USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 22
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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
Jaliman
13 BIRTHPLACE OF MOTHER (State or country)
tôna.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH Jan. 1
/Month)
(Day)
19! / (Year)
yam .
2
.... 1910 , to
au !
, 1912
that I last saw her alive on
DEL
31
, 1910 ,
and that death occurred, on the date stated above, at ... -
-m.
The CAUSE OF DEATH* was as follows :,
Clinic Interstitial Nephritis
.(Duration) yes !
mos. ..
ds.
Contributory ..
Cerebral Harmontage
(SECONDARY)
.. (Duration) . .
yrs. .
mos. . .. ds.
(Signed)
Edward
Granger
M.D.
Jan 2, 1911 ... (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.
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
Brocton, maiiti-3- 1911
ADDRESS
Filed 191
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH Sinthode Beau No 500
Shirley- St. ;
(City or town.)
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
W
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
( Write the word)
16 DATE OF BIRTH
10 (Month)
(Day)
(Year)
7 AGE
If LESS than I day, ....... hrs.
59 yrs. 2 mos. 27 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)
Ruw Foundland
10 NAME OF FATHER Tas. auguste. s. FhalsL
11 BIRTHPLACE OF FATHER (State or country)
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
2 FULL NAME
Hellen Emily Harris
[If married or divorced woman or widow give maiden name, also name of husband.] ARESIDENCE 300 heiligy st
20 UNDERTAKER
If C. Siaggi
14
4
. 180/1
17
I HEREBY CERTIFY that I attended deceased from
Jan. 3, 1911
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 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 be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1911.
CITY OF BOSTON.
53
FULL NAME
Registered No .. .
Place of Death ¿
Boston
and Residence S
Date of Death
Jan . 3
1911.
Age
64
years
months .days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
F
N
M
Callahan
Maiden Name
Thomas J McCormick
Husband's Name
Boston
Birthplace
Name of
Father ..
Birthplace of Father
Ireland
Contributory : (
Shock - 12 hrs
(Duration) S
Maiden Name of Mother
Jane Cole
Birthplace Ireland
of Mother ..
Occupation
Housewife
Informant
Place of Burial or removal
Mt Benedict
7 J Cassidy
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from
1911, to
1911, 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:
RAR'S
Strangulated umbilical hernia
CITY
ST TRIBE SIT DEL Primary (Duration)
TYSICE
20 hrs
BOSTON.I.A. CONDITA.D.
DUNATA A
STO
MASS.
(Signed) J W Manary
M.D.
... ..
1911
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence
Winthrop(263 Bowdoin st)
Filed
Jan . 6
1911
A true copy,
Attest :
Registrar.
Jane McCormick
City Hospt .
Undertaker
Michael J Callahan TIS REGIMINE
Jan. 3, 1911
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
1 PLACE OF DEATH
Somerville
(No.
186 .Highland Ave .,
St. ;..
. Ward)
...
[If death occurred in a hospitel or institution, give its NAME instead of street and number.]
2 FULL NAME
Philip Daley
[If married or divorced woman or widow
give maiden name, also name of husband.]
"RESIDENCEHome for the Aged, 186 Highland Ave. , Somerville, Mass
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
COLOR OR RACE
male
white
6 DATE OF BIRTH
7 AGE
70
yrs.
mos.
ds.
or .. min. ?
& OCCUPATION
(a) Trade, profession, or particular kind of work None.
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE (State or country)
Ireland
10 NAME OF FATHER
Lawrence Daley
11 BIRTHPLACE OF FATHER (State or country)
Ireland
12 MAIDEN NAME OF MOTHER
Catherine Carroll
13 BIRTHPLACE OF MOTHER (State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Sr ...... Catherine (Address) 186 Highland Ave Somervill
Filed. Jan . 11., 191.1 .
REGISTRAR
16 DATE OF DEATH January 9, (Month)
(Day)
191.1 ...
(Year)
17
I HEREBY CERTIFY that I attended deceased from
1909., to.
Jan. 9,
, 191.1,
If LESS than
day ,
... hrs.
that | last saw him. alive on
Jan. 7,
191. 1,
and that death occurred, on the date stated above, at ..
11
tp.m.
The CAUSE OF DEATH* was as follows : Cerebral hemorrhage
.(Duration) .
.. yrs. .
.. mos. ..
ds.
Contributory ....
Arterio-sclerosis.
(SECONDARY)
(Duration) ...
. yrs. ..
mos.
....
ds.
(Signed)
Chas ... E. Mongan
Jan ..... L.O., 191.1 .. (Address).
24 Central 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.
In the
ds.
State
yrs.
mos.
ds.
Where was disease contracted, If not at place of death ?...
Former or usual residence .. 36 Pearl Ave
Winthrop, Mass .
19 PLACE OF BURIAL OR REMOVAL Holy Cross Cem.,
DATE OF BURIAL
Jan .. 12, 19| 1.
Malden Mass.
20 UNDERTAKER T.J.Lane
ADDRESS 120 Havre St .. E Boston.
important. See instructions on back of certificate.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH Home for the Aged,
Somerville, Mass. (City or town.)
Registered No.
25
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word) widowed
(Month)
(Day)
1840 (Year)
PARENTS
., M.D.
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 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, Ilomicide, 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 Winthrop Mass. .(No.
BOSTON (City or town.)
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR ØR RACE
while
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
manual
16 DATE OF BIRTH
nor
30
(Montlı)
(Day)
(Year)
7 AGE
8 OCCUPATION
70
yrs.
1
mos.
)3ds.
or
min. ?
(a)' Trade, profession, or
particular kind of work
Hous wife
(b) General nature of industry, business, or establishment in which employed (or employer).
19 BIRTHPLACE
(State or country)
Littletors nit
10 NAME OF
FATHER
Dewall Dunn.
PARENTS
11 BIRTHPLACE OF FATHER (State or coupfry)
Dryfuld , me ,
12 MAIDEN NAME OF MOTHER Esther unstin.
13 BIRTHPLACE OF MOTHER (State or country)
le anton, rue.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) ...
Hezekiah Zuchauklin
(Address)
Wirthok Wan
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
14.91
(Day)
(Year)
I HEREBY CERTIFY that I attended deceased from
Jama, 13, 191.
, 191.9. ... and that death occurred, on the date stated above, at 3-5 R.M
The CAUSE OF DEATH* was as follows :
ester
Ankeninn que:
Contributory
(SECONDARY)
.yrs.
mos.
ds.
(Signed)
M.D.
(Addres by Plan Anda, est
* 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
BURIAL OR REMOVAL Dingfield, he,
DATE OF BURIAL
Jany $ 1911
....
20 UNDERTAKER
ADDRESS
Boston luca
'FULL NAME.
Emma L Zue. Laughlin
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Park, T Hillside are.
Emma Is bum, Hezekiah Muc. Laughlin
1840
If LESS than
I day,
Mhrs.
that I last saw hy alive on
/13
mos. ds
Filed .. ... 19!
0
Jan 14,1911
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 evory 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 factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," " Manager," "Dealer," otc., 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 faet 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 ; Chronie 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 septieaemia," " 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)
Braintree
man
12 MAIDEN NAME OF MOTHER
18 BIRTHPLACE OF MOTHER (State or country)
Fonte Naymente
man
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
193 Panchina de. Monatrants
18
Filed. -1 191 ..
REGISTRAR
16 DATE OF DEATH
(Month)
16
(Day)
(Year)
17
I HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows :
natural causes. probably heart disease (acute dilatation) (Duration) Sudden death ] .. yrs.
mos.
ds.
Contributory
(SECONDARY)
(Signed)
Senza Burgas Pagalbos
,
M.D.
(Address)
MEDICAL EXAMINER
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
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 Wordlaune ame.
DATE OF BURIAL
Jan. 20'
191.[ ....
ADDRESS
20 UNDERTAKER
EGBrown Om
3009 (City or town.) [lf 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
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
6 DATE OF BIRTH
June
(Month)
(Day)
1850
(Year)
7 AGE
If LESS than
I day, ........ hrs.
60 yrs. . 7 mos. 9 ds.
Or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Fiche dealer.
(b) General nature of industry, business, or establishment in which employed (or employer).
$ BIRTHPLACE
(State or country)
north Weymouth.
mass.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Winthrop or Breton, between Mint Heights and Ingales Stations, & B. R. BOL RR ward B. Newton 2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 193 Pauline Sheet Winthrop
Ward)
mos.
ds.
10 NAME OF
FATHER
Amor S. Vuton
Jan. 16, 1911.
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 luborer, 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-
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