Town of Winthrop : Record of Deaths 1913-1915, Part 25

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 25


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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(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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