USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 33
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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.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
) PLACE OF DEATH
(No 55 allande St. ;....... Ward)
Madalina Isabella.
Perkins
[If married or divorced woman or widow
give maiden name, also name of husband.]
Widow of 990. 9. Perfis
@RESIDENCE
55 allantic
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
§ SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
under
1833
(Year)
7 AGE
If LESS than I day ......... hrs.
yrs.
mos.
ds.
or .min. ?
8 OCCUPATION
al tome
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer).
Housekeeping
9 BIRTHPLACE
(State or country)
nowwerd Man
10 NAME OF
FATHER
1] BIRTHPLACE OF FATHER (State or country) 11
12 MAIDEN NAME OF MOTHER
5
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
(Month)
(Day)
19113
(Year)
I HEREBY CERTIFY that I attended deceased from
May
1913, to
1913
that I last saw her
alive on
2000 8
1913
and that death occurred, on the date stated above, at.
11 45 Pm
m.
The CAUSE OF DEATH* was as follows :
Hemiplegia
arlene 2 decases
.yrs.
Hummusplegia (Duration)
6
mos.
X
ds.
Contributory
antico 2 eleveris
SECOND
Еслищоation)
.yrs.
mos. ... ds.
(Signed)
Orice & lahauser M. D.
nev 11.
191.3 ... (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.
In the
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
191
....
20 UNDERTAKER
ADDRESS
Filed 191
.....
........
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
FULL NAME
6 DATE OF BIRTH
(Month)
17
(Day)
PARENTS
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.
8
17
-
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 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, 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.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH -1913.
CITY OF BOSTON.
FULL NAME
ISABEL KIRWAN
Registered No. 10279
MASS. GENL. HOSPT.
Place of Death ¿ and Residence S
Boston NOV . 17
Date of Death
1913.
Age
years
months days.
STATISTICAL DETAILS.
SEX.
COLOR
F
W
SINGLE, MARRIED, WID., DIV. MAR.
Maiden Name HOWES
Husband's Name
JOHN G. KIRWAN
Birthplace
NEW YORK.N. Y.
Name of Father
JAMES HOWES
Birthplace of Father
NEW YORK.N.Y.
Maiden Name of Mother
ELIZABETH MADDOCKS
Birthplace of Mother
(Signed) H. W . HERSEY
A D.
NOV.18 1913
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
IN HOSPT. 5 DAYS
Place of Burial or removal
WINTHROP (WINTHROP CEM )
Usual Residence WINTHROP (149 MAIN ST)
Filed
NOV.21 1913
Undertaker
C . R . BENNISON
WINTHROP
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1913,
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 :
SI
RAR'S
RE
T PAT RIBES. SIT DEL
Primary (Duration) SIY
331335
BOSTONIA
CONDITAA
3 A 1822
B REGIMINE DONATA A STON MASS
Contributory . ( ICHTHYOSIS - DYS (Duration ) 1
Occupation AT HOME
Informant
CITY
CASICUT
BRONCHO-PNEUMONIA - 10 DYS
.
Registrar
A true copy Attest . EMMYlenen
44?
nov. 1
c
N. B. - Every item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
Important. See instructions on back of certificate.
PARENTS
12 MAIDEN NAME
OF MOTHER
11
1ª BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
2
REGISTRAR
U DATE OF DEATH
(Month)
21
(Day)
191.3
(Year)
$ DATE OF BIRTH
(Month)
4
1833
(Day)
(Year)
7 AGE
If LESS than
§ day, ........ hrs.
80 yrs.
.. yrs.
5 mos ..
_de.
.min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Retired
(b) General nature of industry, business, or establishment In which employed (or employer).
11 I HEREBY CERTIFY that / attended deceased from
191.3 .... to
har
1913
that I last saw him ..
alive on
Nov. 21.
1913
and that death occurred, on the date stated above, at
3 pm.
The CAUSE OF DEATH* was as follows :
antonio Sclerosi and ogame
Heart disease.
.(Duration)
........... yrs. .....
4
..... mos.
de.
Contributory.
(SECONDARY)
(Duration)
.yrs.
.......
mos.
ds
(Signed)
Wm.1.
Porta
M.D.
Non-21, 1913 (Address)
Withings Mars
......
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
1º LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
In the
At place
of death.
......... yrs.
„mos.
da,
State ......... yrs.
........... mos.
d ..............
Where was disease contracted, If aot at place of death ?.
Former or usual residence
1 PLACE OF BURIAL OR REMOVAL Cambridge Cemetery
DATE OF BURIAL
Mr. 24. 1913
" UNDERTAKER
ADDRESS
Cambridge
Filed 191
The Connuwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No ..
3.6,
Beacon
.. Ward)
(City or town.) [If death occurred Im a hospital or institution, give its NAME instead of street and number.]
'FULL NAME
Samuel Whitney
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
36 Beacon ST Wuiltural
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
w.
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widower
Windtwofi
9 BIRTHPLACE
(State or country)
Westrong man.
10 NAME OF
FATHER
12 BIRTHPLACE
OF FATHER
(State or country)
.......
21
STANDARD CERTIFICATE OF UCAIN.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, 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," "Forcman," "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, ete. If the occupation has been changed or given up on account of tlie 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 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-
coma, etc., of .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all discases 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 discase, as A death upon the street, or onc 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.
19. Milliano
St. :..
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME.
Jola Leora Hardure:
[If married or divorced woman or widow give maiden name, also name of husband.] His varie Hourde @ Warduri Registered No. @RESIDENCE 14 Withaus St Wink tion
PERSONAL AND STATISTICAL PARTICULARS
$ SEX H
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
10 DATE OF DEATH
(Month)
23
(Day)
11
1913.
(Year)
6 DATE OF BIRTH
4
3
(Month)
(Day)
(Year)
7 AGE
If LESS than
! day ......... hrs.
55 yrs.
7
mos.
20 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).
Clumic Outrastelial nep toutes
.......
(Duration)
1 yrs.
mos.
ds.
Contributory
(SECONDARY)
..............
(Duration)
............... yrs.
.........
mos.
ds.
(Signed)
Edward J. Frange
M.D.
Nen. 24, 1913 (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.
In the
mos.
ds .............
Where was disease contracted,
If not at place of death ?.
......
Former or
usual residence.
19 PLACE OF BURIAL OR REMOVAL
Simet
DATE OF BURIAL
11-25/ 1913
30 UNDERTAKER J
ADDRESS
-
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
I HEREBY CERTIFY that I attended deceased from
au. 1
1913, t
nov. 23. 1913
....
that I last saw h.
alive on
191
...
and that death occurred, on the date stated above, at
... m.
The CAUSE OF DEATH* was as follows :
9 BIRTHPLACE
(State or country)
10 NAME OF
FATHER
Susiner Dave's
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Brighton Wears.
12 MAIDEN NAME
OF MOTHER
Williams
13 BIRTHPLACE
OF MOTHER
(State or country)
Boston
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address) 14Wielusy St.
....
26
1850 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 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 naturo of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when uceded. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dcaler," etc., without more precise specification, as Day laborcr, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- kccpers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestie 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
coma, etc., of. .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Mcasles; Whooping cough; Chronic valvular hcart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd not be stated unless im- portant. Example: Mcasles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapsc," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old agc," "Shock," "Uracmia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street,, or onc supposed to be duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
important. See Instructions on back of certificate. CAUSE OF DEATH In plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH
(No. 4 Belcher St. ; Ward)
2 FULL NAME
Eliza Belcher
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 4 Beecher St.
Poor-
The derie W. Belcher
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.j
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
$ SEX 1.
4 COLOR OR RACE
5 SINGLE,
MARRIED MCL
WIDOWED,
OR DIVORCED
(Write the word)
Manuel.
6 DATE OF BIRTH
10
5-
1838
(Month)
(Day)
(Year)
7 AGE
If LESS than
[ day ......... hrs.
75 yrs. 1 .mos. 11 .ds.
.... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
athome
(b) General nature of Industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
10 NAME OF
FATHER
James Poor
11 BIRTHPLACE OF FATHER (State or country)
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or country)
Sapere Maz
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Hudenich Bin
(Address)
4 Pelletier St. même
=
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
11 26, 1913-
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Oct 10th
1913 ..... , to
200
1913.
that I last saw h alive on
2000 26
1913
and that death occurred, on the date stated above, at 215Pm.
The CAUSE OF DEATH* was as follows :
Brancho- Pneumonia
(Duration)
X ..... yrs.
×
mos.
2
ds.
Contributory.
Cerebral Tarmenborgh
(SECONDARY)
(Duration)
X
yrs.
X
mos.
49 ds.
(Signed)
Orville E. Colisen
M.D.
nev 28, 1913 (Addres)
* 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.
......
In the
mos. ds ............. Where was disease contracted, If not at place of death 7.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
11-27, 1913.
20 UNDERTAKER ADDRESS We. Ihreggs Withe
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 fircman, 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," "Dcaler," etc., without more precise specification, as Day laborcr, Farm laborcr, Laborcr - Coal minc, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- kccpers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Scrvant, 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cercbro-spinal fever (tlie 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-
coma, etc., of. .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Mcaslcs; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not bo stated unless im- portant. Example: Mcasles (discase causing death), 29 ds .; Broncho-pncumonia (secondary), 10 ds, Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., when a definite disease can be asecrtained as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL scpticacmia," "PUERPERAL peritonitis," ete. State cause for which surgical operation was undertaken.
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