USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 27
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Dr. Johnson
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 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," " All- 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
Minthof (No. 44. Buchanan
St. ;...
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME Susana Braku Collins.
[If married or divorced woman er widow give maiden name, also name of husband.] @RESIDENCE HH Buchanan St Shin Chan/ Quasi
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5
SINGLE,
MARRIED,
WIDOWED,
OR DIVORCER
(Write the word) awad
& DATE OF BIRTH 1 18 (Day)
(Month)
71 yrs. - mos. 29 ds.
or .. ... min. ?
(a) Trade, profession, or
particular kind of work
at home.
(b) General nature of industry. business, or establishment in which employed ( or employer)
10 NAME OF
FATHER
Bartholomew @ Gr
11 BIRTHPLACE OF FATHER (State or country)
12 MAIDEN NAME OF MOTHER
Jours mars
Susannah Hopkins
puno Mars-
7
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) (Address)
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Fb 17 h
(Month)
(Day)
19! 1
(Year)
. 1840 17 I HEREBY CERTIFY that I attended deceased from (Year) 726 8ª , 191./ , to 7.617 1
, 191 } ,
that I last saw her
alive on.
70017
, 191 ] ,
and that death occurred, on the date stated above, at ...
1 pm.
The CAUSE OF DEATH* was as follows :
Pneumunng
(Duration)
yrs. .
mos. ..
9
ds.
Contributory ... (SECONDARY)
yrs. (Duration) 6315 Meterall mos. . ds. M.D.
(Signed)
7619
1913.
* 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
2-19-1911
ADDRESS
20 UNDERTAKER
H.C. Skaago.
( Address)
(City or town.)
Susan B. how John Collins
Registered No.
3 SEX Female 7 AGE 8 OCCUPATION PARENTS WITTE PEAINTET, WITTY ONTADING INK ITIS TO A PERMANENT NEVOND. 9 BIRTHPLACE (State or country)
If LESS than day, ... hrs.
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 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 _It 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 affectiou 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 cercbro-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 ueoplasms) ; 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 casing 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," 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 supposedto be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
THE COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Lois Knowles. Blake Hathaway
.Registered No.
Place of )
Death *
S
55 themandSt
Residence
Age
94
.years.
months.
days
STATISTICAL DETAILS
SEX female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME
Pois Kunales. Blake
HUSBAND'S NAME t
Filmes Hathaway
BIRTHPLACE #
Compton 11. H.
NAME OF
FATHER
Envoli. Jackson Blake
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
Marcin Every
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT §
Care. V. Hathaway
PHYSICIAN'S CERTIFICATE
HEREBY CERTIFY that I attended deceased during last illness, from Jolly 27 19// to man 3 .. 19// , 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 : Double Primaria
(DURATION).
4
.DAYS
Contributory :
Senility
.(DURATION) ......... DAY8
(Signed)
Johnson
M.D.
(Address).
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
.years
.. months .. ...................... days
Where was dlsease contracted,
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, give 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 detalls. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR, REMOVAL II
DATE OF BURIAL
315
19 ‹ ‹
UNDERTAKER
ADDRESS
Date of ¿
Ixar 3
19 /7
Death
S
26
March 3, 19
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
.
(No ..
20 Jevac
St. :..
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 mali 6 DATE OF BIRTH
4 COLOR OR RACE
White
1 10
(Month) (Day)
-
(Year)
7 AGE
If LESS than I day, ... .. hrs.
70 yrs. 2 mos .. Lí 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)
Pensylvania.
10 NAME OF
FATHER
Vibia B. Smith
PARENTS
12 MAIDEN NAME OF MOTHER
Per
Me Laughlin
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Filed. 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
March
(Month)
14 (Day)
, 19: 11 (Year)
I HEREBY CERTIFY that I attended deceased from
March
9
19/11 to March 14, 1911,
that I last saw himalive on
Brauch 14, 1911,
and that death occurred, on the date stated above, at. 2 . 25P.m.
The CAUSE OF DEATH* was as follows :
Hyper-static Aneumonia
.(Duration)
yrs.
mos. ...
6
ds.
Ingreanditis - Senility
Contributory ..
(SECONDARY)
aseara.
.(Duration)
yrs.
mos.
ds.
(Signed)
D. L. Jackson
M.D.
March 14, 1911 (Address)
562 Shirley 89.
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner. Winthrop.
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 good Lawn
DATE OF BURIAL
3-17. 191/
ADDRESS
20 UNDERTAKER
It.C. Skaggs
(City or town.)
Ephraim Smith.
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
1841
17
11 BIRTHPLACE OF FATHER (State or country)
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tiou 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, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But iu many cases, especially in industrial employmeuts, 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- mun, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked ou 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 ('AUSING 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 causatiou), using always the same accepted term for the sam 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, Sur- 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 ueed not be state ? unless im- portaut. 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. 2678
FULL NAME
Anna M Walsh
Registered No ..
2 Mt. Vernon st
Place of Death ¿
Boston
and Residence S
Date of Death
Mar. 17
1911. Age 56
years
months
14
days.
STATISTICAL DETAILS.
SEX
COLOR W
SINGLE, MARRIED, WID., DIV. W
Maiden Name
Doherty
Michael Walsh
Husband's Name
Arlington
Birthplace
Name of
Mathew Doherty
Father
Birthplace of Father
Ireland
Maiden Name Ann Coleman
of Mother
Birthplace of Mother
Ireland
Occupation
Housekeeper
Informant.
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:
ST
RAR'S
PATRIBU SIT DEL Primary (Duration)
Heart dis. - 3 yrs
CITY
CTYTTATI
BOSTDNIA- CONDITA MA
A 1822
IBED.
DONATA A
MASS.
Contributory : 2
Ac.Indigestion -2 hrs
(Duration)
(Signed)
D.McIntyre
M.D.
Mar.17 1911
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal ..
Calvary ( New)
C V Russell
1911
Undertaker
Usual Residence
Winthrop Hds( 79 Cliff ave)
Filed Mar. 23
A true copy.
Attest :
ENMSlenen
Registrar.
B ISREGIN
BOSTON
IMIN
F
anna My. Walsh Mar 17, 1911.
THE COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Florence Lillian Pretoria Black
Registered No.
Date of ¿
inew 2.5
19 '(
Death
S
11
months.
13
.days
STATISTICAL DETAILS
SEX
female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR ( DIVORCED
MAIDEN NAME t
HUSBAND'S NAME +
BIRTHPLACE $
Sussex
England
NAME OF
FATHER
Seo. A. Black
BIRTHPLACE
OF FATHER+
Staplus U.B.
MAIDEN NAME
OF MOTHER
Mary Dlembeck Saunders
BIRTHPLACE
OF MOTHER+
OCCUPATION
INFORMANTS
teacher
Seo. A. Black.
Filed
19
Clerk
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
3/25
19 (r
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from mich 19 19 /
to .. Ich23/197. 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 :
malignant Diphtheria
(DURATION).
.DAYS
Contributory :
... (DURATION) .... .. DAYS
(Signed)
M.D.
Mich 2 5011
(Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents. How long at Place of Death ? . years ...
.. months .. ................ .days
Where was disease contracted,
If not at place of death ?
* 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, give 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 detalls. I/ Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Place of
93 Count Down
Death *
5
Residence
marchiol
Age
/ 0
.. years.
Florence L. P. Black ~ Mar. 23, 1911.
CAUSE OF DEATH in plain terms. so that it may be properly classified. Exact statement of OCCUPATION is very N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop (No ... 198 Circuit Road St. ; Ward)
Winthrop BOSTON
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
mark alfred Whitehead
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 158 Circuit Road Winthrop
PERSONAL AND STATISTICAL PARTICULARS
3 SEX m
4 COLOR OR RACE
w
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
6 DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE
If LESS than I day, . .. .. hrs.
ds.
or
min. ?
(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) Winthrop Mass.
10 NAME OF
FATHER
mark Whitehead
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Bastón
12 MAIDEN NAME OF MOTHER
annie Sullivan
13 BIRTHPLACE OF MOTHER (State or country) East Bastan
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
mark Whitehead
(Address)
155 Circuit Rd Win.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH Mar. 25
(Month)
(Day)
191.1
( Year)
17 I HEREBY CERTIFY that I attended deceased from
, 191
, to
Mar. 25, 1911.
that I last saw heno
Mar. 25,
, 191.2.,
and that death occurred, on the date stated above, at .... P.m.
The CAUSE OF DEATH* was as follows :
Diphtheria
yrs. . ..... .. mos. ds.
(Duration) . General infection. .
Contributory
(SECONDARY)
.(Duration) .
yrs. . mos. .. .ds.
Albert Boorman
M. D.
NaThrop Mais
* 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
Holy Cross
DATE OF BURIAL
march 27, 1911
20 UNDERTAKER
ADDRESS
J.J. Land & D. H. Land 120 Have St E. B.
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
Filed .. 191
8 OCCUPATION 3 yrs. . 6 mos. 28
(Signed)
3/26- 1911. (Address)
Registered No.
March ,
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 liue 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) Forcman, (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, Laborcr - 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 eutered 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, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. (namo 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 stated unless in- 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," "Convulsious," "Debility " ("Congenital," "Seuile," 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:
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