Town of Winthrop : Record of Deaths 1910-1912, Part 21

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 21


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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REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Dec


1


(Month)


(Day)


4


, 1910


(Year)


17


I HEREBY CERTIFY that I attended deceased from


1910


, to.


Dec 14


.. , 1910


If LESS than


1 day,


hrs.


that I last saw her


alive on


De 14


, 1916,


and that death occurred, on the date stated above, at/ 0


p.m.


The CAUSE OF DEATH* was as follows :


Strangulated lerma.


operativi


. (Duration)


.yrs.


mos.


8


ds.


Contributory


(SECONDARY)


(Duration)


yrs.


mos.


ds.


(Signed)


31 Mutcall


M.D.


191.Q .. (Address)


174 Woning st


* 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.


3


ds.


State


In the


yrs.


mos. .


ds ..


Where was disease contracted,


If not at place of death ?


39 NevadaSt walkup


usual residence ..


Former or


39


Nevada St.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


C


20 UNDERTAKER


ADDRESS


...


yrs.


8


mos.


2


ds.


des. 14 1


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 enginecr, 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, 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 ferer (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-


1110


2


culosis of lungs, meninges, peritoneum, 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Metcal Hospital (No. 174 Muchom St. St. :..


174) Theloop St


2 FULL NAME


lebaume lehandluy


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


(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


male


4 COLOR OR RACE


Write


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


December (Month)


15


(Day)


, 19.10


(Year)


7 AGE


If LESS than


I day, 20 hrs.


·mas.


ds.


or 25 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) ·


Muchasto maso


10 NAME OF


FATHER


Powell B. lehandley


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Oladiin no. Carolina


12 MAIDEN NAME OF MOTHER


Fanny Pearl Hauff


13 BIRTHPLACE OF MOTHER (State or country) Greenville Tenn


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


OF. A. Okryss


(Address)


174 Of manttauf St.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


alec.


(Month)


15 (Day) ., 19!0 (Year)


17 I HEREBY CERTIFY that | attended deceased from Des. 15. (1.35a.m) 191 a, to Dec. 15 (10.20,20), 1910. that I last saw him alive 9,56P. m. 1910 and that death occurred, on the date stated above, at. ( & P. m. The CAUSE OF DEATH* was as follows :


Premature. no Vitality


.(Duration)


yrs.


mos.


ds.


Contributory ...


(SECONDARY)


(Duration)


yrs.


mos. .


ds.


(Signed)


1


M.D.


* 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


DATE OF BURIAL


20 UNDERTAKER


ADDRESS


V


WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.


important. See instructions on back of certificate.


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


Ward)


Filed 191


191


(Address)


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits cau 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 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, peritoneum, 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 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," "Hemorrhage," " 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


11 BIRTHPLACE OF FATHER (State or country) (‹


12 MAIDEN NAME OF MOTHER 4


13 BIRTHPLACE OF MOTHER (State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Franck Boney


(Address)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Dec.


(Month)


22


(Day)


(Year)


17 I HEREBY CERTIFY that I attended deceased from


1910, to


Dec. 22ª, 1910


that I last saw her alive on ...


Dea. 22ª , 1910.


and that death occurred, on the date stated above, at 10/,m.


The CAUSE OF DEATH* was as follows :


Cystic Cancer


Uncertain.


.(Duration)


1


yrs. .


mos. ..


ds.


Contributory


Exhaustion


(SECONDARY)


.(Duration)


yrs.


(Signed)


tue, 2+4.1916


(Address)


Winthrop


.,


M.D.


* If deatb 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


yrs.


mos.


ds.


Where was disease contracted,


if not at place of death ?..


Former or usual residence ....


19 PLACE OF BURIAL OR REMOYA


DATE OF BURIAL


die 24


, 191 Ły


20 UNDERTAKER


ADDRESS


Filed 191


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH meccail Hospital


(No.


St. ;.


Ward)


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


2 FULL NAME Frances ..


Joney


Francer. Bowey


{If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 303 Shirley St wieder 2204


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


-


4 COLOR OR RACE


Colore


female


6 DATE OF BIRTH Akar


2


(Month)


(Day)


, 1880


(Year)


7 AGE


If LESS than


I day .... . hrs.


41


yrs.


mos.


21


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


mos.


RS ds.


In the


., 1910.


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


undlow


WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.


1


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. Bnt in many cases, especially in industrial employments, it is uecessary 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 tho 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, uot 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 10 occupation whatever, writo 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 saure disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Cronp") ; Typhoid fever (uever 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 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 canse for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under tho 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 Criminul 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.


FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL


THE COMMONWEALTH OF MASSACHUSETTS


Winthrop


RETURN OF A DEATH


(CITY OR POWN.)


FULL NAME


Catherine Arm Manner


Registered No ..


Place of )


Death


S


Metcalf Hospital


Death


.months.


3


.days _


STATISTICAL DETAILS


SEXY


Jemale


COLOR


White


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME t


HUSBAND'S NAME t


BIRTHPLACE +


NAME OF FATHER James & Farmer


BIRTHPLACE OF FATHER$ Sherman Me.


MAIDEN NAME OF MOTHER Clara Finnegan megan


BIRTHPLACE OF MOTHER $ Staceyville me.


OCCUPATION


INFORMANT § annes Farmer 253 main St Winthrop


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Du 20" 19/0 to ice 22" 19/0, 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 :


Primary :


Premature


Wade 1 Julally U wildly.


(DURATION).


3


DAYS


Contributory :


(Signed)


318hul cal


(DURATION). ........ . DAY8


M.D.


// (Address)


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


How long at


Piaco of Death ?


years.


months.


3


days


Where was disease contracted,


met calf itoJelent


If not at place of death ?.


Filed


19


Clerk


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, glvo its NAME instead of street and number.


t In case of married or divorced woman, or widow.


# State or country; also city, town or county, If known.


§ Name and address of person giving statistical details. || Name of cemetery.


PLACE OF BURIAL OR REMOVAL I


Holy lower


DATE OF BURIAL


DEC 23 1910


UNDERTAKER John F Malay


ADDRESS


79 atlantic


Date of l


Dec 23


19/ 0


Residence


283 Matin St Westlich


.years.


Dec. 23, 1910


..


[1-'09-2MI.]


Medical Examiner's No. 2303


Permit No.


19330


RETURN OF A DEATH. BOSTON, MASS.


1909 2 1


Date of Death,


Dec. 25- 1910


Name in full, Charles Blanchard


(If married or divorced woman give maiden name, also name of husband.)


Sex, Tele


Color, White


Condition,


(White, Black, Mixed, Chinese, Indian, etc.)


(Single, Married, Widowed or Divorced.)


Age, 30 Years, Months, Days. Occupation, Seaman


Residence, E Boston


Ward


Place of Death, Boston Harbor


(State year, month and day.)


Place of Birth, Unknown


Date of Birth, Union un


Unknown


Name and Birthplace of Father, Maiden Name and 1111 Birthplace of Mother, Place of Interment, Mt. Hope


Lewis Jones , Son. Undertaker.


Certificate of the Medical Examiner.


I hereby certify that


age 30 , residence,


Charles Blanchard


East Boston


-


who died on the 25 th day of December , 1910,


-


came to hi death from


Cause : wning


Manner : accidental (member crew Sch. Dans Palmer, wrecked in Broad Sound) Larry Burgers tagrally 1 Medical Examiner for Suffolk County.


Body recovered on Short Beach, Winthrop, adit. 1910


Reid mar. 14.


4 REC.


Charles Blanchard De 25, 1910


Charles Blanchard


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. CI Artonvia C .. St. ; Ward)


Huch Treanor


'FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 1 Atlantic St. Winthrop


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Jule


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED inCle


(Write the word)"


6 DATE OF BIRTH


(Month)


(Day)


1


(Year)


7 AGE


If LESS than


1 day, . ..


. hrs.


72


yrs.


mos.


ds.


Or ........ min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


cson


(b) General nature of industry,


business, or establishment in


which employed ( or employer).


9 BIRTHPLACE


(State or country)


Ireland


10 NAME OF


FATHER


Bernard


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


Ireland


12 MAIDEN NAME


OF MOTHER


Tary VeAlLister


13 BIRTHPLACE


OF MOTHER


(State or country)


Ireland


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Fre. Daniel Chalk


(Address)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Dec


29


1910


(Month) 024 (Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from


auque


. 191.0 , to


Dec 29,1910,


that I last saw ha


alive on


Sec 2 4 , 1910,


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


The CAUSE OF DEATH* was as follows :


Branchitão


(Duration) .yrs.


mos.


ds.


Bronchitis 2 Wk.


Contributory


(SECONDARY)


mos. ..


ds.


Debility


(Duration)


Dellain Fr. 13 coresa.


yrs. 6.


M.D.


(Signed)


vec 30


1910 (Address).


3 Fere fr


* 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


.. yrs.


In the


mos. .


ds.


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL . COLVELO


DATE OF BURIAL


), 1910.


20 UNDERTAKER


ADDRESS


Filed .. 191


...


BOSTON (City or town.)


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


Dec. 29, 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 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 ferer (tho 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.




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