USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 25
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(No.
154
Matilda Dunla
Slocum-David Dunlop
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 154 Boudou St, Withiok
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
w
· SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
mand
6 DATE OF BIRTH
5
(Month)
(Day)
(Year)
If LESS than
I day ......... hrs.
79 yrs ..
„mos.
4 ds.
Or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
at home
$ BIRTHPLACE
(State or country)
Liverpool H.S.
10 NAME OF
FATHER
Robert Scocum.
12 MAIDEN NAME
OF MOTHER
Elizabeth Cole.
1
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
David Develop.
(Address)
154 Boudou St
REGISTRAR
MÉDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
8
(Month)
10
. 1913
....
(Day)
(Year)
/
1834
17
I HEREBY CERTIFY that I attended deceased from
191 ........ ,
to
July 31
, 1913,
that I last saw her alive on
Streep 31
1913
and that death occurred, on the date stated above, at.
aboutgy? m. The CAUSE OF DEATH* was as follows : Tuberculosis of The lung?
1-
berliner Ulcer of Stomach
Followed, I Think by gadece
cancer
3
.(Duration)
.yrs.
-
mos.
-ds.
as come
Contributory
(SECONDARY)
(Duration).
... yrs.
mos. ..............
ds.
(Signed)
M.D.
191(
/ (Address)
180 Wucht 8/-
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
... yrs.
.. mos.
In the
ds.
State ........... yrs.
mos.
ds.
Where was disease contracted, If not at place of death 7.
Former or usual residence.
18 PLACE OF BURIAL OR REMOVAL Winthropo Dem
DATE OF BURIAL
8-13-
1913.
20 UNDERTAKER
W.C. & Pagge
ADDRESS
Filed -. 191
.................
(City or town.)
St. : Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
1 PLACE OF DEATH
2 FULL NAME
1 SEX
Fi.
7 AGE
1
11 BIRTHPLACE
OF FATHER
(State or country)
PARENTS
13 BIRTHPLACE
OF MOTHER
(State or country)
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
(b) General nature of industry,
business, or establishment in
which employed (or employer) ..
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will he 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 he 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 he entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc , Carcinoma, Sar- coma, etc., of. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasms) ; 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 deatlı), 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 " ("Congenitai," "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 ali diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must he 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
(No. 37 Luiour St. ; Ward)
1
Charles &. Crocker 2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of hushand.]
@RESIDENCE
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
m
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Manuel
-
· DATE OF BIRTH
1849 17
(Month) (Day)
(Year)
7 AGE
If LESS than
( day ......... hrs.
64
yrs.
mos.
ds.
or ....... min. ?
& OCCUPATION
P.R. Conductor
(b) Generel nature of industry,
business, or esteblishment i
which employed (or employer).
· BIRTHPLACE
(State or country)
,
Baldumzile Must
10 NAME OF
FATHER
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Roupas, Mass
12 MAIDEN NAME
OF MOTHER
Emerette Firmare
13 BIRTHPLACE
OF MOTHER
(State or country)
Olux, Mas
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informent)
mro. 2.2. Crocker
(Address)
Filed
191 ......
REGISTRAR
18 DATE OF DEATH
8
10
(Month)
(Day)
1913.
(Year)
I HEREBY CERTIFY that I attended deceased from
Queg (oh, 1918, t
Cena 10th 93
that I last saw herwalive on
Clup.10.
, 1913.
and that death occurred, on the date stated above, at
600m.
.m.
The CAUSE OF DEATH* was as follows :
Entero - Coletes
(Duration)
.yrs.
mos.
10
Contributory
arteriosclerosis,
(SECONDARY)
(Duration)
yrs.
mos. .ds,
(Signed)
) W.g. Parter
M.D.
Chung-11, 1913 (Address)
Wineturto
* 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 plece
In the
of death ..
yrs.
.mos.
ds.
State
yrs.
mos.
ds ............
Where was disease contracted, If not at place of death ?.
Former or usual residence
12 PLACE OF BURIAL OR REMOVAL Danna see 42 8-12
DATE OF BURIAL
3
.....
191
30 UNDERTAKER
1
1
2
,
ADDRESS
irulliche
(City or town.) [if death occurred in a hospitel or institution, give its NAME instead of street and number.]
(a) Trade, profession, or
particular kind of work
-10-1913.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement ; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return " Lahorer," "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 he entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE ('AUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup ") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. .... (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasms) ; Measles; Whooping cough ; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy,""Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can he ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must he referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused hy violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disahled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1913.
CITY OF BOSTON.
FULL NAME S.A.R.A.H .... D ...... MORS.E ...
. ........ Registered No ..... .. 7395
Place of Death ¿ Boston C.ARN.E.Y .... H.O.S.P .. . I .. T. A.L ....
....
....
and Residence S
Date of Death
AUG
10
1913. Åge .. .4.2
years
.months 1
days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
F
M
Maiden Name
SARAH
DOYLE
Husband's Name ARTHUR 6 .MORSE
UT B
Birthplace PHILADELPHIA , PA.
Name of Father BERNARD J DOYLE 8.0
Birthplace
of Father I. R.E.L. A.N.D.
Maiden Name
of Mother ..
S.A.R.A.H. C.A.R.L .. I.N.
Birthplace of Mother. P. H.I. LADEL.P.H.I.A .... P.A
Occupation
HO.U.S.E.N.I.F.E
Informant .
A.R.T.H.U.R . G.,
.MORSE
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1913, to from JULY 18 AUG 10 .1913, 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
Primary FIBROID UTERUS OPERATION
(Duration) ).
SHOCK. AC. MYOCARDITIS
Contributory · ? (Duration) 1 OPERATION AND SHOCK
(Signed) .
JAMES J REGAN
M.D.
1913
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial
or removal
MALDEN (HOLY CROSS )
Undertaker
J.QH.N .... F ........ . O .MALEY
Usual Residence
51 PICO
AVE . WINTHROP
Filed.
A.U.G. .. . 1.4
1913.
A true copy.
Attest :
EumSeinen
Registrar.
REGIS
: CITY
VITATI'"
aug 10 - 19 1 3.
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
........
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Hettie (Hollinger ) Hatwell
[If married or divorced woman or widow give maiden name, also name of husband.] .......... Hartwell
@RESIDENCE
Registered No. .
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
& SEX
' COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widowed
5 DATE OF BIRTH
- 18.6.0
1
(Month)
(Day) (Year)
7 AGE
If LESS than I day ......... hrs.
53
.yrs. .... .......... mos.
ds.
Dr ......... min. ?
8 OCCUPATION (a) Trade, profession, or particular kind of work
(b) General nature of industry. business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country)
- Mass
(Duration) ........ yrs. ........... mos. ... ds.
Contributory General novelyais of the
(SECONDARY)
....
insane ..
(Duration))
mos.
.yrs.
ds.
(Signed)
.........
Tendricks
....... .
195
(Address) ........
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 ...
......
.. mos
.........
ds.
State ............ yrs .:
mos.
ds .............
Where was disease contracted, If not at place of death ?.
Former or
winthrop
usual residence.
1 PLACE OF BURIAL OR, REMOVAL Tason Cem
DATE OF BURIAL
(Informant)
(Address)
Worcester
Filed 11g 18. ... 1913
REGISTRAR
15 DATE OF DEATH
(Mouth)
up 11, 1913
1913
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from Sep 14 1912 ., 191 ....... , to .. ....... AUS 11 1913 that I last saw ho.y ..... alive on ..... 1.1.1 ........... 7 1913 and that death occurred, on the date stated above, atOpm ....... m. The CAUSE OF DEATH* was as follows :
cute colitis ( Dysentery)
10 NAME OF
FATHER
Daniel Hollinger
11 BIRTHPLACE OF FATHER (State or country) Germany
12 MAIDEN NAME
OF MOTHER
Harriott harren
13 BIRTHPLACE
OF MOTHER
(State or country) -
Line
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
H V Hendricks
Aug 13,1213
191
3
ADDRESS
20 UNDERTAKER
GeSo
essions Sons Co hortes
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
.
(No ... State -Hospital St. : . .Ward)
Female
PARENTS
In the many
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 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, peritoneum, etc., Carcinoma, Sar- coma, etc., of. .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection 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 "Astlienia," "An- acmia" (mercly 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 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
' PLACE OF DEATHK Winthrop Beuch Channel
St. :
Boston &Harbor Ward) (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Francis Ronan Patrick
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.} @RESIDENCE
30 Tewksbury At Winthrop.
Registered No. 2 739 3
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
i SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
6 DATE OF BIRTH
(Month) (Day)
!
(Year)
7 AGE
25
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
James
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Ireland
12 MAIDEN NAME
OF MOTHER
Margaret Murray
13 BIRTHPLACE OF MOTHER (State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Filed 121
REGISTRAR
16 DATE OF DEATH
August 16, 193
(Month)
(Day)
(Year)
17 1 HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows :
& Aocidentally drowned
in Winthrop Beach
Channel Boston Starboy
mos.
(Duration)
.ds
.. yrs ..
Contributory.
(SECONDARY)
(Duration)
.. yrs.
mos.
ds
(Signed)
Oscar Richardons
M.D.
Aug 1, 1913
(Address).
Associate
MEDICAL EXAMINER Garnity Adultoe
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At placo
of death.
yrs.
.mos.
In the
ds.
State ...
yrs.
mos.
ds.
Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL DATE OF BURIAL
Calvary Cemetery, N. Y.
191
John W. Lawen How 54 d. Voust.
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
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.
coachman.
If LESS than
| day,
.. s.
cung 16-17
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 sufficicut, 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) 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 gaiu- 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, cte. 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 discase. 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, etc., Carcinoma, Sar- coma, etc., of ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Mcasles; Whooping cough; Chronic valvular hcart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need uot 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,"
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