Town of Winthrop : Record of Deaths 1913-1915, Part 120

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 120


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).


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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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