Town of Winthrop : Record of Deaths 1913-1915, Part 41

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 41


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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, ete. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or te minal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL scpticaemia," "PUERPERAL peritonitis," ete. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be duc 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 Winthrop (No. 21, Hawthorne are St. : Ward)


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


2 FULL NAME homan ]. Laveque


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


21 Hawthorne are inunchat


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


man


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


.


11 1868


(Day)


(Year)


7 AGE


if LESS than day,


or ....... min. ?


$ OCCUPATION


(a) Trade, profession, or particular kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer).


montant out


Contributory. (SECONDARY)


(Duration)


yrs.


.. mos.


ds.


( Signed)


Surge Burgers Magnach.


Jan/2013


(Address)


MEDICAL EXAMINER


1.20P


* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES; state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.


16 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At placo


of death.


yrs.


mos.


ds.


Stata


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


O UNDERTAKER


ADDRESS


Filed :91


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH Jan 10 (Day)


Month)


1919


(Year)


17 I HEREBY CERTIFY that I have investigated the death of the deceased.


The CAUSE OF DEATH* was as follows :


Poisoning


by Carbon


monoxide (illuminating


gas), Circumstances in


determinate (not homicidal)


.. (Duration)


. yrs.


mos.


.ds.


9 BIRTHPLACE


(State or country)


10 NAME OF


FATHER


Foreph, Laroque


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Lancaster ont.


12 MAIDEN NAME


OF MOTHER


Sarah Finlyonmonde


1ª BIRTHPLACE OF MOTHER (State or country )


he


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


nuno Punto


(Address)


2 Hawehave are


1913


DATE OF BURIAL


1/15


..


M.D.


6 DATE OF BIRTH


nov (Month)


45 yrs. mos. 29 ds.


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 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 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) Forcman, (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 laborcr, Laborer - Coal minc, etc. Women at home, who are engaged in the duties of tlie houschold only (not paid House- keepers who receive a definite salary), may be entered as Houscwife, 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: Farmcr (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.


k


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: Cercbro-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 ncoplasms) ; 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," "Hacmorrhage," "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 scpticaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of hcad - homicide; Poisoncd by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."


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, ete.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, ete.


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


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


(No. FcDonald Hospital St. :


Ward)


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


Frank E Harris


1 PLACE OF DEATH


Brookline


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


1 SEX


4 COLOR OR RACE


White


Male


" DATE OF BIRTH


(Month)


? AGE


63


8 OCCUPATION


(a) Trade, profession, or


Clerk


particular kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer).


9 BIRTHPLACE


(State or country)


-- Maine


10 NAME OF


FATHER


Unknown


11 BIRTHPLACE


OF FATHER


(State or country)


Unknown


12 MAIDEN NAME


OF MOTHER


Unknown


PARENTS


1ª BIRTHPLACE


OF MOTHER


(State or country)


1Inknown


(Informant)


Chester Harris


important. See instructions on back of certificate.


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


CAUSE OF DEATH in plain terms, so that It may be properly classified. Exact statement of OCCUPATION is very


....


....... yrs.


7


mos.


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED "Ji dowed


(Write the word)


-1851


(Day)


1 (Year)


If LESS than


l day .......... hrs.


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


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


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Address)


Winthrop Wass


15 Filed


Tan 13 1914 Cawurde Jaker


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Jan


10


(Month)


(Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from


Dec 7


to


193


Jan 10


4


191


....


that I last saw h.


im


alive on


Jan


10


191


4


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


5₽


m.


The CAUSE OF DEATH* was as follows : Mitral Regurgi tation


(Duration)


.yrs.


mos.


ds.


Contributory


(SECONDARY)


(Duration)


.yrs. .


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


mos.


ds.


(Signed)


Paul Carson


M.D.


Jan 10


191.


4


(Address).


Boston


* 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


Melrose Brockton


DATE OF BURIAL


Jan 13


191


20 UNDERTAKER


Skaggs


ADDRESS


Winthrop


PERSONAL AND STATISTICAL PARTICULARS


42 Irving st Winthrop


Registered No. 9


1914


.......


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 each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, c. 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," "Dcaler," 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- kcepers 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 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. Tho contributory (second- ary or intercurrent) affection need not bo stated unless im- portant. Example: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acınia" (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 ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicacmia," "PUERPERAL pcritonitis," 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.


8 SEX · DATE OF BIRTH 7 AGE & OCCUPATION (a) Trade, profession, or particular kind of work 12 MAIDEN NAME OF MOTHER PARENTS 13 BIRTHPLACE OF MOTHER (State or country) (Informant) 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 ..... N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state - 191.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH 1 PLACE OF DEATH 41 Jangeul SAMO Warcho


(City or town.)


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


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


41


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


" Jame 15


(Month)


(Day)


1914 (Year)


17


I HEREBY CERTIFY that I attended deceased from


Die 12.


1914, to


U


3


Die 12


1914


that I last saw hume, alive on


Dac 12


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


The CAUSE OF DEATH* was as follows : arterio Salenis


.(Duration)


4 yrs.


mos.


ds.


Chemie Bandits


Contributory


(SECONDARY)


(Duration)


3


yrs.


mos. ds.


(Signed)


Wantatt Taylor


M.D.


June 12


191 ....... (Address)


3 1 Procacto gt 2Rs.


* 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


1ª PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


4/15


1913


20 UNDERTAKER


ADDRESS


REGISTRAR


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widen


(Month)


(Day)


18.37 (Year)


If LESS than I day ......... hrs.


yrs.


4


mos.


29 ds.


Or ....... min. ?


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


Shift many let


· BIRTHPLACE


(State or country)


along low mars


10 NAME OF


FATHER


Eco. Day Phillips


11 BIRTHPLACE


OF FATHER


(State or country)


Rochester Cuy


13 ales


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


St. : Ward)


John. George


Phillips


Registered No.


4 COLOR OR RACE


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 w ben needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. Tbe 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-


Jan 1 2. 1914


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. Tbe 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,"" Exbaustion," "Heart failure," "Haemorrhage," "Inanition," " Marasmus," " Old age," "Sbock," "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. Deatbs under circumstances unknown, as A person found dead, etc.


-- -


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


' PLACE OF DEATH


Winthrop


(No 271


Winthrop


St. : Ward)


(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


14/ 1914


(Month)


(Day)


(Year)


· DATE OF BIRTH


(Month) (Day)


1843 (Year)


7 AGE


If LESS than


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


Or ......... min. ?


· OCCUPATION


(a) Trade, profession, or


particular kind of work


Rublicuregher


(b) General nature of industry,


business, or establishment f


which employed (or employer).


9 BIRTHPLACE


(State or country)


Boston.


PARENTS


12 MAIDEN NAME


OF MOTHER


Bater


13 BIRTHPLACE


OF MOTHER


(State or country)


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


Filed.


_, 191


REGISTRAR


16 DATE OF DEATH


17


I HEREBY CERTIFY that I attended deceased from


pom 14


., 1914, to


m 14


, 1914,


that Nast saw him alive on


14


191Y.


and that death occurred, on the fate stated above, at 915pm.


The CAUSE OF DEATH* was as follows :


Angina Pedoris


vacherin 1 coronary artis


0


1 hour


(Duration)


......... yrs.


ds.


mos.


Contributory


General certeiro schermo


(SECONDARY)


(Duration) .A ...


....... yrs.


mos.


ds.


(Signed)


31) medcall


M.D.


Am 16"


1914


(Address).


withof


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


DATE OF BURIAL


1-17


19144


20 UNDERTAKER


ADDRESS


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.


Charles is Stone


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


Winthrofe-


3 SEX


{ COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


mamed


69 yrs. .. mos. ds.


10 NAME OF


FATHER


moses to I love


LI BIRTHPLACE


OF FATHER


(State or country)


STANDARD GERTIFICATE 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 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 cxamples: (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 laborcr, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.


Statement of cause of death. - Namc, 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 "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-




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