Town of Winthrop : Record of Deaths 1913-1915, Part 8

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 8


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121


11 BIRTHPLACE OF FATHER (State or country) incluate mars.


16 DATE OF DEATH


(Mopch)


(Day)


28


1913


(Year)


-


Feb. 28, 1913


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 caborer, 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, 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


Hinthoop


(No.


176. Bancaria


St. :


Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Im


4 COLOR OR RACE


W


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


5 (Month)


28


(Day)


1829


(Year)


7 AGE


If LESS than


{ day ......... hrs.


83 yrs.


....


9


mos.


..._ ds.


„min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


Retired


0


7


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


9 BIRTHPLACE


(State or country)


East Port. Dr.


PARENTS


12 MAIDEN NAME


OF MOTHER


Sarah


1ª BIRTHPLACE


OF MOTHER


(State or country)


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


174 Boudown


REGISTRAR


17 I HEREBY CERTIFY that I attended deceased from 1


Jan


1913


Feb 28


1913


....


that I last saw him alive on


Feb 28


1913


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


9.30 Km


The CAUSE OF DEATH* was as follows :


Premonia


artisti Delmis General. (age)


Intral Regurgitate Duration)


.. yrs.


2 mos.


Contributory.


(SECONDARY)


.. (Duration)


yrs.


mos.


.......


ds.


(Signed)


31 Mulcall


M.D.


milit, 1913 (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.


In the


ds.


State ............ yrs.


mos.


d8.


.........


Where was disease contracted,


If not at place of death ?.


Former or


usual residence.


19 PLACE OF BURIAL OR REMOVAL Winthrop Quan.


DATE OF BURIAL


3-2-


.,


1918


* UNDERTAKER


H.C. Skaggs


ADDRESS


1. Filed 191


...


(Month)


(Day)


1913


(Year)


1º DATE OF DEATH


Feb


20


.........


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


10 NAME OF


FATHER


John Mooney


11 BIRTHPLACE


OF FATHER


(State or country}


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


5 SINGLE,


Manuel


U


Feb. 28, 1913


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 , 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: Mcasles (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.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1913.


CITY OF BOSTON.


FULL NAME


Carrie B. Gurney


.........


Registered No. 2115


Place of Death


Boston


Emerson Hospt.


and Residence


Date of Death


Mar. 1


1913.


Age


years .


months.


.days.


STATISTICAL DETAILS.


SEX


COLOR


F


W


SINGLE, MARRIED, WID., DIV. M


Maiden Name


Green


ST


GI


REC


UT PATRIE


CITY'


: 321%


Operation for Ventral Hernia


BOSTONTA


1822


and Multiple Adhesions of Bowel


Birthplace


of Father


----


Contributory : (Duration)


2 ds.


Surgical Shock


2 ds.


(Signed)


John A.Morgan


M.D.


Mar. 1 1913


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


Place of Burial


Everett (Woodlawn)


Usual Residence


Winthrop, 69 Sargent St.


or removal


Undertaker


Bromm & Rollins


Filed .


Nar. 4


1913.


A true copy.


Attest :


EromSeinen


Registrar.


MARGIN RESERVED FOR BINDING.


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


1913,


from 1913, 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 : R AR. Surgical Shock following S.SITO 's Primaryo (Duration ) .-


Husband's Name


James Gurney Jr.


Shelburne Falls


Birthplace


Name of


Father Henry B. Green BỘ


CIVITATISREC


831. ING. DONATA A


N. MASS


Maiden Name of Mother ...


---


Burrough


Birthplace of Mother.


---


Occupation


Housewife


Informant


......


46


2


25


CONCITAA


---


по 50 0 50 1 5


mar.


١٫١٩13


٧


C


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.


2


Limerick Op


...


St. :


....... .Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


a SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Single


6 DATE OF BIRTH


2


5


19/3


(Year)


(Month)


(Day)


7 AGE


If LESS than


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


or ...


„min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


2000


(b) General nature of industry,


business, or establishment in


which employed ( or employer).


9 BIRTHPLACE


(State or country)


WinthropMais


(Duration)


......


...... yrs.


mos.


20


ds.


Contributory.


Marasmus


(SECONDARY),


... (Duration)


........


„.yrs.


mos.


ds.


(Signed)


Mamma & Soul


M.D.


Mar 2, 1913 (Address).


Willing Mass


.....


* 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.


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


3-5


3


191


.......


...


18


Filed


191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


March 2ª


1913


...


(Month)


(Day)


(Year)


37


I HEREBY CERTIFY that I attended deceased from


Jeeb 16


1913 to


March 2ª


191


3'


....


that I last saw her


alive on


March 2


3


191


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


11 am.


The CAUSE OF DEATH* was as follows :


Marasmus


Brucho- Pneumonia


10 NAME OF


FATHER


PARENTS


11 BIRTHPLACE


OF FATHER


(State or conntry)


Fuch.


12 MAIDEN NAME


OF MOTHER


.


13 BIRTHPLACE


OF MOTHER


(State or conntry)


P.E. J.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Forphine Foremans


(Address)


Urincheck mars


annie Estella Horeman.


2FULL NAME


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


20 UNDERTAKER W.C. skaggs


ADDRESS


In the


4


„yrs.


mos.


25 ds.


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-


mar . 2, 1913


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.


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.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1913.


CITY OF BOSTON.


FULL NAME


Lydia E. Small


Registered No. 2319


Place of Death ¿ and Residence S


Boston


Winchester Home for Aged Women


90


5


months.


12


days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


F


Maiden Name


Hobart


Francis Small


Husband's Name


Boston


Birthplace


Name of Father


David H. Hobart


5.98


Birthplace


of Father


Hanson


Maiden Name


Sarah N.Pratt


of Mother ..


Birthplace of Mother .. .


Cohasset


Occupation None


Informant


Place of Burial or removal


No.Truto


Geo.H.Gregg & Son


Undertaker


(Watertown)


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from 1913, to. 1913, 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


IS SIT


Arterio-sclerosis


Primaryo (Duration)


TA A. 1822:


E DUNATA A.


N. MA'S. S


Contributory : 3


Catarrhal Enteritis


(Duration)


1 yr.


(Signed)


Nelson M. Wood


.M.D.


Mar. 6


1913 .. ......


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


Usual Residence.


Winthrop


Mar. 11


Filed


A true copy. Attest : Eromheenen 1913.


Registrar.


MARGIN RESERVED FOR BINDING.


RE JT PATR


SICUT


CITY


CTVTTATIS RE


CODITAA


Date of Death


Mar. 6


1913.


Age ...


years


mar. 6, 1913


WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.


important. See instructions on back of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Winthrop (No 44 Cliff are St. : Ward)


4922


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


2 FULL NAME


Sen R. Johnstone


[If married or divorced womanor widow give maiden name, also name of husband.] @RESIDENCE 44 Cliff are.


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


male


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Married


16 DATE OF DEATH


march 8, 1913


(Month)


(Day)


(Year)


17 I HEREBY CERTIFY that I have investigated the death of the deceased.


The CAUSE OF DEATH* was as follows : natural Causes :- arteno Sclerais. probable cardio-renal disease


(Found divide insisted ).


ds.


Contributory (SECONDARY)


(Duration)


.yrs.


mos.


ds.


(Signed)


Liz Burgers Magnat


M.D.


1913


(Address)


3:10Pm MEDICAL EXAMINER


* State the DISEASE CAUSING DEATII, 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).


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 ..


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


9/11, 193


20 UNDERTAKER


ADDRESS


Filed , 191


REGISTRAR


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


:


(Informant)


(Address)


-


mos.


ds.


.. min. ?


8 OCCUPATION


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


Booksuper


(b) General nature of industry,


business, or establishment in


which employed (or employer).


Salesman


9 BIRTHPLACE


(State or country)


Dunoon Lolland


10 NAME OF


FATHER


Geo. Johnslan


PARENTS


11 BIRTHPLACE OF FATHER (State or country)


12 MAIDEN NAME


OF MOTHER


18 BIRTHPLACE OF MOTHER (State or country)


8. 1844


(Month)


(Day)


(Year)


7 AGE


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


69


6 DATE OF BIRTH


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


STANDARD CERTIFICATE OF DEATH.


1


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 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," 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, 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, peritonacum, etc., C'arcinomu, Dur- 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. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCIDENTAL, 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 - prob- ably 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 provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.