USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 4
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Newborn 18 hrs
Birthplace Winthrop
TVTTATIS RE
CONTITAM
11 30.
VE.FON TAO. N. MASS
(Signed)
D L Jackson
M.D.
Jan 23 1913
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence ..
Winthrop"28 Trident Ave"
9
T
Jan. 22, 1913
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.
5 martle ave
St. :
...
Ward)
BOSTON (City or town.) [lf 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
5 SINGLE,
MARRIED,
WIDOWED,
ØR DIVORCED
(Write the word)
6 DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE
If LESS than
I day, ....... hrs.
45
.yrs.
mos.
ds.
Or ....... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work,
Manager
(b) General nature of industry,
business, or establishment in
which employed (or employer) ..
Liquor Store
9 BIRTHPLACE
(State or country)
Boston
10 NAME OF
FATHER
James
PARENTS
11 BIRTHPLACE ' OF FATHER (State or country) Ireland
12 MAIDEN NAME OF MOTHER Ellen@alford
18 BIRTHPLACE OF MOTHER (State or country) seland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) ..
Mrs . Olen Barron
(Address)
5M:the ave.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Feb.
(Month)
2,
(Day)
,
1913
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Dec 30
1912
to
Feb 1
1913
that I last saw h wy alive on.
Feb. 1.
1913
and that death occurred, on the date stated above, at 930am.
The CAUSE OF DEATH* was as follows :
Perforated Lastic Ulcer
.(Duration)
... yrs.
.. mos.
1
ds.
Contributory (SECONDARY)
(Duration)
John a. Hicken
.yrs.
mos. ds.
(Signed)
Sel.3
193
(Address) 144-Saratogadi
* 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.
In the
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 toly Cra22
DATE OF BURIAL
fica Cf. 1912
20 UNDERTAKER
Thosal Lama
ADDRESS 120 Havreft
M.D.
Filed 199
Thomas Edward Barron
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
5 majath ave
Registered No.
tel. 2, 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 cngincer, 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 needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobilefactory. 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 definito salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or it 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-
4
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. . (name origin : "Cancer" is less definite ; avoid use of "Tumor" fer 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," "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 street, or one supposed to bc 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
Winchist Mass
.(No
58 Ovnicht
St. :
Ward)
(City or town.)
{If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Clara, E. Harvey
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Wwwchiot mart
widow of William Henry Harvey-Stevens
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
wilan
16 DATE OF DEATH
Felly
(Monthi)
2
. 1913
(Day)
(Year)
6 DATE OF BIRTH
(Month)
7 AGE
32
.. yrs. mos. ds.
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer)
If LESS than I day ........ hrs. that I last saw alive on V 1915.5 Or ......... min. ? and that death occurred, on the date stated above, at 3 0 m. The CAUSE OF DEATH* was as follows :
Concer of Sines
(Duration)
2
yrs.
×
mos.
X
.ds.
Contributory.
(SECONDARY)
X
(Duration)
yrs.
mos.
.ds.
(Signed)
....
M.D.
fily 4
. 19LS ... (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.
.......
In the
ds.
State
Where was disease contracted,
.. yrs.
.. mos.
ds.
....
If not at place of death ?.
Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
2/ 5
1913
.....
20 UNDERTAKER
ADDRESS
Filed 191 ........
REGISTRAR
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
Susan Ensimán
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
ulice. Ti Lus
(Address)
10 NAME OF
FATHER
Cmos. ¿ tevens
9 BIRTHPLACE
(State or country)
3 1840 17 1912 (Day) (Year) ., I HEREBY CERTIFY that I attended deceased from $430 Fily 2 1913
:
Tel. 2, 1413
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, 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 Westlow State Hospital
.St. ;
....... Ward)
Westboro
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
augustus M. Fisher
{If married or divorced woman of widow
give maiden name, also name of husband.]
@RESIDENCE
5 grover Que. Winthrop Hlas
Registered No.
18
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
16 DATE OF DEATH
February 2013
(Month)
(Day )
(Year)
6 DATE OF BIRTH
(Month)
(Day)
1 (Year)
7 AGE
62 vs.
.yrs.
mos. ds.
or ......... min. ?
8 OCCUPATION
Sales Manager
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment In
which employed (or employer)
adding Machine
9 BIRTHPLACE
(State or country)
Content class.
10 NAME OF
FATHER
PARENTS
11 BIRTHPLACE OF FATHER (State or country)
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
C. R. Bennison
(Address)
Wintheron Mass
Filed, Feb. 2. 1913
....
REGISTRAR
17 I HEREBY CERTIFY that I attended deceased from
191.
., to
191
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 :
Natural Causes unknown ... probably heart trouble Sudden. ... (Duration) ............. yrs. ................ mos. ds.
Contributory
(SECONDARY)
.(Duration) .ds.
(Signed)
Charles S. Knight
M.D.
Feb. 2, 1913 (Address) Westland 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).
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 Winthrop Hlass
DATE OF BURIAL
2/6
3
191
Mais.
20 UNDERTAKER
C. P. Bennison
ADDRESS
Winthrop
M-'19-7-3M1 )
( '10-11-34- 12.
If LESS than
1 day ......... hrs.
PERSONAL AND STATISTICAL PARTICULARS
Feb. 2.1913
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 " Laborer," "Foreman," " Manager,""Dealer," etc., without more precise specification, as Day laborer, Farm taborer, 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 Servont, 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, 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 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 ^aused 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.
... ...
time of said birth, marriage or death, stating in case of a birth, the name of the street and number of the house, if any, where such parents resided, the place of birth of such parents and the maiden name of the mother, whenever the same can be ascertained ; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording births, marriages and deaths. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the state board of health.
COPY OF THE RECORD OF A DEATH.
recorded in the books of the City of Providence (Town or City;)
during the month of
February
1913.
.
Feb 3 1913.
1. Date of Death ?
2. Name in FULL ?
Martha Elisabeth Bottom
3. Date of Birth ? Jan 1. 1865 Are? 48 yrs. 1
... mos ..
2 dys.
4. Place of Death ? City or Town. Providence
5. St. or Road & No? At Joseph's Hospital
6. Usual Residence ? Winthrop Mass
7. Sex ? Female
Color ?
White
Single, Married,
9. Widowed or Di-
married
( vorced ?.
10. Name of Husband or Wife ?
William V Bottom
11. Occupation of decedent ?
12. Place of Birth ? Providence
13.
Father's Name ?
Edward & Godfrey
14 Mother's Name ? Katherine Jodfred
15. Parents' Birthplace ? Fa .. Gern many. y Mo Ireland
16. Where to be Buried ?
north Burial
17. Cause of Death ?
Appendectomy Hysterectomy Shock
Name of Physician
John Madden Uhr
Name of Informant
Fannie W Johnson
Name of Undertaker.
Horace B Koulas Jons
I certify that the foregoing is a true copy.
Attest Martes V. Chapin
C+ Registrar Clerk. (Town or City.)
MAR 10 43 19
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
I PLACE OF DEATH
.netharen
(No.
381
Lowell
St. :.
.....
Ward)
Methen (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2FULL NAME
Harrier Lowe
Harriet Wacker- Samuel Lowe
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop, mass,
Registered No. 22
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)
widowed
6 DATE OF BIRTH
nov
(Month)
6
(Day)
(Year)
7 AGE
If LESS than
1 day ......... hrs.
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
(State or country)
England
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
England
12 MAIDEN NAME
OF MOTHER
Sarah Stacy
1ª BIRTHPLACE
OF MOTHER
(State or country)
England
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Anno, George H, Brayton
(Address)
Tombhester Bran
Has . Howe
REGISTRAR
16 DATE OF DEATH
February.
3
(Day)
(Year)
(Month)
1824
17
I HEREBY CERTIFY that I attended deceased from
Dec. 31, 1912, to
Fiel, 3
., 1918
..
that I last saw her alive on
Feb 2, 1913
and that death occurred, on the date stated above, at 3-10 m.
The CAUSE OF DEATH* was as follows :
Cholecystitis
(Duration)
1
mos.
ds.
Contributory
arteria
, .. yrs.
Sclerosis
(SECONDARY)
(Duration)
yrs.
mos.
ds.
(Signed)
James & Berwick.
M.D.
Ac6.5. 1913 (Address)
methuen Blake
* 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
Bellevue Cemetery
Laurence Mah
DATE OF BURIAL
1913
Filed Feb.6, 1913
ADDRESS
1 UNDERTAKER
W. W. Cole, Son Lawrence, Many
10 NAME OF
FATHER
Daniel Walker
88 ... yrs. 2 mos. 27 ds.
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 singlo word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architcet, Loco- motive engincer, Civil engincer, 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 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-
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