USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 119
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RETURN OF A DEATH-1915.
CITY OF BOSTON.
FULL NAME
ISAAC B. KLOUS
Registered No.
11267
Place of Death ¿ and Residence S
Boston
Date of Death
DEC. 15
1915.
Age
70
years months days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
M
W
MAR.
Maiden Name
GIST
Husband's Name
Birthplace
GERMANY
Name of Father MORRIS KLOUS
Birthplace of Father GERMANY
Maiden Name of Mother
Birthplace of Mother
BERMANY
Occupation
NONE
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from
1915, to
1915, that to the best of my knowledge and belief death occurred, on the date stated above, and that the CAUSE OF DEATH was as follows : RAR'S
T PATRIUNS. SIT DE
Primary. ( Duration)
s
4
BOSTONIA
CONTAA
1130. IMINE DONATA A
BOSTO
MASS
Contributory . ! (Duration) SUDDEN DEATH
(Signed)
G. B. MAGRATH MED. EX.
M. D.
DEC. 15 1915 SPECIAL INFORMATION from Hospitals, Institutions, Transients, of Recent Residents.
Place of Burial or removal
OHABEI SHOLOM
Usual Residence
WINTHROP ( 187 SHORE DRIVE)
Filed
DEC. 20
1915 .
A true copy. Attost : Emblemen
Registrar.
0
Undertaker
S. M. CARO
CITY
SICUT
FICE
NATURAL CAUSES-HEART DISEASE
( ORGANIC) PRESUMABLY CORONARY SCLEROSIS
CIVITATISRE
33 WINTHROP ST. (C.D. )
C
1.
,
。
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No ....
2 5. Crystal can are
Ward)
Quali Fikserland Wilson
2 FULL NAME
[If married or divorced woman or widow give maiden name, atso name of husband.] @RESIDENCE 0
1
189
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
& SEX
Male
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
$ DATE OF BIRTH
(Month) (Day)
7 AGE
70
yrs. mos.
........... ds.
or ....... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry, business, or establishment in which employed (or employer).
9.y.n.H+H.R.R.
9 BIRTHPLACE
(State or country)
Warren Mass
10 NAME OF
FATHER
PARENTS
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or country)
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
15
Filed
191
REGISTRAR
17 I HEREBY CERTIFY that I attended deceased from
Dec
1915
22 1915 .. . and that death occurred, on the date stated above, at 2 A.m.
The CAUSE OF DEATH* was as follows : acute bronchitis
(Duration)
.......
7
.yrs. ............. mos. ..... ds.
Contributory
Chronic pusocarditis
(SECONDARY)
.. (Duration) ...
1 yrs.
mos. ds.
(Signed)
( Raymond ( B. Tanken
M.D.
Wec
23, 1915 (Address).
Winthrop Mars
* 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).
In the
At place
of death.
.........
.yrs.
mos. .............
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
Sec 24 195
.......
ADDRESS
D UNDERTAKER
E. R. Pamani
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.
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
16 DATE OF DEATH
tramber
22
1915
(Month)
(Day)
(Year)
1
(Year)
Dec
22
1915, to
22
.......
that I last saw him
alive on
Dec.
If LESS than
I day ........ hrs.
black
Contre myocarditis
11 BIRTHPLACE OF FATHER (State or country)
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 ncedcd. 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, Laborcr -- Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- kccpers 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, 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 (rctired, 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 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," "Uracmia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the 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.
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
67 Canção
(No.
Panie
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
67 Cerca de marchiRegatas No.
PERSONAL AND STATISTICAL PARTICULARS
$ SEX
' COLOR OR RACE
White
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
$ DATE OF BIRTH
23/1/5
(Month)
(Day)
(Year)
7 AGE
If LESS than
day, 8 hrs.
or ....... min. ?
S 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)
mass
PARENTS
12 MAIDEN NAME
OF MOTHER/
Natte Dewar
18 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
C.R. Person
(Address)
16
Filed
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Decr
(Month)
23 5
1913
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from Dec 203, 1915, to Des- 23 1915 ....
that I last saw halive on
Dec. 26.
1915~
and that death occurred, on the date stated above, at
SP.
m.
The CAUSE OF DEATH* was as follows :
Premiatire Birth
(Duration)
/
.. mos.
ds.
Contributory
(SECONDARY)
.. (Duration)
yrs. ..
.........
mos. ds.
(Signed)
A& Parter
M.D.
Que. 241916 (Address)
* 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 RECENT RESIDENTS).
In the
At place
of death ..
.......... yrs.
..... mos. ........
ds.
State ............ yrs. ...........
mos. ..
Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL 1
DATE OF BURIAL
11/24
1915-
· UNDERTAKER
ADDRESS
(City or town.)
[If death occurred In a hospital or institution, give its NAME instead of street and number.]
Ward)
.............. yrs.
.........
10 NAME OF
FATHER
Geo. Fr. Panie Ja
11 BIRTHPLACE
OF FATHER
(State or country)
.mos. ds.
yrs.
......
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits ean be known. The question applies to eaclı 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, 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 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, 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 Houscwifc, 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 domestie 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 oecu- 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 (Icfinite 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, ete., 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," ete., when a definite disease can be ascertaincd as the cause. Always qualify all discases 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 Medieal Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, ete.
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, ete.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(No.
22
Summit ate
......
Wucherof
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Regist ed No.
PERSONAL AND STATISTICAL PARTICULARS
1 PLACE OF DEATH
2 FULL NAME
$ SEX
7 AGE
& OCCUPATION
(a) Trade, profession, or
particular kind of work
9 BIRTHPLACE
(State or country)
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
PARENTS
IS BIRTHPLACE
OF MOTHER
Important. See instructions on back of certificate.
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
which employed (or employer)
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED.
OR DIVORCED
(Write the word)
1859
(Year)
If LESS than [ day ......... hrs.
.yrs. mos. ds.
......
Or ........ min. ?
at home
2
10 NAME OF
FATHER
raction
Henderson
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
CR Ben
-
(Address)
18
Filed
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
24
(Month)
(Day)
1915
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Dec. 14th
191_E ... , to
Dea. 24/ 1995
that I last saw h.t.L/ alive on
Dee 24
191.N.
and that death occurred, on the date stated above, at
4.5 m
m.
The CAUSE OF DEATH* was as follows :
Chronic Interstitial Nephritis
(Duration)
.........
yrs. .......
ds.
Contributory Valvular Heart Aceeace
... mos.
...........
(SECONDARY)
Necolef.
(Duration)
Parler
mos.
.......
ds.
.yrs.
M.D.
(Signed)
Alec. 26
191. (Address)
Withref.
* If death followed injury or vlolence the certificate of death must be made out by the Medical Examiner.
16 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
18 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Qc 26
1915
ADDRESS uruch
" UNDERTAKER
C.R. Bunun
Ward)
Marcha, Eva. Butter
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 22 dimont ase
Wiam of Walden-Vi Bytter
$ DATE OF BIRTH
may
1
(Month)
(Day)
Dec. 24,1915 STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits ean 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," ete., 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 serviee 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 oecu- pation whatever, write Nonc.
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, ete., 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; Chronic interstitial nephritis, ete. 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," ete., when a definite disease can be ascertained as the eause. 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, ete.
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, ete.
1
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No.
90 Jagune our
(City or town.)
Ward) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
...
2 FULL NAME
¿ SEX
7 AGE
& OCCUPATION
(a) Trade, profession, or
particular kind of work
11 BIRTHPLACE
OF FATHER
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or country)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
PARENTS
important. See instructions on back of certificate.
(Address)
Filed
N. B. - Every item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
(State or country)
{ COLOR OR RACE
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
* DATE OF BIRTH June 15 (Month) (Day)
57
.... yrs.
mos.
ds.
or ........ min. ?
17 I HEREBY CERTIFY that I attended deceased from aug, N., 1915, to. Dee. Ser. . 1915. that I last saw h Z alive on Des ved and that death occurred, on the date stated above, at 5 -9 m. The CAUSE OF DEATH* was as follows :
(Ca reuniones of lutesting
.(Duration)
1
yrs.
............... mos.
ds.
Contributory
acute Mphrites
(SECONDARY)
.(Duration)
.yrs. ....
1
mos.
ds.
(Signed)
M.D.
* 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.
......... yra.
mos. .............
ds.
State ...........
.. yrs.
In the
....... mos. ...........
Where was disease contracted, if not at place of death ?.
Former or usual residence
18 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
191
* UNDERTAKER
ADDRESS
191
REGISTRAR,
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dec.
25 95
(Month)
(Day)
(Year)
1
(Year)
If LESS than
| day ......... hrs.
(b) General nature of industry,
business, or establishment In
which employed (or employer)
-
19 BIRTHPLACE
(State or country)
Feland
10 NAME OF
James Mc Fadden
2
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
C . R. Bunun
Isabella, Mago
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
90 Pagamos
werden of com
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
........
(Address)
Weuthof
2Rec . 25, 1915
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, Architcet, 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 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 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 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-
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culosis of lungs, meninges, peritonaeum, etc., 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; 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," "Senilc," 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 septicacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
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