Town of Winthrop : Record of Deaths 1910-1912, Part 12

Author: Winthrop (Mass.)
Publication date: 1910
Publisher:
Number of Pages: 956


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 12


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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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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