Town of Winthrop : Record of Deaths 1913-1915, Part 83

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 83


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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 Winthrop


(No/4) LaringPar


St. :. ......... Ward)


V. Littlefield


2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] RESIDENCE 141 Foring Rd Winthrop


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Male


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widower


· DATE OF BIRTH


Jan


(Month)


13


(Day)


(Year){


7 AGE


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


.... 78 yrs. 1 .


8 de.


Or ......... min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Retired Milleriale


(b) General nature of industry,


business, or establishment In


which employed (or employer).


9 BIRTHPLACE


(State or country)


Lyman ter.


10 NAME OF


FATHER


Nathaniel y Littlefiles


11 BIRTHPLACE


OF FATHER


(State or country)


nan Ke "


12 MAIDEN NAME


OF MOTHER


13 BIRTHPLACE


OF MOTHER


(State or country)


Furman He.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


149 Brukar Dr 2/3


Filed 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


18 DATE OF DEATH


Feb-


21


1910.


.....


(Month)


(Day)


(Year)


1839


17


I HEREBY CERTIFY that I attended deceased from


kes. 18


191.


to


feb. 26,


191


FL6.20


that I last saw alive on 191 and that death occurred, on the date stated above, at .!........ 2m. The CAUSE OF DEATH* was as follows :


Cerebral Gryplexy.


Did a surgical operation precede death 2


Date


(Duration) ..


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


yrs.


.. mos.


3


ds.


Contributory ...


(SECONDARY)


(Duration)


yrs.


mos. da.


(Signed)


Swillneboy.


M.D.


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


Feb.21


191


(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.


In the


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


"el 23


1910


ADDRESS


20 UNDERTAKER Drown Non Cuer Doston


Winthrop BOSTON


(City or town.)


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


Registered No.


...


mos. .....


PARENTS


atero


8 chemin .


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 cngincer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborcr, Farm 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 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 (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 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-1915.


CITY OF BOSTON.


FULL NAME


Place of Death } and Residence S


Boston


CITY HOSPT.


Date of Death


FEB. 24


1915.


Age 58


years 9


months


24


days.


STATISTICAL DETAILS.


SEX.


COLOR.


SINGLE, MARRIED, WID., DIV.


M


W


MAR.


Maiden Name


Husband's Name


IRELAND


Birthplace


Name of Father


WILLIAM GRAHAM


Birthplace of Father IRELAND


Maiden Name of Mother


ANNA JAMESON


Birthplace of Mother IRELAND


Occupation


WARDER (B.EL.)


FEB. 25 1915 SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Place of Burial or removal


WINTHROP ( WINTHROP CEM) Usual Residence


WINTHROP ( 62 MAI N ST )


Undertaker


C.R. BENNISON


Filed


MAR. I 1915.


A true copy.


Attest :


EumSeinen


Registrar.


1


BOSTONIA VITA TONTITAA


D. 1022


18331.


E DONATA A


CANCER LIP


Contributory : -


(Duration)


(Signed)


J. W. MANARY


M.D


Informant


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


GIST


S. SIT DE


T PATRIENS


Primary. ( DurationT


PNEUMONIA - 7 DAYS


CITY


OFFICE


ISREGIMINE


POSTO


1. MASS


JOHN GRAHAM


Registered No.


1885


Feb 24, 1915


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.


t


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


2 FULL NAME June allen Mac Donald


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 195 Wanthet At lunch./


Widowof alexander Mac Donall


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


¿ SEX


4 COLOR OR RACE


Vitate


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


widow


25 1915


(Month)


(Day)


(Year)


6 DATE OF BIRTH


Fico


,8


1934


(Month)


(Day)


(Year)


7 AGE


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


yrs.


X


mos.


ds.


or ....... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


C/ Homme


(b) General nature of industry,


business, or establishment in


which employed (or employer).


2


9 BIRTHPLACE


(State or country)


Scotland


PARENTS


12 MAIDEN NAME


OF MOTHER


Jane templeton-


18 BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informent)


(Address)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


17


I HEREBY CERTIFY that I attended deceased from


1914


191


Fl 25


to


1915


that | last saw


alive on


Feb 24"


1915


and that death occurred, on the date stated above, at 9:45 Am.


The CAUSE OF DEATH* was as follows :


Chronic


Interstitial hephritis


(Duration)


1


.yrs.


mos.


ds.


Contributory


arteriosclerosis


(SECONDARY)


(Duration) 2 yrs.


mos.


ds.


3 Mutual


M.D.


(Signed)


Feb 26 0, 5


(Address)


Winshop


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


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


At place


of death.


yrs.


mos.


ds.


State


In the


yrs.


mos.


ds


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


2/2 8


191.


20 UNDERTAKER


6 12 3.


ADDRESS


Filed. 191


The Commmwwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH Winther of Mars (No. 195 Windteroti


1 PLACE OF DEATH


St. : Ward)


10 NAME OF


FATHER


James allen-


11 BIRTHPLACE


OF FATHER


(State or country)


Sevilan. C


tel. 25, 1915


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, 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 Examinors :


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.


important. See instructions on back of certificate. 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 PARENTS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


I PLACE OF DEATH


Withrah


(No 8 Summers Selve Ward)


Winthrop


BOSTON


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


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Homale Whita


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,“


OR DIVORCED


(Write the word)


Widow


' DATE OF BIRTH


(Month)


(Day)


1


(Year)


& OCCUPATION


(a) Trade, profession, or


particular kind of work ...


Home


(b) General nature of industry,


business, or establishment in


which employed (or employer)


9 BIRTHPLACE


(State or country)


Halifax n. J.


10 NAME OF


FATHER


James Flanigan


11 BIRTHPLACE


OF FATHER


(State or country)


Ireland


12 MAIDEN NAME


OF MOTHER


Eliza Kelly.


1ª BIRTHPLACE


OF MOTHER


(State or country)


Ireland


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


22 body


(Address)


58 Somenet Pases


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


280


(Month)


(Day)


1915


....


(Year)


17 HEREBY CERTIFY that I attended deceased from for fast yasal to


191


.........


that I last saw h EU


alive on


Frb.


26tt


1915


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


8 % a.


.m.


The CAUSE OF DEATH* was as follows :


CEchal Lennboys.


Did a surgical operation precede death ‹


Date


.(Duration)


.. yrs.


mos.


ds.


Contributory


Criterio Selemani


(SECONDARY)


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


mos.


ds.


(Signed)


nr. 4. mirnom


M.D.


F. 28. 1915


(Address)


80 Princeton 21.


....


* 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.


ds.


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


Former or usual residence


12 PLACE OF BURIAL OR REMOVAL Int. auburn


DATE OF BURIAL


Franch 2. 1915


20 UNDERTAKER


ADDRESS


Edward .Dando 12.2 haverich .8.


WilliamJ.


Registered No.


[If married or divorced woman or widow give maiden name, also name of husband. L @RESIDENCE 58 Junhaving ave


Mary a. Flanigan


Edwards


? FULL NAMEY ... ,


FAGE 79 yrs. -


If LESS than


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


mos.


ds.


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


16 Filed 191


....


1 7 15


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 cngincer, 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 minc, 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 domestie service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.


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


culosis of lungs, meninges, peritoneum, etc., Carcinoma, Sar- coma, etc., of .... .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Mcasles; Whooping cough; Chronic valvular heart discasc; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affcetion 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" (inerely 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 scpticaemia," "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.


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 Commmuwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Winthrop


(No ...


79


ittanche


St. :


........... Ward)


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


2 FULL NAME


Vem Mehice


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Winthrop- 79 ittantie St.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


2


28


1915-


(Month)


(Day)


(Year)


$ DATE OF BIRTH


2 -


23


..


1915.


(Month)


(Day)


(Year)


7 AGE


If LESS than 1 day ......... hrs.


yrs. mos.


or ....... min. ?


& 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


Charlie Mimcneill


PARENTS


11 BIRTHPLACE OF FATHER (State or country) é Bastan. 11. 10.


12 MAIDEN NAME


OF MOTHER


1ª BIRTHPLACE OF MOTHER (State or conntry) C. V Lastone. 1 200


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


hai.fr. neste


(Address)


Filed. 191


....


REGISTRAR


17


1 HEREBY CERTIFY that I attended deceased from 2 % 1915 to File 2805 , 19115


that I last saw him alive on 1915. and that death occurred, on the date stated above, at. 11 ? m_ The CAUSE OF DEATH* was as follows :


(Duration)


-


... yrs.


mos.


ds.


Contributory


(SLCONDARY)


(Duration)


yrs.


.mos. .


ds.


(Signed)


M.D.


ST:00 (Address) T Foot 2/


* 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.


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


Where was disease contracted, If not at place of death ? Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


3


........


......


1914


T


20 UNDERTAKER W.S. Sharan


ADDRESS


withof


3 SEX


4 COLOR OR RACE


6 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Single


.... Registered No.


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, (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 specifieation, 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 domestie service for wages, as Servant, Cook, Housemaid, etc. . If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.


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


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 ean 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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