USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 43
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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 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 one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dcad, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1914.
CITY OF BOSTON.
1028
Registered No.
Place of Death and Residence
Boston
Date of Death
JAN.27
1914.
Age
48
years
months
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
W
WID.
Maiden Name
PITTS
Husband's Name
ALMORE W. QUIMBY T PATRIES Primary ( Duration)
SICUT
FFICE
Name of Father
WILLIAM A PITTS
Birthplace of Father
SKOWHEGAN . ME.
Maiden Name of Mother
SARAH E SNOW
Birthplace of Mother
SKOWHEGAN. ME
(Signed)
M.D.
1914
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents. IN HOSPT. 5 DAYS
Place of Burial or removal
SKOWHEGAN. ME.
Undertaker
J. S. WATERMAN & SONS
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1914, from 1914, 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
PULMONARY TUBERCULOSIS -
18 YRS
CTYTTATISR
BOSTONIA
D 1 22.
CONDITAA 1130.
IMINE DONATA D
Contributory . ( Duration)
MYOCARDIAL WEAKNESS &
1
ALCOHOLISM - 21 DYS H. W. HERSEY
Occupation
Informant
Usual Residence
WINTHROP (66 SAGAMORE AV)
Filed
FEB.2 1914
A true copy.
Attest :
ENMSlenen
Registrar.
O
GRACE H QUIMBY
FULL NAME
MASS. GEN. HOSPT.
Birthplace
SKOWHEGAN. ME.
CITY
BOSTON. MASS
Jan. 27, 1914
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 WirThok (No 335 Winthrop
St. :
...... Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Steny B. Dickinson,
-
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Winthrop St, 335 =
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
$ DATE OF BIRTH
4
(Month)
23
(Day)
(Year)
7 AGE
If LESS than I day ........ hrs.
6+1 yrs.
......
mos.
3 ds.
Of ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work.
Paneter
(b) General nature of Industry, business, or establishment which employed (or employer).
9 BIRTHPLACE
(State or country)
Capecod Mass
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Cape Cod Mars.
12 MAIDEN NAME
OF MOTHER
Eldidas.
13 BIRTHPLACE
OF MOTHER
(State or country)
Capecod. Mark.
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
4. Makaron
(Address)
64 /2audou St.
REGISTRAR
....
(Month)
(Day)
(Year)
1852 17 I HEREBY CERTIFY that I attended deceased from
-
191.3 ... , to
Jan 28
1919
that I last saw h zu alive on
Sam 2F
1914
and that death occurred, on the date stated above, at.
3 Am.
The CAUSE OF DEATH* was as follows :
Hypertrophy of Heart
(Duration)
-
.yrs.
mos
ds.
Contributory.
(SECONDARY)
Chemin Internetuad Replication
.......
.yrs ..
......
.... mos.
ds.
(Signed)
M.D.
Jan 29, 1914 (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 Windnick Ccnl.
DATE OF BURIAL
1-30
1914
D UNDERTAKER
W.C. sicagyp
ADDRESS
Winchwok
Filed 191
16 DATE OF DEATH
January
28che
4
10 NAME OF
FATHER
(Duration)
)
STANDARD CERTIFICATE OF DCATII
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, 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) Groecry; (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, cte. 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 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-
coma, etc., of .. .(name origin: . Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; Chronie interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-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 septieacmia," "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, 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, 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
CITY OF LYNN
1 PLACE OF DEATH
Lynn
(No ...
13So Elm street
St. :
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Elizabeth A. Stephenson
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop, Mass.
Futtle - Unknown
Registered No.
105
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
¿ SEX
F
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
W
· DATE OF BIRTH
(Month)
(Dầy)
(Year)
1 AGE
If LESS than
[ day, ......... hrs.
73
yra7 0
mos.
17
ds. or ......... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) Generel nature of industry,
business, or establishment
in
which employed (or employer)
9 BIRTHPLACE
(State or country)
(Duration)
.............. yrs ..
mos.
.............
ds
Contributory.
Diabetes
(SECONDARY)
(Duration)
... yrs ..
.mos.
ds.
(Signed)
C.L.Hcitt
M.D.
191 ...
(Address).
Lynn
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
10 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
... yrs. ............ mos. ............. ds.
In the
State ............ yrs.
.......
mos.
ds .............
Where was disease contracted, If not at place of death ?.
Former or usual residence
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs. Charles Tewksbury
(Address)
,
Filed Feb. 5, 1914 Jasephil ottwill REGISTRAR
19 PLACE OF BURIAL OR REMOVAL Winthrop, lass.
DATE OF BURIAL
Feb. 2. 191.
· UNDERTAKER C. Skaffa
ADDRESS
winthrop
16 DATE OF DEATH
Jan. 28. 1914
191
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Jan. 27, 191.
4 to Jan 28,
191.4 ...
that I last saw h .....
alive on.
191.4 ...
.....
and that death occurred, on the date stated above, at
... m.
The CAUSE OF DEATH* was as follows :
old age
10 NAME OF
FATHER
Christopher Ruttle
PARENTS
Ireland
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland
12 MAIDEN NAME
OF MOTHER
- Delmage
13 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
77
1.840 1
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 agc. 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 laborcr, Farm laborcr, Laborer - Coal mine, etc. Women at home, who arc engaged in the duties of the household only (not paid House- kcepcrs 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. - 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 (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, ctc., of .. ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular hcart discasc; 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 ascertaincd 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 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 strect, 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
Winthrop
BOSTON (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Nuola a Branch 2FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 184 Comment avz
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEY
4 COLOR OR RACE
Female (Ments
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)/
Manual
18 DATE OF DEATH
tch 8%
1914
(Month)
(Day)
(Year)
DATE OF BIRTH
30
(Month)
(Day)
(Year)
7 AGE
63
.yrs.
4
mos.
.... ...... ds.
„mln. ?
8 OCCUPATION
(a)' Trade, profession, or
particular kind of work
nous
(b) Genaral nature of industry. business, or establishment i which employed (or employer).
9 BIRTHPLACE
(State or country)
Goma mama
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Vinna Many
12 MAIDEN NAME
OF MOTHER
Lucinda I Prescott
13 BIRTHPLACE
OF MOTHER
(State or country)
Roma Many
IS THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Char. It Branch.
(Address)
184 Somment Clor
REGISTRAR
1850 17 I HEREBY CERTIFY that I attended deceased from
1914, to 7 ELE, 194 that I last saw h ......... alive on F/ 2, 1914. and that death occurred, on the date stated above, at/ 200fm. The CAUSE OF DEATH* was as follows :
(Duration).
........ yrs. .............
.mos.
.ds.
Contributory
(SECONDARY)
.(Duration)
...... yrs.
... mos.
ds
(Signed)
M.D. 7 218, 1914 (Address) 325 Withyou
* If death followed injury or violence the certificate of death must be made out by tho Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
of death .......... yrs.
mos ..
da.
Stato ........... yrs.
In the
„mos.
Where was disease contracted, If not at place of death ?..
Former or usual residence
10 PLACE OF BURIAL OR REMOVAL Mt Vernon Mr
DÁTE CF BURIAL
.. 1914
YUCERTAKER
Fuck Bugge Comment Steder
ADDRESS
Filed 191
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No.
184 Donnent Cze
Ward)
Registered No.
....
10 NAME OF
FATHER
Charlie Annel
If LESS than
I day ......... hrs.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthifulness 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, Sur- coma, etc., of ... (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease ; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," " Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
8. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
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
Many Hamilelow
18 BIRTHPLACE OF MOTHER (State or country)
vel Tom mme
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informent)
Ber Benni
(Address)
Filed .....
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Feb.
(Month)
(Day)
1914 (Year)
17 I HEREBY CERTIFY that I attended deceased from
1914, to Ler get
191111
that I last saw h/w alive on
191.50
and that death occurred, on the date stated above, at
... m.
The CAUSE OF DEATH* was as follows :
Pleuro -formumonia (lobar)
(Duration)
yrs.
mos.7
ds.
Contributory
Palaular Aheart Disease
(SECONDARY)
(Duration)
.. .
.. yrs.
mos. ds.
M.D.
(Signed)
Hh. 11 that
(Address)
Winetrop.
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
yrs.
mos.
ds.
State
In the
. yrs.
mos.
ds
Where was disease contracted, if not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL It Wollaston Quany
DATE OF BURIAL
2/15
19!
25
........
20 UNDERTAKER
ADDRESS
Withany
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mar
4 COLOR OR RACE
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Marcel
6 DATE OF BIRTH
(Month) (Day)
1
(Year)
If LESS than
I day, ........ hrs.
.yrs. mos. ds.
or ....... min. ?
8 OCCUPATION
(e) Trade, profession, or
particular kind of work
at home
(b) General nature of industry,
business, or establishment in
which employed (or employer).
· BIRTHPLACE
(State or country)
10 NAME OF
FATHER
Foster Brown
11 BIRTHPLACE OF FATHER (State or country)
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No. 147 Wundert St. :
nellie Schafer 2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
83 Washington are
Registered No.
7 AGE 59
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 Ilouse- keepers who receive a definite salary), may be entered as Housewife, Hlousework, 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.
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