USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 32
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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 duc to Alcoholismi, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH
Winthrop
(No.
66 PlummerQue
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female White
5- SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Midow
" DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE 72
If LESS than
I day. ....... hrs.
.yrs.
mos.
ds.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
At Home.
(b) General nature of industry, business, or establishment in which employed (or employer).
9 BIRTHPLACE
Bedford hince Eduard eland
10 NAME OF
Hugh Macaulay.
PARENTS
12 MAIDEN NAME OF MOTHER Margaret Bronson
18 BIRTHPLACE OF MOTHER (State or country)
J. C. Joland.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
michael . macaulay
(Address)
66 Plumones Que
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
och
218h
3
(Month)
(Day)
191
(Year)
17
I HEREBY CERTIFY that I attended deceased from
0 0/ 20. 1913.
that I last saw her alive on.
June 15, 19/20
and that death occurred, on the date stated above, at.
5 cm.
The CAUSE OF DEATH* was as follows :
Losis of Live
2
yrs.
8
mos.
ds.
(Duration)
2
Contributory
(SECONDARY)
(Duration)
. yrs.
mos. ds.
(Signed)
Grossem. Multant
M.D.
Och- 22
1913 (Address)
130 Princeton 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).
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.
19 PLACE OF BURIAL OR REMOVAL
Calvary Cemetery Oct 23 1913
20.UNDERTAKER
J. CO. maley
DATE OF BURIAL
ADDRESS 79 CUlantic It
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.
Sarah
Johns
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
widow of Richard forma
.... Registered No.
BOSTON (City or town.)
11 BIRTHPLACE OF FATHER (State or country)
P.E. bland
Oct . 21, 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 caclı 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 engincer, 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 iu the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, IHousework, 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.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Commonwealth of Massachusetts
1 PLACE OF DEATH
STANDARD CERTIFICATE OF DEATH Monthof (No 22 Hooderde Coc
Minttuoh (City or town.) {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
11 lute
· SINGLE,
MARRIED,
WIDOWED,-
OR DIVORCED
(Write the word) Jingle
6 DATE OF BIRTH
200
(Month)
(Day)
1912
(Year)
7 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)
Winthrop have.
1$ NAME OF FATHER
11 BIRTHPLACE OF FATHER (State or country)
East Boelon
colon
12 MAIDEN NAME OF MOTHER li zabeth floods
18 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST-OF MY KNOWLEDGE
(Informant)
Ichno Loberty
(Address)
22 Woodside QUE
16
Filed
191
REGISTRAR
16 DATE OF DEATH
(Month)
26
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Cer 26, 1913, to.
Cet 26 1913
that I last saw
eralive on
and that death occurred, on the date stated above, at )19 m. The CAUSE OF DEATH* was as follows :
for tuno.
(Duration)
yrs.
mos.
Contributory
(SECONDARY)
(Duratien)
.......... yrs.
mos.
.........
ds.
(Signed)
- Harrey all elly
M.D.
Cet 28 1913 (Address)
325 Winch
.....
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
16 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
.. yrs.
mos.
ds. State ............ yrs.
.........
. In the
mos.
.... ds ............
Where was disease contracted, If not at place of death ?.
Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL Holy Cow Ceny
DATE OF BURIAL
Oct 20, 1913
20 UNDERTAKER
oli f maley
ADDRESS
79 Atlantic
Pinchaof
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.
.
·
Anna Marco Doherty
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
22 Hordoide Are.
Ward)
191.3.
4
10
mos.
22
ds.
.yrs.
PARENTS
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 terui 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 chauged 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 affectiou with respect to time and causatiou), 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 neoplasuis) ; 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 (disease causing deatlı), 29 ds .; 1 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," " Wcakness," 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 operatiou was uudertaken.
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.
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
Writtenon Man (No.
15 Bates Cv
St. ;....
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Caroline, amelia Tewksbury
wife of
Russell Tewksbury
Registered No.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
29. (Day)
0 (Year)
I HEREBY CERTIFY that I attended deceased from
1918
Ord 29
to.
Det- 28! 1913 that I last saw her- alive on. and that death occurred, on the date stated above, at." (z.
m . The CAUSE OF DEATH* was as follows : )
.
Cento ericardolos
(Duration)
TOS ...
ds.
Contributory
(SECONDARY)
(Duration)
mos. . ds.
yrs. .
(Signed) .
Charles Levels,
, M.D.
rt 30
,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 death ..
yrs. .
mos.
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 Willau
DATE OF BURIAL
1
~. 191
ADDRESS
20 UNDERTAKER
Ca 123 Emmeri
Winthrop
(City or town.)
1 PLACE OF DEATH
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
15Bales
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
female
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
(Month)
(Day)
7 AGE
75
10
mos.
12.
·ds.
yrs.
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
at Home
(b) General nature of industry,
business, or establishment in
which employed ( or employer).
11 BIRTHPLACE
OF FATHER
12 MAIDEN NAME
OF MOTHER
amelia Colly
PARENTS
1ª BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Shan R Benmoi
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.
(Address)
Filed
191
N. b. Every fem of information should be partially supplied. Aus should be stated LAUTET. divino Should Statt
(State or country)
Boston Mass
manuel
(Year)
If LESS than
I day, .. .. hrs.
or ...... .min. ?
9 BIRTHPLACE
(State or country)
Hohlunglon U.H.
10 NAME OF
FATHER
Joseph Fiennes
Hoplenglan 4.1+,
REGISTRAR
In the
3
6 DATE OF BIRTH
Lec
17
18,37
17
Oct . 21, 1
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 " 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: C'erebro-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 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 childbirthi or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
7
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.
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.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1913.
CITY OF BOSTON.
FULL NAME CLARENCE H. PIKE
Place of Death l
Boston
and Residence S
Date of Death
OCT.30
1913.
Age
50
years
months days.
STATISTICAL DETAILS.
SEX.
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
MAR.
Maiden Name
Husband's Name
( EAST ) BOSTON
Birthplace
Name of Father
CHARLES P.PIKE
Birthplace of Father
ENGLAND
Maiden Name of Mother
NORAH S. BEHAN
Birthplace of Mother
IRELAND
BOOK-KEEPER
Occupation
Informant
PHYSICIAN'S CERTIFICATE.
1913, I HEREBY CERTIFY that I attended deceased during last illness, from 1913, 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 :
ISTRAR'S
-SICUT P
CIVITA DOSTONIA CONDITAAL
2. 1829
OF A BOAT
Contributory . Į (Duration ) 1
G. B.MAGRATH MED. EX.
(Signed)
OCT . 30
1913
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
DORCHESTER ( OLD )
Undertaker
T.J. LANE
Usual Residence
WINTHROP (75 WASHINGTON
AV)
Filed
NOV. 3
1913
A true copy .
Attest :
EMMYlenen
Registrar.
CITY RE
T PAT 2186S. SIT DEL Primary ( Duration) OFFICE
IMMERSION WITH RESULTING EX-
HAUSTION - ACCIDENTAL CAPSIZING
1850. REGIMINE DONATA A BOSTON. MASS
Registered No.
9788
BOSTON HARBOR - NEAR SPECTACLE ISLAND
Det . 30 , 1913
-
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Wiechat
(No.
64 Wincheck
St. :..
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Sarah. Perfis Young
[If married or divoreed woman or widow give maiden name, also name of husband.] @RESIDENCE 64 Wochen d'h
Saidden Lade
wina Registered NO.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Singer
6 DATE OF BIRTH
Dec
(Month)
(Day)
13
18,32
(Year)
7 AGE
If LESS than
[ day .......
hrs.
80° yrs.
9 mos. 20
.. .. 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).
School Teacher
9 BIRTHPLACE
(State or country)
Sunafica n. H.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Sunafec n.1+
12 MAIDEN NAME
OF MOTHER
Sarah. W. Verken.
18 BIRTHPLACE
OF MOTHER
(State or country)
Sunakce Hilf
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informent)
Celino 12,Je ...
(Address)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
LANOV
(Month)
6
1913.
(Year)
(Day)
17
I HEREBY CERTIFY that I attended deceased from
delph 1st
1913
to
nov. 2th
1913
that I last saw het alive on
1913,
and that death occurred, on the date stated above, at
27 m.
The CAUSE OF DEATH* was as follows :
Carcinoma of left whitney
(Duretion)
1
yrs.
mos.
ds.
Contributory
(SECONDARY)
(Duration)
.... yrs.
. . mos.
ds.
(Signed)
M.D
" 0 8, 9 (Address)
Bencharzo
* If death followed injury or violence the certifieatc 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
yrs.
In the
.mos.
ds.
Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL neurfort. 11.1+.
DATE OF BURIAL
400 8
30 UNDERTAKER
Ce.R. 1Sammeni
ADDRESS
Filed.
191
(City or town.)
....
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.
10 NAME OF
FATHER
Williami Tommy
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 "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 ro- 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.
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