USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 87
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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-1912.
CITY OF BOSTON.
FULL NAME
DONALD MC LENNAN
Registered No ...
9635
Place of Death
Boston
and Residence S
82 ALBION ST
Date of Death
OCT.30
1912.
Age
52
years
months.
. day's
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
MAR
Maiden Name
Husband's Name
Birthplace
CAPE NORTH.CAN.
Name of Father
JOHN MC LENNAN
Birthplace of Father
CAPE NORTH.CAN.
Contributory : 2 (Duration)
Maiden Name of Mother . SARAH MORRISON
Birthplace of Mother
CAPE NORTH.CAN.
(Signed)
T. LEARY MED. EX. M.D.
O.C.T ... 30 .1912
SPECIAL INFORMATION from Hospitals, Institutions, Transients of Recent Residents.
Place of Burial or removal
WINTHROP (WINTHROP CEM)
Usual Residence WINTHROP ( 14 FREMONT ST)
Undertaker . .
C. R. BENNISON
Filed
NOV.4 1912
WINTHROP
A true copy
Attest '
ErMSlenen
Registrar.
PATRICUS SIT DI RE n'aIs
CITY
Primary- (Duration) FICE:
BOSTONYA
CEVTTAT
TONDITAA 183₺.
B SREOTMINE DONATA A STO N. MASS
TA A. 1822
FALL OVER BALUSTRADE
Occupation ... PAINTER
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from .. 1912, to 1912, 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 :
STRAR'S
FRAC. SKULL (ACCIDENTAL)
Oct 30, 1912
L
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 Boston Harbor ? (No. Point Shirley Beach St. : Ward)
4537 Winthrop (City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME Unknown Man ( Case Nº 4537 ). [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Unknown.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
1
· SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
6 DATE OF BIRTH
(Month) (Day)
(Year)
7 AGE
If LESS than I day, ....... hrs.
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
PARENTS
12 MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Found
(Month) October 31, . 1912 (Year)
(Day)
I HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows :
Iron Stances -
under circum.
(Duration) .
.. yrs.
mos. .ds.
Contributory. (SECONDARY)
.(Duration) yrs.
mos. .ds.
(Signed) Lenge Buyans Magnety 1 M.D.
har2. 1912 (Addres) ...
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.
.S 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
.
191
* UNDERTAKER
ADDRESS
V
Filed. , 191
17
1
30 - 35 .. yrs. mos. ds.
11 BIRTHPLACE OF FATHER (State or country)
Oct. 31, 1912
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, Sur- coma, etc., of .. (name origin: "Cancer" is less definite; avoid use of " Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy,""Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident ; Revolver wound of head-homicide ; Poisoned by carbolic acid - prob- 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 street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
3 SEX Cfc 4 COLOR OR RACE Mute 6 DATE OF BIRTH (Month) 7 AGE & OCCUPATION (a) Trade, profession, or particular kind of work. (b) General nature of industry, business, or establishment in which employed (or employer) 11 BIRTHPLACE OF FATHER (State or country) m PARENTS (Address) 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. 16 Filed ... 191 N. D. Every item of imformation should be caretuny supplied. AGE should be stated LARvill. ThistolANS should state 10 NAME OF FATHER Edmund
The Commmwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Winthrop (No. 50
Maine
St. :
Ward)
Marie alma Woode
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
50 Maine St Muchof
Registered No.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH
nor- 1
(Month)
(Day)
191
(Year)
17
I HEREBY CERTIFY that I attended deceased from
lect 29
1912
Dar 1 92
., to
that I last saw h & alive on
Cect 30
, 191 2
and that death occurred, on the date stated above, at.
3 Pm
The CAUSE OF DEATH* was as follows :
TuTalnutrition
(Duration)
... yrs.
mos. ds.
Contributory. (SECONDARY)
(Duration) ... „yrs. mos. ds.
(Signed)
325 Winther ... M.D. Nor2 191.2 ..... (Address)
* If death followed injury or violence the certificate of death must bo made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At piece
of death.
. yrs.
mos.
In the
ds.
State
yrs. ...
mos.
d ..............
„Where was disease contracted,
if not at place of death ?. Former or usual residence
1 PLACE OF BURIAL OR REMOVAL Haty Sauce Malden
DATE OF BURIAL
NO 2. 1912
20 UNDERTAKER
ADDRESS Cash Bastar
BOSTON
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
§ SINGLE,
MARRIED,
WIDOWED,
OR . DIVORCED
(Write the word)
Chugle
(Day)
(Year)
If LESS than
I day, ....... hrs.
... yrs.
3
mos.
ds.
Or ........ min. ?
9 BIRTHPLACE
(State or country)
Withroh
12 MAIDEN NAME
OF MOTHER
Mary a. Simperou
18 BIRTHPLACE
OF MOTHER
(State or countryy
Gast Bulatore
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Hacher
REGISTRAR
1
nov. . 1,1912
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 taborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. . The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," " Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "Shock," " Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
161
(No. Almont
St. : ....... Ward)
(City or town.) [If death occurred In a hospital or institution, give its NAME instead of street and number.]
FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
temale white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
16 DATE OF BIRTH Oct
(Month)
(Day)
18
6862
(Year)
7 AGE
If LESS than
[ day ......... hrs.
50
„yrs.
mos.
.....
ds.
„.min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Houseurfe
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Germany
10 NAME OF
FATHER
Hyman Weise
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Servane
12 MAIDEN NAME
OF MOTHER
Estherunkuru
1ª BIRTHPLACE
OF MOTHER
(State or country)
Germany
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
Louis Ramslourdes
(Address)
Filed 191
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
1912 to
1912
that I last saw her alive on
non rot
191
.........
and that death occurred, on the dato stated above, at
m.
The CAUSE OF DEATH* was as follows :
Cerebral Hemorrhage
.(Duration) ........
.. yrs.
........
.. mos. .
Contributory.
(SECONDARY)
W.R. Portas
.(Duration) .
........ yrs.
mos.
1
ds.
(Signed)
M.D.
Nov. 2 012 (Address)
Winetrop Mais
* If death followed Injury or vlolence 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.
In the
mos.
Where was disease contracted, If not at place of death ?.
Former or usual residence.
D PLACE OF BURIAL OR REMOVAL . Hoyed Panko
DATE OF BURIAL
can 3
......
.. 191.12
" UNDERTAKER Mayer Salmon
ADDRESS
V
(Month )
10h
(Day)
1912
(Year)
10 DATE OF DEATH
nov.
BOSTON
Theresa Weiss Runalaska
....
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 laborcr, 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 necd 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 Examinors:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms. so that it may be properly classified. Exact statement of OCCUPATION is very
important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop .. (No ... 35 Holdermert St. :
Hubuif timowany
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of busband.] @RESIDENCE
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
não
(Month)
(Day)
3
1912
(Year)
17
I HEREBY CERTIFY that I attended deceased from
March
1910 , to
Two 3, 19/2
If LESS than | day, . hrs. that I last saw huncalive on 2, 19|2 or ... min. ? and that death occurred, on the date stated above, at 60 m. The CAUSE OF DEATH* was as follows :
(Duration) 2 yrs. 9
ds.
Contributory. (SECONDARY)
(Duration)
. yrs.
mos.
ds.
(Signed)
1912
( Address)
Winterof
* 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
hor. 5, 191."
ADDRESS
Filed .. 191.
5 SINGLE, MARRIED, WIDOWED OR DIVORCED (Write the word)
nisamed
6 DATE OF BIRTH
3
(Month) (Day)
-1902
(Year)
7 AGE
38 yrs. ..
mos. .. ds.
8 OCCUPATION
(a) Trade, profession, or particular kind of work
Manufactis Dass
(b) General nature of industry,
business, or establishment in
which employed (or employer)
Einfluss
9 BIRTHPLACE
(State or country)
Huddersfield Inglunico
10 NAME OF
FATHER
PARENTS
12 MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
. .
(Informant)
(Address)
REGISTRAR
· UNDERTAKER
C.R. Bunuion
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
3 SEX
4 COLOR OR RACE Vinte
11 BIRTHPLACE OF FATHER (State or country) ntry Hud dersfisher higland
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, o. 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 («) 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) Sules- 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, Ilousework, 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 havo 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, Sur- comu, 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 childbirthi or miscarriage, as " PUER- PERAL septicemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
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