Town of Winthrop : Record of Deaths 1910-1912, Part 20

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 20


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95


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 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. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident ; Revolver wound of head- homicide ; Poisoned by carbolic acid - prob- ubly suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."


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.


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1910.


CITY OF BOSTON.


FULL NAME


Caroline M Smallhoff


......


Registered No.


10551


Place of Death ¿


Boston


Boston State Hospt.


and Residence S


Date of Death


Dec. 1


1910.


Ag


68


4


months.


25


.days.


STATISTICAL DETAILS.


SEX


F


COLOR


W


SINGLE, MARRIED, WID., DIV. M


I HEREBY CERTIFY that I attended deceased during last illness,


from 1910, to 1910, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows:


IST


T PATRIBU


SITD


: Primacy (Duration)


Involution Melanchia - 4 mos.


FFICE


A.182


DONATA A


. MAS. S.


Contributory : 3


Broncho-Pneumonia - 3 dys


(Duration)


Maiden Name


Caroline A Wells


of Mother.


of Mother Boston


Occupation Housewife


Dec.1 1910


.........


SPECIAL INFORMATION from Hospitals, Institutions, Transier.ts, or Recent Residents. In hospital 16 days


Place of Burial


Dorchester(Codman Ground )


Usual Residence


Winthrop(63 Buchanan st)


or removal.


Undertaker J P Cleary


Filed


Dec.5


1910


A true copy.


Attest :


EumSeinen


Registrar.


....


Birthplace


(Signed)


S E Vosburgh


..... .. M.D.


Informant


PHYSICIAN'S CERTIFICATE.


Maiden Name


Morgan


Husband's Name


Jacob Smallhoff


Boston


Birthplace


Name of


Father ..


James H Morgan


REGISSEN


BOSTON


Birthplace


Eastport, Me.


of Father.


AR'S


CITY:


BOSTONIA CONDITAA.


years


4 ٠


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1910.


CITY OF BOSTON.


FULL NAME


James R Dunn


Registered No.


10757


Place of Death ¿


Boston


City Hospt.


and Residence S


Date of Death


Dec.6


.1910.


Age


26


. years .


4


months.


25


.days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


W


S


Maiden Name


Husband's Name


Birthplace Lockport, N.S.


Name of


Father Simon G Dunn


Birthplace of Father.


Maiden Name


Lydia Dixon


of Mother


===-- IT S


Occupation


Physician


Informant


Contributory : 2 (Duration)


(Signed)


A J White


M.D.


Dec.7 1910


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Place of Burial


or removal.


Winthrop"Winthrop Cem


1 C Skaggs


Undertaker


Winthrop


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from 1910, to 1910, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows:


T


RAR'S


PATRIBUTE


SITA


Pneumonia - 5 dys


Primary: (Duration) BIS


FFICE:


BOSTONTA TIVIT


CONDITA MA


TISREGISSINE DONATA D. BO.STO 1830.


MASS.


Usual Residence.


Winthrop(45 Cottage aye)


Dec.10


1910.


Filed


A true copy.


Attest :


Registrar.


CITY


Birthplace of Mother


MOTPOE


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Nightin a: (No. 25. Perkunna St. ;.. Ward)


Gilliam Me Laughlin 'FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 25 Telkens TI.


Winthrop


(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX an


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


(Month)


(Day)


1


(Year)


7 AGE


If LESS than I day, ... hrs.


yrs. mos.


ds.


or min. ?


8 OCCUPATION


(a)' Trade, profession, or


particular kind of work


Stevecore


(b) General nature of industry, business, or establishment in which employed (or employer).


9 BIRTHPLACE


(State or country)


1


PARENTS


12 MAIDEN NAME OF MOTHER


1


13 BIRTHPLACE OF MOTHER (State or country)


Brefand


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant).


(Address)


15


Filed 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


(Month)


(Day) ., ( Year)


17


I HEREBY CERTIFY that I attended deceased from


DEe


69%


1912, to


,


that | last saw h .... alive on 1., 1916. and that death occurred, on the date stated above, at. 9-15m. The CAUSE OF DEATH* was as follows :


Dencertain (Duration)


yrs.


mos. ds.


Contributory (SECONDARY)


(Duration)


yrs.


mos. .


.ds.


(Signed)


. M.D.


Dea.10/ 19/0 (Address)


MiniTrope


* 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.


In the


ds.


State


. .. yrs.


.


mos. .


ds.


Where was disease contracted, If not at place of death ?..


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL r


DATE OF BURIAL .5. 1912.


20 UNDERTAKER


ADDRESS 2


-


1910


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.


10 NAME OF


FATHER


tatrici


11 BIRTHPLACE OF FATHER (State or country)


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 necded. 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 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 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Winthrop


(No.


7 . Temple Not


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


3 SEX


Male


4 COLOR OR RACE


While


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widower


6 DATE OF BIRTH


March


(Month)


(Day )


1839


(Year)


7 AGE


71


yrs.


2


mos.


28


ds


(a)' Trade, profession, or


particular kind of work ...


Broken


(b) General nature of industry,


business, or establishment in


which employed (or employer)


9 BIRTHPLACE


(State or country)


Boston Mass


PARENTS


(State or country)


Proton dass


12 MAIDEN NAME


OF MOTHER


Mary B, Parker Sam,


1ª BIRTHPLACE


OF MOTHER


(State or country)


Pepperell Mars


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Clark Parku


(Address)


> Comple ave


REGISTRAR


16 DATE OF DEATH


Dec


(Month)


12


....... 1910


(Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from


Decr 8


191 0, to


Dec. 12 1910


If LESS than


1 day, .


hrs.


that I last saw hAM alive on


12 th Dec., 1910.


and that death occurred, on the date stated above, at 9.40 m.


or .....


. min. ?


The CAUSE OF DEATH* was as follows :


Lobar Pneumonia


(Duration)


yrs.


mos.


1/2 ds


ds.


Contributory.


Chronic Gastritis


SECONDARY)


Malignant !? )


(Duration)


2 yrs.


mos. .


.ds.


(Signed) ..


I. E. Brandon


M.D.


Dec. 13


1910 ..


(Address).


Ilentral Aux E 13.


* 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.


In the


ds.


State


yrs.


mos.


ds.


Where was disease contracted, If not at place of death ?.


Former or usul residence.


19 PLACE OF BURIAL OR REMOVAL Gerest Abil


DATE OF BURIAL


Dec 16 . 1910


.....


20 UNDERTAKER


AL Eastman Co


ADDRESS


251 Cremant LE


BOSTON (City or town.)


Benjamin W Parker


'FULL NAME. enjamin


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 7 Temples ave


Filed. 191.


10 NAME OF


FATHER


Nathaniel Parker


11 BIRTHPLACE


OF FATHER


Marris


OCCUPATION


alec. 12, 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 - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Ilouse- 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 neoplasms) ; Measles; 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: Mcasles (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.


The Commonwealth of Massachusetts


1 PLACE OF DEATH


STANDARD CERTIFICATE OF DEATH Wucherplass (No. 335 Wineherfst St. ;


Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


2 FULL NAME Kenneth, Belcher


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Mule


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


lec 10


(Month)


(Day)


.,


(Year)


7 AGE


If LESS than I day. .. .. hrs.


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)


10 NAME OF


FATHER


alphonso. W. Belcher


PARENTS


12 MAIDEN NAME


OF MOTHER


Mary. L'dich, Inoses


13 BIRTHPLACE OF MOTHER (State or country)


14 THE ABOVE IS TRUE, TO THE BEST OF MY KNOWLEDGE


(Informant)


Aiphones L.V. Selche


(Address)


x


335 Winthrop St. Trustmy


REGISTRAR


16 DATE OF DEATH


December


(Month)


(Day)


14


., 19 !... 0


(Year)


17


I HEREBY CERTIFY that I attended deceased from


10


1910


/4


., to.


, 191º,


that I last saw him alive on


Dm 14


, 1910


and that death occurred, on the date stated above, at/.30 Pm.


The CAUSE OF DEATH* was as follows :


Haemophilia neonatorum


(Duration)


yrs. .


×


mos.


4


ds.


Contributory ... (SECONDARY)


mos.


yrs.


ds.


(Duration)


DEplusan


M.D.


(Signed)


Su 15


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 placo


of death.


yrs. ..


. mos.


In the


ds.


State


yrs.


mos.


ds.


Where was disease contracted, If not at place of death ?..


Former or usual residence ..


PLACE OF BURIAL OR REMOVAL winthrop Cence.


DATE OF BURIAL


De 15, 1910


20 UNDERTAKER


Chas P. Bennison


ADDRESS


winthrop


15 Filed 191


11 BIRTHPLACE OF FATHER (State or country) Wwwchinh mars


1910


yrs.


mos.


(City or town.y


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 kuown. 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- 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, 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), usiug 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, Sur- coma, etc., of ........ .. (uame origin: "Cancer" is less definite ; avoid use of " Tumor" for malignaut neoplasms) ; 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, Fulls, 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH metcalf Hospital (No ... Within St St. ;


Wantingto


(City or town.)


Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


'FULL NAME Jusannan. albertu 1 ay lor


[If married or divorced woman or widow give maiden name, also name of husband.] . @RESIDENCE 34 nevada Slices Wurscht Than


Sausannan Ultrale Parker Wife of Oscars M. Taylor Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


temale


7 AGE


62


8 OCCUPATION


(a)' Trade, profession, or


particular kind of work.


PARENTS


13 BIRTHPLACE


OF MOTHER


(State or country)


(Informant)


important. See instructions on back of certificate.


(Address)


18


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


(b) General nature of industry,


business, or establishment in


which employed (or employer)


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


mannen


6 DATE OF BIRTH


cipria


12


(Month)


(Day)


1848


(Year)


or


min. ?


at home


9 BIRTHPLACE


(State or country)


Wylesford, Kungs County.


nova Scotia


10 NAME OF


FATHER


Church Parker


11 BIRTHPLACE


OF FATHER


(State or country)


nova Scotia


12 MAIDEN NAME


OF MOTHER


Lichen Parrish


Luva Scola-


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


Filed.


.... . 191.




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