USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 120
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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, 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 Conunawealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No. Charles . W: Chandler
St. :
Ward)
{If death occurred in a hospital or institution, give its NAME Insteed of street and number.]
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband, @RESIDENCE
145 Sommensch an Wuch Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
1915
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from De 18 5
191
to
the 25
1915
....
that I last saw him alive on
Dec 25
1915
and that death occurred, on the date stated above, at
66
.m.
The CAUSE OF DEATH* was as follows :
Dobry Precuming
(Duration)
.............. yrs. ................ mos.
7 ds.
Contributory.
(SECONDARY)
.(Duration)
yrs.
mos. ......
ds.
(Signed)
Ben Muday
M.D.
De 21; 1915 (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 desth.
.. yrs.
mos.
5 de.
In the
Stete.
......
... yrs.
............ mos.
Where was disease contracted,
If not at place of death ?.
145 Jourset wy
Former or
usual residence.
145 Inmail m
19 PLACE OF BURIAL OR REMOVAL
newfield the
DATE OF BURIAL
12/29
..
ADDRESS
Filed 191
REGISTRAR
16 DATE OF DEATH
· DATE OF BIRTH
un 22
(Month)
(Day)
(Year)
7 AGE 60
... yrs.
1
mos.
ds.
3
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Muchasto
(b) General nature of industry, business, or establishment In which employed (or employer).
9 BIRTHPLACE
(State or country)
Charlott mer
10 NAME OF
FATHER
Avseth . W Chandler
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Charlott men
12 MAIDEN NAME
OF MOTHER
HER Sarah Olivia Fisher
1ª BIRTHPLACE
OF MOTHER
(state or country
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informent)
e . R. Gen
(Address)
whichit man
20 UNDERTAKER C. R . Bem
(City or town.)
3 SEX
Mal
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1855
If LESS than
! day ......... hrs.
(Month)
25
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 applics 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 linc 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 minc, etc. Women at home, who arc 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 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 diseasc. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid usc of "Croup"); Typhoid fever (never rc- 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 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 (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report merc 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 discase 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 discase, 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-1915.
CITY OF BOSTON.
FULL NAME
WILLIAM J. BRADY
Registered No.
11599
MASS. GEN. HOSPT.
Place of Death ¿ and Residence S
Boston
DEC.25
1915.
Age
27
years
months
days.
STATISTICAL DETAILS.
SEX.
COLOR.
M
W
SINGLE, MARRIED, WID., DIV. MAR.
Maiden Name
ISTRAR'S
Husband's Name
Birthplace
NASHUA. N. H.
Name of Father
JOHN BRADY
Birthplace of Father
IRELAND
Maiden Name of Mother
ANNIE MULLIGAN
Birthplace of Mother
IRELAND
Occupation
CONDUCTOR ( B.EL)
Informant
CITY RI
T PATRIBUS SIT DE Primary (Duration!
GEN.PERITONITIS - 3 DYS
BOSTONIA CONDITA A. LYUAL TIS REGIMINE DONATA A. 1130.
A. 1822.
ST
N. MASS
Contributory : (Duration)
AC. APPENDICITIS - 5 DYS
(Signed)
J.F . BRESNAHAN M.D.
DEC.25 1915 SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen! Residents.
IN HOSPT. 3 DAYS
WINTHROP (42 MYRTLE AV)
Usual Residence
DEC.28 1915.
Filed A true copy. Attest :
Emblemen
Registrar.
O
HUDSON . N. H.
Place of Burial or removal
Undertaker
OSHEA & GAFFNEY
NASHUA . N. H
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1915, from 1915, to 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 :
Date of Death
م
N. B .- Every item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH In plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important. See Instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
.(No.
75
.......
...........
St.
..............
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Danné Và linger
[If married or divorced woman or widow
give maiden name, also name of husoand.]
@RESIDENCE
75 mainst Smith 2/22
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED, -
·
OR DIVORCED
(Write the word)
$ DATE OF BIRTH
15
1810
(Year)
7 AGE
If LESS than
i day ......... hrs.
100 %
__ yrs.
3
mos.
1 x ds.
or ........ min. ?
& OCCUPATION
(s) Trade, profession, or
particular kind of work
(b) General nature of Industry, business, or establishment which employed (or employer)
9 BIRTHPLACE (State or country) .U
10 NAME OF FATHER
1.0
11 BIRTHPLACE OF FATHER (State or country)
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) n
16
Filed ., 191
REGISTRAR
16 DATE OF DEATH
27. 1913
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from Der 26 1915 to Un 272 1910 that I last saw his alive on 26 1915 and that death occurred, on the date stated above, 8:30 Pm.
The CAUSE OF DEATH* was as follows : Nobar Pracumany
(Duration)
.... yrs.
......
.. mos.
1
ds.
Contributory.
(SECONDARY)
(Duration) ....... yrs.
mos.
ds.
(Signed)
Du 28'
, 1915
(Address).
15 met call
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 desth
.. yrs.
„mos. ............ ds.
In the
State.
............ yrs. ............ mos.
.......
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Due 29. 1915
D UNDERTAKER
david Budgeten
ADDRESS Ca
(Month)
(Day)
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 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 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. - Namc, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. 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 discase; 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 discase can be ascertaincd as the cause. Always qualify all diseases resulting from childbirth or miscarriage, às "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, S 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
56 Sargent
Thomas Copeland
Ward)
(City or town.) {If death occurred in a hospital or institution, give its NAME instead of street and number.]
....
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
' COLOR OR RACE .
5 SINGLE, MARRIED, WIDOWED, OR DIVORCES (Write the word)
* DATE OF BIRTH
aprile 22 (Month) (Day)
(Year)
7 AGE 69
If LESS than [ day ......... hrs.
Or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Returet
(b) General nature of industry, business, cr establishment In which employed (or employer).
9 BIRTHPLACE
(State or country)
meruyouwish hova
Scotia
10 NAME OF
FATHER
William
PARENTS
12 MAIDEN NAME
OF MOTHER
ElychatSuit
13 BIRTHPLACE
OF MOTHER
(State or country)
Nova Scotia
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Filed
191
REGISTRAR
17 I HEREBY CERTIFY that i attended deceased from 1
10
1915
to
Dec 28
1915.
that I last saw h
... alive on
Der 22
1915.
and that death occurred, on the date stated above, at.
6.30m.
The CAUSE OF DEATH* was as follows :
(Duration).
14
ds.
Contributory
(SECONDARY)
(Duration)
.yrs.
mos. ds.
(Signed)
M.D.
Due 28, 1915 (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).
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.
IS PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Leca 30.
191
......
ADDRESS
20 UNDERTAKER
CR.Bem
Registered Mo
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dic
2.8
(Month)
(Day)
1915
(Year)
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
56 Sargent &h WW
...
............... yrs. .............. mos. .
11 BIRTHPLACE OF FATHER (State or country) nora Reocín.
.yrs. mos. 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 eachı 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) Salcs- man, (b) Grocery; (a) Foreman, (b) Automobilc 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 Nonc.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to tinc and causation), using always the same accepted term for the same diseasc. Examples: Cerebro-spinal fever (the only definite synonyın 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 discase 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- posurc, 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.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Lynn
.................. (No .......
.. Lynn ..... Hospital ...
.St.
......
.. Ward)
CITY OF LYNN
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
" FULL NAME
Lillian Hanton
{If married or divorced woman or widow
give maiden name, also name of husband.]
Miller
Unknown
@RESIDENCE
Winthrop, Mass.
Registered No.
1365
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F.
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
D.
' DATE OF BIRTH
18.81
-
(Month)
(Day)
1
(Year)
7 AGE
If LESS than
I day ......... hrs.
34 ...... 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 BIRTHPLACE
(State or country)
Ireland
10 NAME OF
FATHER
John
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland
12 MAIDEN NAME
OF MOTHER
Jane Maloney
13 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) (Address)
Filed Jan . 5, 1916
REGISTRAR
16 DATE OF DEATH
December 28.1915.191
(Month) (Day) (Year)
191
17
I HEREBY CERTIFY that I attended deceased from
Dec. 33,
, 191
5
Dec. 28,
5
that I last saw h ... alive on = 191 ..... 5. and that death occurred, on the date stated above, at 11.10 .m. The CAUSE OF DEATH* was as follows :
double lobar pneumonia
(Duration)
... yrs.
.. mos.
........
ds.
Contributory
non compensated heart
(SECONDARY)
(Duration)
yrs.
........
mos. . ds.
(Signed)
Geo. H. Schwartz
M.D.
191. (Address)
LynnHosp.
* 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 ............ yra. ....
.mos.
d ..............
Where was disease contracted, If not at place of death 7 ...
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL Holy Cross, Everett
DATE OF BURIAL
Jan ... 1
.........
191.6
* UNDERTAKER
C.R. Bennison
ADDRESS
Winthrop
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
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) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be 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: Cercbro-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) ; Mcasles; Whooping cough; Chronic valvular heart discase; 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," "Comna," "Convulsions," "Debility" ("Congenital," "Senilc," ctc.), "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 septicacmia," "PUERPERAL peritonitis,", etc. State cause for which surgical operation was undertaken.
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