Town of Winthrop : Record of Deaths 1913-1915, Part 73

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 73


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.


Que Hemiplegia


(Duration)


............ yrs.


X


mos.


3


ds.


Contributory


aortic aneurisma


(SECONDARY)


(Duration).


7


yrs.


.mos.


X ds.


(Signed)


Quiere & Johnson


M.D.


No0 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).


Åt 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


12 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


7200 30


1914


· UNDERTAKER


ADDRESS


Filed 191


REGISTRAR


17


I HEREBY CERTIFY that I attended deceased from


Fax 27, 1914, to


nov 27


191.4.


If LESS than


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


that I last saw h cercalive on


200 22


1914.


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


7- Pm.


(b) General nature of industry,


business, or establishment In


which employed (or employer).


9 BIRTHPLACE


(State or country)


Souris P.E.A.


10 NAME OF


FATHER


John macgowan


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


England


12 MAIDEN NAME


OF MOTHER


Jane. E. Mac Callum


18 BIRTHPLAGE


OF MOTHER


(State or country)


So Pelão Bay P. E.G.


"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


E-R-Bem


(Address)


.. yrs.


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 fircman, 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 necded. 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 laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- 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. - 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-


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 discasc; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (discase 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," "Scnile," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., which 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 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 dead, etc.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1914.


CITY OF BOSTON. 10686


ROBERT LAWTON


FULL NAME


Place of Death )


Boston


and Residence S


Date of Death


NOV.29


1914.


Age


53


years


months 8


days.


STATISTICAL DETAILS.


SEX.


COLOR.


SINGLE, MARRIED, WID., DIV.


M


MAR .


Maiden Name


Husband's Name


SHIRLEY


Birthplace


Name of Father


ABEL L LAWTON


CTYITATI R


CONIIT M.


8 REGIM


DONATA A.


MASS. Contributory : 2. (Duration)


SEPTICAEMIA - 5 DYS


(Signed)


HUGH CABOT M. D.


1914


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen! Residents.


Place of Burial or removal


AYER E.C. BURKE


Usual Residence


WINTHROP ( 36 PROSPECT AV ) DEC.4


Filed


1314


A true copy. Attest :


Registrar.


O


2


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from 1914, 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 :


GIST


RAR


R


T PATRIGIS


Primary


CANCER CAECUM - DRAINAGE OF


ICUT H ( Duration)


OFFICE


ABSCESS - 6 MOS.


Birthplace of Father


SHIRLEY


Maiden Name of Mother


SARAH HELENA


Birthplace of Mother


HARVARD


REAL ESTATE


Occupation


Informant


Registered No.


NEW ENG. BAPTIST HOSPT.


Undertaker


CITY


OSTON


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.


(


1 PLACE OF DEATH


Franklin


(No. 58


Main


St. :


Ward)


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


76


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


PERSONAL AND STATISTICAL PARTICULARS


$ SEX mal


4 COLOR OR RACE


artuta


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


rite the w


Odourch


6 DATE OF BIRTH


4


(Month)


(Day)


(Year)


7 AGE


If LESS than


1 day .......... hrs.


82


yrs. 5 mos. .........


30 ds.


.min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


Carkruten Retired vara


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


BIRTHPLACE


(State or country)


Novia Scotia


PARENTS


12 MAIDEN NAME


OF MOTHER


Cynthia Fremman


18 BIRTHPLACE OF MOTHER (State or country) Novia Scotia


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Que Walter babett


(Address)


Franklin Mask


Filed Dan 4, 1915 Michau Y Gentille


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


18 DATE OF DEATH


....


(Month)


(Day)


3


(Year)


1832 17 I HEREBY CERTIFY that I attended deceased from


to


.,


1914.


In-30


191


4


that I last saw him alive on


191


020- 30


4


and that death occurred, on the date stated above, at -500. m.


The CAUSE OF DEATH* was as follows :


Chronic Interstitial Nephritis


.(Duration)


...... yrs.


........... mos.


...... ds.


Contributory


Old age


(SECONDARY)


(Duration)


............ yrs.


............... mos.


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


M.D.


DE047, 1914 (Address) Franklin Mask.


* 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.


Stato


... yrs.


in the


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


.. mos. ........ ds .............


Where was disease contracted, If not at place of death ?.....


Former or usual residence.


1 PLACE OF BURIAL OR REMOVAL Wirthok Masa


DATE OF BURIAL


SEC 6


1913


ADDRESS


2 UNDERTAKER Isalie is Wiggin Franklin


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


'FULL NAME


David D'unlok


Registered No. 2246


1914


10 NAME OF


FATHER


David Dunlop


11 BIRTHPLACE


OF FATHER


(State or country)


novia Scotia


(Signed)


a. Gallison


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," " Manager,"" Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of " Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., C'arcinoma, Sar- coma, etc., of ... .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough ; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example : Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," " Old age," "Shock," "Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


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


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


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


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


N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See Instructions on back of certificate.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Winthink


(No. 39


Malélure


St. : Ward)


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


39 Wilshire dr Manchop


Weicherop


BOSTON


(City or town.)


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


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Malinthite


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Marcos


$ DATE OF BIRTH


2.2.20, 180 52


(Month)


(Day)


(Year)


7 AGE


If LESS than i day ........ hrs.


61 yrs. 11 mos


1.2) ds.


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


8 OCCUPATION


(s) Trade, profession, or


particular kind of work


Clarks


(b) General nature of industry.


business, or establishment


In


which employed (or employer)


· BIRTHPLACE


(State or country)


10 NAME OF


FATHER/


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


Fortlands


12 MAIDEN NAME


OF MOTHER


-


1ª BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


Filed


191.


REGISTRAR


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


At place of death. yrs. .... mos.


In the


ds.


Stato .........


.yes ..


Where was disease contracted,


mos. ......... di ..... ...... If not at place of death ?.


Former or usual residence


" PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


20 UNDERTAKER


ADDRESS


-


A


Did a surgical operation precede death ? hc, Date


.(Duration) .. yrs.


mos.


......


5


ds.


Contributory


Pulmonary Dedeuna


(SECONDARY)


.(Duration) .yrs.


mos.


/


ds.


(Signed)


Willian & Parte


M.D.


Dea 7., 1914 (Address)


Menthis


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


I HEREBY CERTIFY that I attended deceased from Dea Jak, 1917 to Dea 6th 1914 1 .... that I last saw h be alive on Dea 5th 191. and that death occurred, on the date stated above, at. 82,m. The CAUSE OF DEATH* was as follows :


(Month)


(Day)


1915 (Year)


16 DATE OF DEATH


Dec.


Registered No.


Davier


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of oecu- pation is very important, so that the relative healthfulness of various pursuits ean 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 eases, especially in industrial employments, it is neeessary 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) Solcs- 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 speeification, as Day laborer, Farm laborer, Laborer - Coal mine, ete. 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 Nonc.


Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affeetion with respect to time and causation), using always the same aceepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic eerebro-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 volvular heart disease; Chronic interstitial nephritis, etc. The contributory (seeond- 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 eause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," ete. State eause 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 eonditions 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, ete


4. Deaths under eircumstances unknown, as A person found dead, etc.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1914.


CITY OF BOSTON.


FULL NAME


MORRIS TENNENBAUM


Registered No.


10915


B.C.H. RELIEF


and Residence S


Date of Death


DEC. 7


1914.


Age


26


years


months days.


STATISTICAL DETAILS.


SEX.


COLOR.


SINGLE, MARRIED, WID., DIV.


M


W


SIN.


Maiden Name


Husband's Name


Birthplace


AUSTRIA


Name of Father


JOSEPH TENNENBAUM


Birthplace of Father AUSTRIA


Maiden Name of Mother


DORA


Birthplace of Mother AUSTRIA


Occupation


TAILOR


Informant


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from


1914, to


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 :


GI


UT PATRU


Primaryx! ( Duration)


POISONING BY ILL.GAS WITH CON-


SEQUENT BRONCHO-PNEUMONIA


BOSTONIA


CONTITA AL


E DONATA A.


MASS.


Contributory : 2 (Duration)


(Signed) G. B. MAGRATH MED.EX. M.D.


DEC.8 1914


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Place of Burial or removal


BETH ABRAHAM


Undertaker


J. STANETSKY


Usual Residence WINTHROP ( 51 CREST AV)


Filed


DEC.II 1914


A true copy. Attest : ErMSlenen


Registrar.


-


RAR'


CITY RE


ICUT PA


TVITATI


A /D. 1822.


CIRCUMSTANCES INDETERMINATE


TO


FFICE


Place of Death }


Boston


1


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


: PLACE OF DEATH


Winthrop


(No


15-


St. ;... ........... Ward)


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


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED.


WIDOWED,


OR DIVORCED


(Write the word)


Manuel


· DATE OF BIRTH


Mach 23


(Month)


(Day)


184811


(Year) 4


" AGE


66 yrs.


8.


14 ds.


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


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


Restauranteur


(b) General nature of industry.


business, or establishment in


which employed (or employer).


9 BIRTHPLACE


(State or country)


Shubook Can


10 NAME OF


FATHER


PARENTS


12 MAIDEN NAME


OF MOTHER


13 BIRTHPLACE


OF MOTHER


(State or country)


IS THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


Filed


191


REGISTRAR


Un definite


(Duration)


........... yrs.


mos. .............. ds.


Contributory.


Pulmonary Cedera


....


(SECONDARY)


(Duration)


.yrs.


......


mos.


ds.


(Signed)


William.


M.D.


Dee. g.


191 H (Address)


Wintheret.


* If death followed injury or violence the certificate of death must be made ont 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


1º PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


12-10. 1914


ADDRESS


D UNDERTAKER


W. C. Skaggs


12-


(Month)


(Day)


7


.... 1914


(Year)


Dec. 7 th.


19121


I HEREBY CERTIFY that I attended deceased from


nov.1ch


1914


to


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


If LESS than


1 day,


.. hrs.


that i last saw him


alive on


Die 7th


1914


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


3 Pm


„.m.


The CAUSE OF DEATH* was as follows :


arterio- acerca


2


11 BIRTHPLACE


OF FATHER


(State or country)


11


18 DATE OF DEATH


Registered No.


William S. Mc Donald- 'FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 15 Junkatury St. Winthrop


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 examples: (a) Spinner, (6) 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 laborer, Laborer - Coal mine, etc. Women at honie, 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 gaill- fully employed, as At school or At homc. Care should be taken to report specifically the occupations of persons engaged in domestie 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. - Name, first, the DIS- DASE 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-


culosis of lungs, meninges, peritonaeum, ete., Carcinoma, Dar- coma, etc., of. ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (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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