Town of Winthrop : Record of Deaths 1913-1915, Part 43

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 43


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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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