Town of Winthrop : Record of Deaths 1913-1915, Part 76

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 76


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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Important. See Instructions on back of certificate.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


(No. Coral arc 735 St. : .Ward)


Vinterof


(City or town.)


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


Hilary. Gertrude Kenney


2FULL NAME


[If married or divorced woman widow give maiden name, also name of husband.] @RESIDENCE 95 00ml


widay of Edwards P Kerney


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


18 DATE OF DEATH


Ercember


(Month)


19


1914


(Year)


(Day)


& DATE OF BIRTH


6 1864


(Month)


(Day)


(Year)


7 AGE


If LESS than


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


50


.yrs.


6


mos. ....


13


de.


Dr ......... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


, or al form


(b) General nature of industry,


business, or establishment In


which employed (or employer).


Frecuentes right,non late


(Duration)


...... ... yrs. ................ mos .. ds.


Contributory. (SECONDARY)


(Duration).


yrs.


mos. ....... ds


(Signed)


M.D.


Lec


1914 (Address).


148 l wether fst


* 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).


At place


of death ......


.. yrs.


mos.


de.


State ..


... ул.


In the


.. mos. ....


d ..............


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


Former or usual residence.


" PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


13/2/


1914


D UNDERTAKER


ADDRESS


Filed _, 191


REGISTRAR


I HEREBY CERTIFY that l attended deceased from


Lec 4


, 1914


to Lee 19


191 ...


that I last saw his.


alive on


1917


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


230 A.m.


The CAUSE OF DEATH* was as follows :


9 BIRTHPLACE


(State or country)


D'autant


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


Porcíar e man


12 MAIDEN NAME


OF MOTHER


Mary Meaning


1ª BIRTHPLACE


OF MOTHER


(State or country)


Parlant me


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


C. R. (BEMANDRA.


(Address)


16


10 NAME OF


FATHER


John Kellers


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 matcrial 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 dutics of the household only (not paid House- keepers who reccive 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: 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 indefinitc) ; 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: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report merc 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 discase 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 street, or one supposed to be due to Alcoholism, etc.


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


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.


Cenils atrophy


(Duration) ............ yrs. .... .......


mos. ds.


Contributory


(SECONDARY)


unknown


(Duration)


.. yrs.


mos. ds.


(Signed) Dawin P. Stickney M.D. 1914. (Address) lington * 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.


In the


de.


State ......


.yrs.


mos.


ds.


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


(Informant)


(Address) .


18 Wachusett


voirlireton


Filed


., 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


December G71} 911.


(Day)


191


(Year)


$ DATE OF BIRTH


White


JuneMond, 18(1)


(Year)


7 AGE


If LESS than


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


70


yrs. mos.


ds.


min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Retire Merchant


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


9 BIRTHPLACE (State or country)


10 NAME OFardner, Maine


FATHER


PARENTS


11 BIRTHPLACEDen N. Byram OF FATHER (State or country)


12 MAIDEN NAME


OF MOTHER


Yarmouth, Hatne


1$ BIRTHPLACE OF MOTHER (State or country)


" THE ABOVE IS TRUE TO THEBEST OF MY KNOWLEDGE


Arlington (City or town.)


1 PLACE OF DEATH


Arlington


(No.18 Wachusett Avenue St. : ........ Ward)


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


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


Joseph Robinson Byram


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


1


17 I HEREBY CERTIFY that I attended deceased from


July 18th .194 Dec. 27 1914~191 ....... . that I last saw h ...... alive on Dec . 27 1914-19 and that death occurred, on the date stated above, at. m. The CAUSE OF DEATH* was as follows :


DATE OF BURIAL


12/31, 191


4


20 UNDERTAKER


ADDRESS


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


Cetta Dimock


25-


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 eachi 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- mrolive 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 inaterial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ctc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who arc engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.


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


culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of. .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (sccond- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (sccondary), 10 ds. Never report mere symptoms or teminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senilc," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the causc. Always qualify all diseases resulting front 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 dead, etc.


11


- - ---


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1915.


CITY OF BOSTON.


FULL NAME


ROSE M. HARTIN


Place of Death ¿ and Residence


Boston


JAN.6


26


10


months 5


days.


STATISTICAL DETAILS.


SEX.


COLOR.


SINGLE, MARRIED, WID., DIV.


F


W


SIN.


Maiden Name


Husband's Name


CAMBRIDGE


Birthplace


Name of Father


JOHN HARTIN


Birthplace of Father


IRELAND


Maiden Name of Mother


ELIZA MC ELROY


AUTOMOBILE


(Signed)


T. LEARY MED.EX.


M.D.


JAN . 7


1915


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


Place of Burial


or removal


MALDEN ( HOLY CROSS)


Usual Residence


WINTHROP(SHIRLEY & BEACON


STS) 1915


Filed


JAN. II


A true copy.


Attost :


Registrar.


O


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from


1915, to


1915, 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 : RAR'S


G PATRIONS, SIT DEL


Primary: ( Duration)


MULT. INJURIES -FRAC.SKULL -


EFICE


LACERATION & SONT.BRAIN - RUPT.


CIVIT


SOSTONIA


CONTITAA


A). 1822


INTESTINE-LAC.MESENTERY -


OSTO


.J. MASS Contributory : { (Duration)


HEMOPERITONEUM - STRUCK BY


Birthplace of Mother


CHARLESTOWN


Occupation


CLERK


Informant


-


166


Registered No.


CITY HOSPT.


Date of Death


1915.


Age


years


Undertaker


D .H. CURTIS


CITY


TIS REGIMITE DONATA 11 30.


Jan.


لا


-


19 一 ـى


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 Commmwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


I PLACE OF DEATH


Winthrop


(No.


14


. Linden


St. :


...


.Ward)


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


*FULL NAME


E Jessie J. Watson


{If married or divorced woman or widow Willian Italiani


give maiden name, also name of husband.]


@RESIDENCE


W Linden St. Winther2


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


8 SEX


4 COLOR OR RACE


MARRIED Mamed.


OR DIVORCED


(Write the word)


18 DATE OF DEATH


1-


(Month)


(Day)


7, 1915


(Year)


I HEREBY CERTIFY that ! attended deceased from


December 1 191 4, to


Xan 75


1915


---


that I last saw hel


alive on


Jan 65


1913


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


12:30/tm.


The CAUSE OF DEATH* was as follows : Mitral Señora & regurgitation


(Incompetence) Passiv congestion


Sivas, Cerebral hiemalis


2


Embolism


.(Duration)


.......


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


mos.


da.


Les abre


Contributory


(SECONDARY)


(Duration)


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


mos.


...........


M.D.


(Signed)


lan 8".


191. (Address)


180 UmathurSt- Directing


* 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.


In the


State ......... yra.


mos.


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


Where was disease contracted,


If not at place of death ?.


Former or usual residonce.


D PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


1- 9-1965-


(Address)


14 Lundi St.


REGISTRAR


17


(Month)


(Day)


11


.. 1852


(Year)


7 AGE


If LESS than


day ..


62 yrs. 5 mos. 26


da.


Of ......... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


athome


(b) General nature of Industry.


business, or establishment in


which employed (or employer)


9 BIRTHPLACE


(State or country)


Scotland-


10 NAME OF


FATHER


Phillips Houston


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


"Scotland-


12 MAIDEN NAME


OF MOTHER


Mary Muir


18 BIRTHPLACE


OF MOTHER


(State or country)


Scotland


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


-


D UNDERTAKER


IS. Skaggs


ADDRESS


Filed 191


5 SINGLE,4


6 DATE OF BIRTH


7


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, Architcet, 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, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write Nonc.


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


culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of .. .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; 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- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieaemia," "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- 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.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


I PLACE OF DEATH Writings (No. 23 Indent are St. ;............ .Ward)


6006


(City or towf.)


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


2 FULL NAME


Elizabetto


agnes Doyle Celebert a Keinan unk Richard fi Lloy Ce


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 23 Tudent ave, Winthrop


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR' RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Married


6 DATE OF BIRTH


(Month)


(Day)


(Year)


7 AGE


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


Est. 47 yrs.


mos. ds.


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


8 OCCUPATION


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


Hva Wife


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


Cet Homme


9 BIRTHPLACE


(State or country)


Ireland


PARENTS


12 MAIDEN NAME OF MOTHER Eller Pinvers


13 BIRTHPLACE OF MOTHER (State or country) Ireland


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informan*)


Richard& Klagte


(Address)


23


Fed 12


C STRAR


16 DATE OF DEATH


11, 1915


(Day)


(Year)


17 I HEREBY CERTIFY that I have investigated the death of the deceased. The CAUSE OF DEATH* was as follows : natural Causes: acute dilatation ofthe


Heart. Oedema att


(Duration)


.yrs.


mos.


ds.


Contribute Sudden death)


(SECONDARY)


(Duration)


. yrs.


...


mos. ds.


Serge Burgers Magrath,


M.D.


(Signed)


Jan


12.19 85 (Address).


1:50 am MEDICAL EXAMINER


* State the DISEASE CAUSING DEATH, or, In deaths from VIOLENT CAUSES, state (I) 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.


Stato


yrs. .


mos.


ds.


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


Former or usual residence


·9 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Finaldays


.O UNDERTAKER


ADDRESS


Mccudle q/ Colsetient


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.


10 NAME OF


FATHER


1


James Drinau


11 BIRTHPLACE OF FATHER (State or country)


leland


In the


1


MEDICAL CERTIFICATE OF DEATH


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, Architeet, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in inany 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) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ete., without more precise specification, as Day laborer, Farm laborcr, Laborer -- Coal minc, 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 homc. 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: 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," unqualificd, is indefinite) ; Tuber-


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culosis of lungs, meninges, peritoneum, etc., Careinoma, Sar- coma, ete., of_ ... (nanie origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasmns) ; Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (second- ary or intereurrent) affection need not be stated unless imn- portant. Example: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mero symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "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. 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 carbolie 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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