USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 60
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2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posurc, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1914.
CITY OF BOSTON.
FULL NAME
JOHN O MALEY
Registered No.
6587
Place of Death
Boston
and Residence
Date of Death
JULY 11
1914.
Age
8
years
months
14
days
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
M
W
SIN.
Maiden Name
Husband's Name
Birthplace BOSTON (EAST)
Name of Father
JOHN F. OMALEY
Birthplace
of Father
PORTSMOUTH. N. H.
Maiden Name of Mother
ELLEN T. KELLY
Birthplace of Mother BOSTON (EAST)
Occupation
NONE
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1914, 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 : from 1914, to
GIST
RAR.
T PATR
Primary‹! ( Duration)
TETANUS FOL. INFECTION LOWER
LEG & FOOT
S EGTM BOSTON
CDO /TA MASS. Contributory : (
BURNS OF ARM -ACC. APPLICA-
(Duration)
TION OF HOT BRICKS FOR NEURITIS
(Signed)
T. LEARY MED.EX.
M. D.
JULY 12 1914 SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen! Residents.
Place of Burial or removal
MALDEN (HOLY CROSS )
Undertaker
F. A . MAGRATH
1914.
Filed
A true copy.
Attest :
JULY 14
ErMSlenen
Registrar.
O
CITY RE
IC 7
FFICE
CTVTTAT S
Usual Residence
WINTHROP (79 ATLANTIC ST)
LONG ISLAND HOSPT.
July 11,19
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
1 PLACE OF DEATH
(No. 20 Perkins
St. :
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
James ? Mccarthy
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
20 Parking Px
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
S SEX
m
4 COLOR OR RACE
Hdowey
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
* DATE OF BIRTH
(Month)
(Day)
5
(Year)
....
If LESS than
day .
„.hrs.
that I last saw h 5
...........
alive on
11
1914
and that death occurred, on the date stated above, at.
3/7 m. .
The CAUSE OF DEATH* was as follows :
Sem. Cutivo Sclerosis
Did a surgical operation precede death? The Date
-
.(Duration)
....... yrs.
... mos.
ds.
Contributory
Evening of hungs.
(SECONDARY)
(Duration)
.. yrs.
mos ds.
(Signed)
Mary all elly
..... .
M.D.
Julia 11. 1914 (Address).
325 / Vithun 2St
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.
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 St. Joseph's
PATE 05 BURIAL
July 20
191
4
.......
Filed .. 191
.....
REGISTRAR
16 DATE OF DEATH
(Month)
11, 1914
(Day)
(Year)
7 AGE 63
.. yrs.
mos.
ds.
Or ........ min. ?
S OCCUPATION
Lace dealer
(a) Trade, profession, or
particular kind of work
(b) General nature of Industry,
business, or establishment
In
which employed (or employer)
9 BIRTHPLACE
(State or country)
Ireland
10 NAME OF
FATHER
Felix In i, Cathy
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Queland
12 MAIDEN NAME
OF MOTHER
armi Cameron
18 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
20 UNDERTAKER
F.d. Crosby
ADDRESS
Box.
BOSTON ....
Registered No.
:
17
I HEREBY CERTIFY that I attended deceased from
June 2 4, 1914, to
11
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 cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the 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," cte., 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 domestie service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebro-spinal fever (the only definite synonym is "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-
culosis of lungs, meninges, peritonacum, etc., Careinoma, 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 bo stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report merc symptoms or te. minal conditions, such as "Asthenia," "An- acmia" (mercly 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 discase 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, etc.
3. Sudden deaths of persons not disabled by recognized discase, 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 wenche (No. 16 2 Circuit. Rd St. ;.. ........... Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME Instead of street and number.]
2FULL NAME
[If married or divorced woman of widow give maiden name, also name of husband.] @RESIDENCE
mamin wife of Henry Mc Lean
.......
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)
18 DATE OF DEATH
July 16
1914
(Month)
(Day)
(Year)
6 DATE OF BIRTH
6
1844
(Month)
(Day)
(Year)
7 AGE
CC
.yrs.
mos. ds.
Gr ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry. business, or establishment "In which employed (or employer).
9 BIRTHPLACE
(State or country)
10 NAME OF
FATHER
Luften Moffatt
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
1
18 BIRTHPLACE
OF MOTHER
(State or country)
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
(Address)
Fli.d
191
REGISTRAR
Contributory.
(SECONDARY)
.. (Duration) ......... yrs.
mos.
ds.
31 Met calf
M.D.
(Signed) July 18, 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).
In the
At place
of death ............ yrs.
da.
State ............ yrs.
mos.
ds ............
Where was disease contracted, If not at place of death ?...
Former or usual residence
PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
4/18
1915
* UNDERTAKER
C.R Beman
ADDRESS
wenchert
:
-
I HEREBY CERTIFY that I attended deceased from
april
191.4
to
July 16"
1914
that I last saw her alive on
1914
and that death occurred, on the date stated above, at
26m.
-
The CAUSE OF DEATH* was as follows ; Pernicious anaemia
Chronic Plesatitial Nphritis
.. (Duration)
2 yrs.
.......
.......
.. mos.
da.
·
PARENTS
If LESS than
t day ......... hrs.
Elizabet, Edit Mc Lean
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, 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 cxamples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dcaler," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the houschold 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 domestic service for wages, as Servant, Cook, Housemaid, ctc. 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- LASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cercbro-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 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: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acinia" (mercly symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old agc," "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 peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc. ..
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dcad, 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
11 BIRTHPLACE OF FATHER (State or conntry)
Unk. M. S.
12 MAIDEN NAME OF MOTHER Rebecca Brownell
13 BIRTHPLACE OF MOTHER (State or conntry)
wnik. M. S.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Find Ong 5 1914 Enlaby Churchill aust. REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
single
6 DATE OF BIRTH
--
(Month)
(Day)
(Year)
7 AGE
If LESS than I day, ........ hrs.
44
yrs. mos.
ds.
or ..
min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work.
(b) General nature of industry, business, or establishment in which employed (or employer).
(Duration)
. .. yrs.
mos. ds.
Contributory
(SECONDARY)
(Duration)
.. yrs.
mos. .ds.
(Signed)
Timothy Leary
M.D.
July 21, 1914 (Address)
MEDICAL EXAMINER
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
In the
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 Tidnich. n.S.
DATE OF BURIAL
191-
-
ADDRESS
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH
waters of Winthrop Beach
sei certificato attached! Winthrop St. Ward) (City or towu.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
ada James Taylor
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop mass.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH
July
(Month)
(Day)
16 .. 1914 (Year)
17 I HEREBY CERTIFY that I have investigated the death of the deceased. The CAUSE OF DEATH* was as follows :
Drowning multiples contusions
Manner unknown.
9 BIRTHPLACE
(State or country)
Chapman, M.S.
10 NAME OF
FATHER
Silas Taylor
-
CO UNDERTAKER
J & Waterman & Son
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Preeise 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, 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 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," ete., without more prceise spceification, 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. Carc 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 aceeptcd term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cercbro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualificd, is indefinite) ; Tuber-
coma, etc., of ..
en
·Cancer" is less
definite; avoid use of "TuCor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd not be 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- acmia" (merely symptomatic), "Atrophy," "Collapsc," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertaincd as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical .operation was undertaken. 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 head - homicide; Poisoned 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. Deatlıs supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Commonwealth of Massachusetts
1 PLACE OF DEATH Water
STANDARD CERTIFICATE OF DEATH of Westtop Brach- St. ... Ward)
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
8545
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
single.
6 DATE OF BIRTH
(Month) (Day)
(Year)
7 AGE
44
yrs. mos. ds.
or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Nurse
(b) General nature of industry, business, or establishment in which employed (or employer).
.(Duration)
yrs.
mos.
ds.
Contributory.
(SECONDARY)
mos. ds.
., M.D.
.191 (Address). MEDICAL EXAMINER
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
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
DATE OF BURIAL
191
20 UNDERTAKER
ADDRESS
Filed
191.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH July16 (Day) (Month)
4 191. (Year;
17 I HEREBY CERTIFY that I have investigated the
death of the deceased.
The CAUSE OF DEATH* was as follows :
Drocom
Multiple Contención XX
9 BIRTHPLACE
(State or country)
Chapman N.S.
10 NAME OF
FATHER
Silas Taylor.
PARENTS
12 MAIDEN NAME
OF MOTHER
Rebecca Brownell.
13 BIRTHPLACE
OF MOTHER
(State or country)
unk N.S.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) (Address)
1$
ada Jace Taylor
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop Mass
CAUSE OF DEATH in p. n terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructie.is on back of certificate.
would be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
N. B. - Every item v ..
19 PLACE OF BURIAL OR REMOVAL Tidnish N.S.
11 BIRTHPLACE OF FATHER (State or couk N.S.
If LESS than
I day, ....... hrs.
July 16, 1914
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oecu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when nceded. 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 "Laborcr," "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 oecu- 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 "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broneho- pneumonia ("Pneumonia," unqualified, is indefinite); Tubei
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 intereurrent) affcetion 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 symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Ūraemia," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieaemia," "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: Aecidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by earbolic 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."
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