See instructions on back of certificate. (Address) 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 73 yrs.
MARRIED,
married
WIDOWED
OR DIVORCED
(Write the word)
4 COLOR OR RACE white 0 LED. 14.1837 (Month) (Day)
..
(Year)
If LESS than I day, .. . hrs.
7 mos. I
or min. ?
England
Thomas Mahar
Ireland Katherine Jaules.
13 BIRTHPLACE OF MOTHER (State or country) Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- right on that the relative healthfulness of various pursuits can be known. d'he question applies to each and every person, irrespective of age. For many occupations a single word or term on the fra line will be sufficient, e. g., Farmer or Planter, Physician Supositor, Architect, Loco- motive engineer, Civil engineer, Summary 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 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 ('AUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis ") ; Diphtheria (avoid use of " Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritoneum, 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," "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 septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions 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, 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
12 MAIDEN NAME OF MOTHER Annie M. ODonnell
13 BIRTHPLACE OF MOTHER (State or country) Scotland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) ....
Annie M. Donovan
(Address)
122 Main St
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH Sept18
19:0
(Month) 18 (Day) /9/6 Year)
. 1881 17 I HEREBY CERTIFY that I attended deceased from (Year) in mos, 1910, to Seff 18" , 1910,
If LESS than I day, hrs. that I last saw hi malive on Soft 18 ., 191 6,
and that death occurred, on the date stated above, at.
m.
The CAUSE OF DEATH* was as follows :
Chronic Antes Paranchymatus
neplatis
1
(Duration) .
/
yrs.
mos.
ds.
Contributory. (SECONDARY)
(Duration)
mos. ..
.. ds.
(Signed)
M.D.
Seft 18
1910
(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
DATE OF BURIAL
Holy Cross Malden Sup 21 21910
20 UNDERTAKER
M. J. Kelly
ADDRESS
49 Neveriet Sp.
Winthrop BOSTON
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
+ COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
6 DATE OF BIRTH
Sefih (Montlı)
18Th
(Day)
7 AGE
28 yrs. - mos. -
ds.
or min. ?
8 OCCUPATION
(a) Trade, profession, or particular kind of work
Machinist
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
Each Boston Mass
10 NAME OF
FATHER
Timothy Donovan
11 BIRTHPLACE OF FATHER (State or country) Ireland
Filed . 19|
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop (No. 122 Main St Cornelius James Donovan 2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] ... @RESIDENCE 122 Main
St. ;...
Ward)
Registered No.
Sept. 18, 1910.
STANDARD CERTIFICATE OF DEATH.
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, 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, Laborer- Coul 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, Hlousework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no 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: 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-
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