Town of Winthrop : Record of Deaths 1913-1915, Part 30

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 30


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121


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, ctc


4. Deaths under circumstances unknown, as A person found dcad, 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 Winthrop


(No. 123.


St. :..


Ward)


(City or town.) [If death occurred in a hospital or institution, give its NAME Instead of street and number.]


'FULL NAME Mary Adelaide Mulloy


[If married or divorced woman or widow give maiden name, also name of mushand.] aRESIDENCE 123 Locual SI


Mary @ Crandall Hra mulloy


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


Female White


5 SINGLE,


MARRIED,


Married


WIDOWED,


OR DIVORCED


(Write the word)


1º DATE OF DEATH


steht 24


1913


(Month)


(Day)


(Year)


6 DATE OF BIRTH


august


26


1801


17


I HEREBY CERTIFY that I attended deceased from


-


(Month)


(Day)


(Year)


Hept 21


1913.


to


7 AGE


If LESS than


1 day .......... hrs.


62


yra. mos.


of ...... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


housewife


(b) General nature of industry.


business, or establishment in


which employed (or employer).


at home


9 BIRTHPLACE


(State or country)


East Boston


PARENTS


11 BIRTHPLACE


OF FATHER


State of country Deene Dis.


12 MAIDEN NAME


OF MOTHER


Unknown


18 BIRTHPLACE


OF MOTHER


(State or conntry)


Maine


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


Im a. Mulloy


(Informant)


(Address) 123 Locust St


Filed 191


REGISTRAR


ation) 1 yrs. -


.... mos. ............... da.


Contributory


(SECONDARY)


(Duration).


-yrs ..


6


mos. ............... ds.


(Signed)


E Silvio fissa.


M.D.


Jeff 29, 1913 (Address) 1022- Bennington 2


* 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


In the


of death ...... yrs.


mos.


ds.


Where was disease contracted, if not at place of death ?.


Former or usual residence.


" PLACE OF BURIAL OR REMOYAL Holy Cross Malden


DATE OF BURIAL


Sept29, 191


3


AM


" UNDERTAKER


ADDRESS


Than C. Morris 699 Janaloyal


Hept 24


1913.


that I last saw he2


alive on


+/igt , 6


1913


and that death occurred, on the date stated above, at.


62 m.


The CAUSE OF DEATH* was as follows :


0


Chronic Vandocarditis


18 NAME OF


FATHER


George Crandall


Winthrop


BOSTON ...


sept .


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Preciso 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, o. g., Farmer or Planter, Physician, Compositor, Architect, Loeo- 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 minc, 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 Ilousewife, 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 (rctired, 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 , C'arcinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasmns) ; Measles ; Whooping cough; Chronie valvular heart disease ; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not bo stated unloss 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., whon a definite disease 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 provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Ilomicide, 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


1 PLACE OF DEATH


"Vinttrop Miss.


Metcalf Hospital.


Ward)


WinthropMyers. (City or townĄ [If death occurred in a hospital or institution, give its NAME instead of street and number.]


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Female


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Married


16 DATE OF BIRTH


(Month) (Day)


1


(Year)


7 AGE


If LESS than


I day, ........ hrs.


64 .. yrs. mos. ds.


min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


House-Work


(b) General nature of industry, business, or establishment in which employed (or employer).


· BIRTHPLACE


(State or country)


Quatria


.(Duration)


2


mos.


ds.


Contributory


Exploratory operation


(SECONDARY)


(Duration).


L .. yrs.


. mos.


...... ds.


(Signed)


Sept 24


1913


(Address)


without mass


* 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).


of death.


......... yrs.


mos.


13


de.


State


In the


yrs.


mos.


ds .............


Where was disease contracted,


If not at place of death ?.


34 Quevere St walther,


Former or


usual residence.


" PLACE OF BURIAL OR REMOVAL COM. 1


Wolvery Pride of Boston


DATE OF BURIAL


Sept 2019J


Filed 191


REGISTRAR


17


I HEREBY CERTIFY that I attended deceased from


to


191


3


Sept 29"


1913


that I last saw Ha


alive on


Salt 29"


1913


and that death occurred, on the date stated above, at 2 am.


The CAUSE OF DEATH* was as follows :


Carcinoma / Lower multiple


0


yrs.


10 NAME OF


FATHER


Max Rouch


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


austria


12 MAIDEN NAME


OF MOTHER


Unknown


13 BIRTHPLACE


OF MOTHER


(State or country)


Quatria


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Jou


(Address)


51 Beach Rd.


IS


March ASchwarts


2 FULL NAME


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE


Sarah Rouch wife of Morris 51 Beach Rd. Whathop


16 DATE OF DEATH


Sylt


29


(Month)


(Day)


1913


(Year)


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.


2 UNDERTAKER


Façon Vanetaky


ADDRESS


11 Cooper At.


M.D.


At place


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, ctc. 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 Ilouse- 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 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., C'arcinoma, 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 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 provisions of chapter 24 of the Revised Laws deatbs under the following 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.


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


Pointtrop, man


.(No ...


96 Bartlett Road


St. : . Ward)


(City or town.) [If death occurred In a hospital or institution, give its NAME Instead of street and number.]


2FULL NAME


( Will- born) ¿ acentra


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


96 Bartlett Rd. Winthrop


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


ª SEX


female


4 COLOR OR RACE


while


§ SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


19/3


(Month)


(Day)


(Year)


" AGE


If LESS than


I day .......... hrs.


or ......... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry.


business, or establishment in


which employed (or employer).


· BIRTHPLACE


(State or country)


mars.


.(Duration)


......... yrs. ............... mos. ................


.ds.


Contributory


(SECONDARY)


(Duration)


......


.... yrs.


mos.


... ds


Low/walker


M.D.


(Signed)


001 2


1913


(Address).


Beachment


* 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 residonce


" PLACE OF BURIAL OR REMOVAL


C. R. Bernini


DATE OF BURIAL


Del 4th.


5


» UNDERTAKER


ADDRESS


16 Filed 191


REGISTRAR


IS DATE OF DEATH


September


30


(Month)


(Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from


Sehr. 30


1913


to


same-


191.


that I last saw h __...... alive on


191.


and that death occurred, on the date stated above, at ...


10 pm.


The CAUSE OF DEATH* was as follows :


Still buit - caux, premaline bult


6/ handles gestalten.


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


hran


12 MAIDEN NAME


OF MOTHER


Marion Gertrude Howlett


1ª BIRTHPLACE


OF MOTHER


(State or country)


Canada


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Gerard La Centía


(Address)


9h, Bartlett Rd Winthrop


N. B .- Every Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state


191.


$ DATE OF BIRTH


September 30


yrs. ... mos.


10 NAME OF


FATHER


Gerard Lacentía


...............


0


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 (6) 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 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) ; 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 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 provisions of chapter 24 of the Revised Laws deaths under the following 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.


8. 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.


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS important. See instructions on back of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Wenchenote (No .... 70 2220000 St. ;..


Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


William . H. Walsh ( 2 FULL NAME


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 70 movie F/-


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


16 DATE OF BIRTH


8


(Month)


(Day)


(Year)


1 7 AGE


If LESS than 1 day, ....... hrs.


yrs.


mos. 22 ds. ds.


or ....... 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}


walerting@our


10 NAME OF


FATHER


Richard, Walch


11 BIRTHPLACE OF FATHER (State or country)


12 MAIDEN NAME OF MOTHER Catherine Gilbert


13 BIRTHPLACE OF MOTHER (State or country)


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Globe 14.


-


(Month)


(Day)


1913


( Year)


HEREBY CERTIFY that attended deceased from


19+3 . ... 1912 Sell-27 , that I last saw h~ alive on Spe: 27 1913, and that death occurred, on the date stated above, at 7.30 amthe The CAUSE OF DEATH* was as follows :


Come Valvula Kreal


Luo


(Duration) 2 yrs. - mos ...


ds.


Contributory


(SECONDARY)


... (Duration). 2 yrs.


mos. ...-. ds.


Ortwoeller


(Signed)


M.D.


,


1913 .. (Address).


483 Beaconli


* 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.


ds.


State


In the


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


001.3.1913


30 UNDERTAKER


ADDRESS


Filed 191


--


N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state


(City or town.)


855


17


Semal over world and


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, Loeo- 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 Ilousewife, 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, perdonacung


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 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 provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.