Town of Winthrop : Record of Deaths 1913-1915, Part 114

Author: Winthrop (Mass.)
Publication date: 1913
Publisher:
Number of Pages: 1094


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 114


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


.


(N American Hotel 211 norths.


.


Ward)


(City/or town.) [If death occurred in a hospital or institution, give ita NAME instead of streat and numbar.]


William f. Frx


'FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 36 Sagamore St. Winthrop, Ma Registered No. MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


221


4 COLOR OR RACE


SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Married


" DATE OF BIRTH


October 18


(Month)


(Day)


18.59


(Year)


PAGE


If LESS than


[ day ......... hrs.


58


yrs. ..


mos.


26 ds.


or ........ min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Traveling Salesman


(b) General nature of Industry,


business, or establishment in


which employed (or employer)


Contractors Supplic


9 BIRTHPLACE


(State or country)


Massachusetts


PARENTS


12 MAIDEN NAME


OF MOTHER


Elizabeth Willis Long


1$ BIRTHPLACE


OF MOTHER


(State or country)


maine


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Harrison @ Army


(Address)


Ninatherapy Maso.


Filed Mar.16, 1915 JE NARE W 1: 1X. REGISTRAR


1ª DATE OF DEATH


Nov. 13, 195


(Month)


(Day)


(Year)


17 I HEREBY CERTIFY that I attended deceased from have investigated The death of The


deceased.


191.


-to.


191 ... that I last saw h


and that death occurred, on o date stated


The CAUSE OF DEATH* was as follows :


Probable acute cardiac


dilitation. All but a fur


minutes


.. (Duration)


............. yrs.


..............


mos.


ds.


Probable Dattes degeneration


Contributory.


(SECONDARY)


of heart


(Duration)


yrs.


. mos.


ds.


(Signed)


Henry Colt


M.D.


Mr. 13. 1915 (Address)


Pistefield, Mas.


* 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


In the


RECENT RESIDENTS).


At place


of death ..


.yrs. ........


.... mos. .


ds.


State ............ yrs.


........


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


mos ..


ds ....


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL Hanthrow, Mess.


DATE OF BURIAL


Nov. 16. 1915


.DO UNDERTAKER Wellington + Crosier


ADDRESS


Pittsfield


Pitts field


10 NAME OF


FATHER


Edward S. Thay


11 BIRTHPLACE


OF FATHER


(State or country)


" New Hampshire


1


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach 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, Architcet, Loco- motive engineer, Civil engineer, Stationary fireman, cte. 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) Salcs- 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, Laborer - Coal minc, cte. 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 oceu- pation whatever, write None.


Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affcetion 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 "Epidemie 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, peritonacum, cte., Carcinoma, Sar- coma, etc., of ... .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Mcasles; Whooping cough; Chronic valvular heart disease; Chronie interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus,", "Old age," "Shock," "Uracmia," "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," ete. State eause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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 discase, as A death upon the street, or one supposed to be due to Alcoholism, ete


4. Deaths under circumstances unknown, as A person found dead, cte.


important. See instructions on back of certificate. CAUSE OF DEATH in plain terins, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Mintha/


(No ..


2,55Cleanants .:


Minttrop


BOSTON


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


2 FULL NAME.


Joseph Ralexander


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


PERSONAL AND STATISTICAL PARTICULARS


1 SEX


make It Trite


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6


183.


(Day)


(Year)


7 AGE


If LESS than


1 day ......... hrs.


2 .... yra.


mos.


9 ds.


or ........ min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


Retired


(b) General nature of industry,


business, or establishment in


which employed (or employer).


9 BIRTHPLACE


(State or country)


Topsham be.


10 NAME OF


Stanwood alexand


11 BIRTHPLACE OF FATHER (State or country) "Brunswick Ine


12 MAIDEN NAME OF MOTHER Nancy In Iherriman


13 BIRTHPLACE OF MOTHER/ (State or country) Hardwell


14 THE ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE


(Informant) Sehralexander


(press) 25-3-Theavantst


16


Filed ., 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


(Month)


nor,


(Day)


14


1915


........


(Year)


I HEREBY CERTIFY that I attended deceased from


at intervale 19 Porto try Mettre


. 191


.. .


that ! last saw h ............. alive on


0


Det. 1.


191 .......


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


1 1 .m.


The CAUSE OF DEATH* was as follows :


indiandite, nunca Citic


Did a surgical operation precede death


Date


(Duration)


.yrs.


mos.


ds.


Contributory


atie_


....


(SECONDARY)


(Duration)


.............. yrs.


mos. ....


.........


ds.


(Signed)


M.D.


r -1 4, 19 (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. .


ds.


State.


.. yrs ..


In the


.mos.


ds ...


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


Former or usual residence.


19 PLACE OF LLAMA OR REMOVAL Tapshar Ine


DATE OF BURIAL


nov.18


1911


20 UNDERTAKER


ADDRESS


Igueradian


Lotet Spraque ERista


Ward)


Registered No.


1 COLOR OR RACE


Married


-


$ DATE OF BIRTH


6


(Month)


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of oceu- pation 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 wlien needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Groecry; (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, ete. 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 domestie service for wages, as Servant, Cook, Housemaid, ete. 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 occu- pation whatever, write None.


Statement of cause of death. - Name, first, the DIS- EASE 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 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., Careinoma, Sar- coma, etc., of. ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronie 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" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage,". "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," ete., when a definite disease ean be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State eause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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 eaused 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.


....... I SEX 7 AGE PARENTS important. See Instructions on back of certificate. N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very .....


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Winthrop


.(No ...


21


Woodside


(seve


Ward)


2 FULL NAME


Frederick


.


& Kwell In


[If married or divorced woman or widow


give maiden name, also name of husoand.]


@RESIDENCE


21 Woodside ave


Widowed


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


+ COLOR OR : RACE


Muito


6 SINGLE


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Indouce


· DATE OF BIRTH


Sept 10 1847


(Month)


(Day)


(Year)


If LESS than


! day ......... hrs.


68


yrs. mos.


ds.


or ........ min. ?


· OCCUPATION


(a) Trade, profession, or


particular kind of work


Guildw


(b) Generat nature of industry.


business, or establishment in


which employed (or employer).


9 BIRTHPLACE


(State or country)


Barton Mass


·


10 NAME OF


FATHER


Unknown


11 BIRTHPLACE


OF FATHER


(State or conntry)


England


12 MAIDEN NAME


OF MOTHER


Ellen Convers


13 BIRTHPLACE


OF MOTHER


(State or conntry)


Burlington Anass


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Fredericky Anell


(Address)


21 Novdride que


winthrop may 20 UNDERTAKER


Flted 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


1800


(Month)


14


1915


(Year)


(Day)


17


I HEREBY CERTIFY that I attended deceased from


imv 12


1915 to


AV 14


1915


that I last saw h w alive on


1915,


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


9 A.m.


The CAUSE OF DEATH* was as follows :


Coronary Delemis


Did a surgical operation precede death ?


Date


(Duration)


Guddy


2


.yrs.


mos.


ds.


Contributory


Dineral artrosebasis


(SECONDARY)


(Duration)


2 yrs


... mos.


ds.


.........


(Signed)


M.D.


MV 14


, 1915 (A


(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 placo


of death.


... yrs. .......


.mos.


In the


ds.


Stato


.......... yra. .........


... mos.


......


ds.


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


Former or usual residence.


1 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Nov 17, 1915


ADDRESS


Bostero.


Winthrop BOSTON


(City or town.)


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


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach 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 needcd. 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 Housc- kccpcrs 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 homc. 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 occu- pation whatever, write Nonc.


Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Ccrebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup"); Typhoid fever (never rc- 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 provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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 dcath upon the street, or one supposed to be due to Alcoholism, etc


4. Deaths under circumstances unknown, as A person found dcad, 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


' PLACE OF DEATH


Winthrop


(No. 48, Dieshine


St. Ward)


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


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


& SEX


Fr


{ COLOR OR RACE


W


6 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widowed


10 DATE OF DEATH


november 14


1915


....


(Month)


(Day)


(Year)


$ DATE OF BIRTH


2


(Month)


(Day)


(Year)


7 AGE


....


If LESS than


1 day ......... hrs.


· OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry,


business, or establishment


which employed (or employer).


9 BIRTHPLACE


(State or country)


10 NAME OF


FATHER


1


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


-


12 MAIDEN NAME


OF MOTHER


1$ BIRTHPLACE


OF MOTHER


(State or country)


721 9


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


H. L. Lowle


(Address)


4.8 Milebure Sl


Filed DEC. 4, 1915 PRESTEN B. Churchill


I.a.) REGISTRAR


I HEREBY CERTIFY that I attended deceased from


Sett 16


1915 to


nov 14


1915


that I last saw h ........... alive on


19150


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


100 am.


The CAUSE OF DEATH* was as follows :


Carchal Salvario


Contributory


arteriosclerosis


...


(SECONDARY)


Ялла (видео) ..


.. yrs.


X


.mos.


X


ds.


(Signed)


Quiere 8, Solo M.D.


Nov 14. 1915 (Address)


Il meeting mars


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


1ª LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


In the


of death


. yrs. ....


.... mos. ...


ds.


Stato ............ yra.


.......... mos.


.......................


Where was disease contracted,


If not at place of death ?.


Former or usual residence


D PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


11-16


1915


20 UNDERTAKER


1


W.C. H/ 1 932


ADDRESS


2 FULL NAME


Elizabeth. Curtis


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 48 WilshireSt, Winthert.


Lasker Por Renson Gusti2


.... Registered No.


5


1836


17


79 yrs. ........ 9 mos 9 ds.


or ........ min. ?


.. (Duration)


........ yrs. ............. mos.


X


.ds.


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- pation 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 occu- pation whatever, write None.


Statement of cause of death. - Name, first, the DIS- CASE 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, peritonacum, 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," "Hacmorrhage," "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 septicacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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.


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.


N. B. - Every Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.