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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