USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 7
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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.
0 - May 29, 1910
52
Thos. Foley
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Winetrop masa
(CITY OR TOWN.)
FULL NAME
obert GeorgE I Larris
.Registered No.
53
Place of Ho Bowdown So. Hunitung
Date of l
June 1'
198 0.
Death
Residence
Ho Bowdown St. Finition Age ...
68
7
years.
months.
.days
STATISTICAL DETAILS
SEX
16.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
England
NAME OF
FATHER
unknown
BIRTHPLACE
OF FATHER #
England
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
England
OCCUPATION-
INFORMANT § Edmund R. e dami
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from 1 May 20 190/010 .. 196 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 :
P. trong stral seler.
POSTERIOR Spinal Sclerosis
(DURATION)
1 yrs
LOLYS
Contributory :
(DURATION)
.DAYS
.M.D.
(Signed)
m 21
.190
.(Address).
worthy moss
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
. years.
months.
....
. days
Where was disease contracted,
If not at place of death ?.
Filed
190
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 details. Il Name of cemetery.
PLACE OF BURIAL OR REMOVALI I ordlawn (One
DATE OF BURIAL
UNDERTAKER
m.
ADDRESS 28h receive Face Breton
ALL NAMES TO BE IN FULL
Death *
S
53
Robert george Harris
June 1, 1910.
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. N. B .- Every Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE PARENTS
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winterof Mass. (No. 30 Looral ave.
St .; - .. Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Martin &. OBrien a FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.] .
2ª RESIDENCE
30 Coral ave. Winthrop Mass. Registered No,
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
· COLOR OR RACE
White
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
6DATE OF BIRTH
...
(Month)
(Day)
1
(Year)
7 AGE
If LESSthan I day, ........ hrs.
137
yrs. mos.
.ds.
or ........ min .?
BOCCUPATION 1 (a) Trade, profession, or Journalist particular kind of work ..
(b) General nature of industry, business. or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
Ireland
10 NAME OF
FATHER
Jahn
11 BIRTHPLACE OF FATHER (State or country)
Ireland
12 MAIDEN NAME OF MOTHER Mary Fahey
13 BIRTHPLACE OF MOTHER (State or country)
Theland
14THE ABOVE IS TRUF. TO THE BEST OF MY KNOWLEDGE
Innie OBrien
(Informant)
30 leoral and Winthrop
Filed
191
REGISTRAR
16 DATE OF DEATH
..
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from 1916 ., to. 6 2 14, 1910 ... that I last saw h ........ alive on Joan 13 1910 and that death occurred, on the date stated above, at. ..... )7m.
The CAUSE OF DEATH* was as follows : .
(Duration).
8
ds.
Contributory (SECONDARY)
(Duration) .yrs.
.....
mos. ........... .. ds.
(Signed) ..
., M. D.
(5, 191.0. (Address)
50 Charles Se
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
IS LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR ds. State In the .. yrs .. RECENT RESIDENTS). At place of death .yrs. mos. ........ .. mos. ........ ds .....
Where was disease contractad, If not at placa of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
1
-1206 16
191.9.
20 UNDERTAKER This. binance
ADDRESS
120 Have Lt.
S. Boston
54
MEDICAL CERTIFICATE OF DEATH
(Month)
14
191.2 ...
............ yrs. .......... mos.
Winthrop Mass. - BOSTON
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 oceupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, ete. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of - work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, ete. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Houscwork, Dor At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically the oceupations of persons engaged in domestie service for wages, as Servant, Cook, Housemaid, ete. If the oceupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at begin- ning of illness. If retired from business, that 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 eausation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is " Epidemie eerebro-spinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia "); Lobar pneumonia;
Broncho-pneumonia (" Pneumonia," unqualified, is indefi- nite); Tuberculosis of lungs, meningcs, peritonaeum, etc., Carcinoma, Sarcoma, etc., of ..... ........ (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or intereurrent) affection need not be stated unless important. Example: Mcasles (disease eausing death), 29 ds .; Broncho-pneumonia (second- ary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anaemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Con- vulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemor- frugt," "Inanition," "Marasmus," "Old age," "Shoek," " Uraemia," "Weakness," ete., when a definite disease ean be ascertained as the eause. Always qualify all diseases resulting from childbirth or misearriage, as " PUERPERAL scpticaemia," "PUERPERAL peritonitis," ete. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Exam- iners :
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly eaused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under eireumstances unknown, as A person found dead, ete.
0
+ MartinJ. O'Brien - June 14, 1910 .5 4
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) Lubec me
12 MAIDEN NAME OF MOTHER Maria. LiCoggins
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
alonzo. Coyquo
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
X (Day)
- 190 (Year)
17 I HEREBY CERTIFY that I have investigated the death of the deceased. The CAUSE OF DEATH" was as follows : Steps Localeyes of wife of collar have
accidental- fall for
(Duration)
yrs.
mos. .. ds.
Contributory
(SECONDARY)
ds.
June 191 (Address) MEDICAL EXAMINER
M.D.
* 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.
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
Wanntrop Maso
20 UNDERTAKER C. R. Brunson
DATE OF BURIAL
June 16
1910
ADDRESS
Worethink
(Opy or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
24 Belchen Slied
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mall
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
widowed
6 DATE OF BIRTH
(Month) (Day)
(Year)
7 AGE 84 .yrs. 6 mos. 22 ds or ......... min. ?
If LESS than I day, .. hrs.
8 OCCUPATION (a) Trade, profession, or particular kind of work Carpenter
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
Lukec me
10 NAME OF
FATHER
William Coggins
Filed ., 191
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH metcalf Hospital (No. 1TX William
1 PLACE OF DEATH . luthers St. : Ward)
H. Coggins
Registered No.
55
STANDARD CERTIFICATE OF DEATH.
Williams Ar. Coggins- June 14, 1918
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 engincer, 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 laborcr, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- 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 .; Broneho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (mcrely 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- ably 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 strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
55
THE COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
May &.
Steven 2011,
Place of l
23 Bulehaman St
Death *
Residence
Age
79)
(
.. years .. 10 months. 16 days
STATISTICAL DETAILS
SEX
COLOR
LU
SINGLE; MARRIED, WIDOWED, OR DIVOROED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE +
NAME OF FATHER Hauding Batis.
BIRTHPLACE OF FATHER$
MAIDEN NAME
OF MOTHER
BIRTHPLACE OF MOTHER $ Cancan Int. 41-5.
OCCUPATION 1
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 19 /0 to June 2/2 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 : Primary : abdominal Cancer
Contributory :
GOURATION). . DAYS
(Signed)
315 mercato
M.D.
you 22 .. 19/₫ (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? .. years ..
.. months .. ..... days
Where was disease contracted, If not at place of death ?
Filed
19
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
UNDERTAKER
ADDRESS
Colinnicas Si-
* 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. || Name of cemetery.
ALL NAMES TO BE IN FULL
Registered No. 56
Date of ¿
Death
france 21 19 10
(DURATION).
.. DAYS
56 Mary E. Stevenson June 21, 1910,
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1910.
CITY OF BOSTON.
FULL NAME
Theodore I Boyd
Registered No.
5783
Place of Death
Boston
Mass. Gen.Hospt.
and Residence S
Date of Death
Jun. 21
1910.
Age
32
years
10
months
4
days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
S
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:
Maiden Name
ST
PATRIBU
SITDEL
Syncope, Opr.ac. retention -
stricture of urethra
Birthplace
Name of
Isaac L Boyd
ISREGIM
MIN
MA.SS.
Birthplace
of Father
Cuba
Contributory : ! (Duration)
Maiden Name Mary Carpenter
of Mother
Birthplace of Mother.
St John, I. B.
Laborer
Occupation
Informant
........
Place of Burial
Winthrop"Winthrop Ceml
or removal
Undertaker w C Skaggs
Winthrop
Usual Residence
Winthrop(30 Cora St)
Jun. 25
Filed
1910.
A true copy,
Attest :
Ermslenen
Registrar.
RAR'S
Husband's Name
CITY.
Prima? (Duration) TICE
D. 1822.
183D.
Father.
Boston(East)
CEVTTAT
CONDITAA.
BOSTO
DONATA A.
(Signed)
G B Magrath, Med. Ex.
M. D.
Jun. 23 1910
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
.
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
..
DINI - HT
THE COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Williard Hami Loveil
(CITY OR TOWN.)
FULL NAME
Place of #150 Losing Road
Death *
5
Residence
-
1
Wichnt
Age
56
... years ..
X
.months.
days
STATISTICAL DETAILS
SEX
Male
COLOR
Wtute
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Manuel
MAIDEN NAME T
HUSBAND'S NAME t
BIRTHPLACE # Malden Mass
NAME OF
FATHER
George Soveil
BIRTHPLACE
OF FATHER$
MAIDEN NAME
OF MOTHER
Carolina Sopron
BIRTHPLACE
OF MOTHER #
OCCUPATION
cistiologer
INFORMANT §
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. May 28 .1910 to fame 23, 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 : Primary : Chronic Rettinites
x
(DURATION) . DAYS
Contributory :
(DURATION ).
.. DAYS
(Signed)
richard S. que
... M.D.
June 24 1910 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
.. years.
.....
months. .. days
Where was disease contracted, If not at place of death ?
Filed
19
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
June 26#
1910
UNDERTAKER
6. R Benna-
ADDRESS
Wieland.
1
* 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. || Name of cemetery.
ALL NAMES TO BE IN FULL
Registered No.
57
Date of ¿
June 23
19/0
..
Death -
57 Williard Henri Joveil June 23, 1910
3 SEX quale 7 AGE 8 OCCUPATION (a) Trade, profession, or particular kind of work PARENTS important. See instructions on back of certificate. (Address) N. B. - Every Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very (b) General nature of industry, business, or establishment in which employed (or employer)
The Commonwealth of Massachusetts
1 PLACE OF DEATH
Rutland
STANDARD CERTIFICATE OF DEATH (No. Huntren Sanator
Irving 6. Shea 'FULL NAME [If married or divorced woman of widow give maiden name, also name of how band.] @RESIDENCE Muchrol Beach mass
St. ;...
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
momed
6 DATE OF BIRTH
april 6
(Month)
(Day)
1879
(Year)
If LESS than
I day, ....
hrs.
31
1 yrs.
2 mo
20
ds.
or ........ min. ?
Engineer stationary
9 BIRTHPLACE
(State or country)
Wicasset Mail
10 NAME OF
FATHER
Thomas F thea.
11 BIRTHPLACE
OF FATHER
(State or country)
Westport Mail
12 MAIDEN NAME
OF MOTHER
Enelen 2. hate
1ª BIRTHPLACE OF MOTHER (State or country) Wir casset Mail
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Walter S. Chalmer
505 Shirley at Wunderof mass
Filed June 30 1910
for In. Hanff REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
une
26
(Month)
(Day)
1910
(Year)
I HEREBY CERTIFY that I attended deceased from
25
191
grue 2.5. 1910.
....... , to
that I last saw him alive on
June 25, 1910,
and that death occurred, on the date stated above, at 6:30 qm.
The CAUSE OF DEATH* was as follows :
Laryngeal Luber culosis
.. (Duration)
.yrs.
mos.
ds.
Contributory.
Pulmonary
Tuberculosis
.
(SECONDARY)
(Duration)
2 yrs. 2
mos. .
C ds.
(Signed)
D. P. Butter
M.D.
June 86, 1910 (Address)
Rultand low
* 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
5
.mos.
Y ds.
In the
State.
.. yrs.
mos.
ds ...
Where was disease contracted,
If not at place of death ?
Mas cussett marie
Former or
usual residence.
1 PLACE OF BURIAL OR REMOVAL
mueller Wis carnet mano
20 UNDERTAKER
Frankst, Miles
DATE OF BURIAL
June 29.
191 .
ADDRESS
Jefferson Ian
17
Ruland (City or town.)
Registered No.
45
' COLOR OR RACE
White
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; Broneho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritoneum, etc., Carcinoma, Sar- coma, eto., 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 in- portant. Example: Measles (disease cansing 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 septicemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
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