Town of Winthrop : Record of Deaths 1913-1915, Part 88

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 88


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


3 SEX


Male


4 COLOR OR RACE


White


5 SINGLE.


MARRIED.


WIDOWED,


OR DIVORCED


(Write the word)


Manuel


· DATE OF BIRTH


9 1858


1


(Month) (Day)


(Year)


7 AGE


If LESS than


( day ........ hrs,


56 yrs.


yrs.


mos.


ds.


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


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Luft Sheets


-


(b) General nature of industry.


business, or establishment in


which employed (or employer).


1


' BIRTHPLACE


(State or country)


Hollowell me


(Duration)


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


mos.


10 ds.


Contributory


Pacteraemig


(SECONDARY)


(Duration)


mos.


ds.


(Signed)


Mch 15, 1915


(Address)


will be


* 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 pisco


of death


......... yrs.


.... mos.


In the


ds.


Ststo ........


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


3/16


1915-


D UNDERTAKER


ADDRESS


Wuchnot .......


1 PLACE OF DEATH


Wencheof-


(No. 225 Pleasant 81-


St. :


....... Ward)


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


2 FULL NAME


alvan, Hall Dean


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


225 Pleasant Ih Wurdeny mary


....


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


16 DATE OF DEATH


Auch


(Month)


(Day)


14


1915


(Year)


17


I HEREBY CERTIFY that I attended deceased from


5


191


to


much 14 ^


1915


that I last saw him alive on


mich 14


1915


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


8 Am. .


The CAUSE OF DEATH* was as follows :


Lobar Pneumonia


10 NAME OF


FATHER


Samuel De am


11 BIRTHPLACE


OF FATHER


(State or country)


Solon me


M.D.


1


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


Man. 7 .


1 7 1


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," "Dcaler," 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, Houscwork, 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, peritonaeum, 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 discasc; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "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 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.


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


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Winthrop


(No


187 Show Duri


St. :


Ward)


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


2 FULL NAME


Catherine


Elizabet Mc/Kenney


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


widow of John S. Mckennay


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX female


4 COLOR OR RACE


mute


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


16 DATE OF DEATH


Tauch


(Month)


15


(Day)


1915 -


(Year)


$ DATE OF BIRTH


July


25


1843


(Month) (Day)


(Year)


7 AGE


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


71 yrs. 7 mos. 18 ds.


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


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


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


· BIRTHPLACE


(State or country)


Middleton- mass


10 NAME OF


FATHER


11 BIRTHPLACE


OF FATHER


(State or conntry)


12 MAIDEN NAME


OF MOTHER


Susan . A. Puller


13 BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


C.R. B cuma


(Address)


REGISTRAR


...


17 I HEREBY CERTIFY that I attended deceased from


1915. to March, 6 , 1910. that I last saw he alive on III auch 15, 1914. and that death occurred, on the date stated above, at 17m. The CAUSE OF DEATH* was as follows : Cerebral applied


(Duration)


........


yrs.


3


ds.


Contributory (SECONDARY)


(Duration)


mos. ds.


(Signed)


Hurry all the


M.D.


& luckice, 1915 (Address) 22511 will


-


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


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


In the


At place


of death ............ yrs.


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


ds.


State


y's.


mos.


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


3,8


1910


........


20 UNDERTAKER


C.R. Beroun


ADDRESS


Filed .. 19!


PARENTS


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


mar. 15, 1915


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits ean be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, ete. 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," ete., 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 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, ete. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease ean be ascertained as the eause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State eause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medieal Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homieide, ete.


2. Deaths supposedly eaused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, ete.


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.


1


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


important. See instructions on back of certificate.


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Scotland.


12 MAIDEN NAME


OF MOTHER


Quiz a Miadellam


18 BIRTHPLACE OF MOTHER (State or country)


Lance Eduna Solama


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informent)


hurdignes macdonal d'


(Address)


62 Choes Nite


14


Filed 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


1 SEX


male White.


' COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR-DIVORCED


(Write the word)


Dnavira


16 DATE OF DEATH


11 anch


15 1


191


5


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


(Month)


(Day)


(Year)


$ DATE OF BIRTH


(Month) (Day)


1


(Year)


If LESS than


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


ds


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


* OCCUPATION


(·) Trade, profession, or


perticuler kind of work


Retired


(b) General nature of industry,


business, or establishment in


which employed (or employer) ..


17 I HEREBY CERTIFY that I attended deceased from 11,0ml 13. 191.5 .... , to. 11 1 week 15, 1919. that / last saw h. alive on , and that death occurred, on the date stated above, at ...........?...... m. The CAUSE OF DEATH, was) as follows :


1


(Duration).


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


.. mos.


3


..


Contributory (SECONDARY)


.. (Duration) .. yrs.


mos.


ds.


(Signed)


M.D.


Jack 15/1915 (Address) 325 Wwith08


* 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 pisce


of death.


.......


In the


.. yrs.


.mos.


ds.


Stete ............ yrs. ...........


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


M PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Phan 17. 1915


20 UNDERTAKER


ADDRESS


Winthrop


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


Alexander Macdonald


2 FULL NAME


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


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


82 avse St


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


PLACE OF DEATH


nathrop


.......


(No ...


82 Cosa


St.


Ward)


.........


....


$ BIRTHPLACE


(State or country)


Sim unic Eduardas Land


Bland


10 NAME OF


FATHER


John Lacclovald.


7 AGE


81


„yrs.


.... mos.


STANDARD CERTIFICATE OF DEATH. 1


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, 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- CASE 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 ecrebro-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 (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," "Hacmorrhage," "Inanition," "Marasmus," "Old age,". "Shock," "Uracmia," "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.


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


I PLACE OF DEATH


Brookline


(No Free Hospital for Women


ST.


.... Ward)=


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


2 FULL NAME Eliza H Huxley (Eliza H Booth)


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


widow of David G Huxley


@RESIDENCE


#90 Cottage ave Winthrop


Registered No.


76


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


March


1 9 .....


1915


(Month)


(Day)


(Year)


" DATE OF BIRTH


May


(Month)


(Day)


1.85117 (Year)


TAGE


If LESS than


! day, ......... hrs.


57


... yrs.


mos. ds.


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


& OCCUPATION


(a) Trade, profassion, or


particular kind of work


At home


(b) General nature of Industry.


business, or establishmant in


which employad (or employar)


3 BIRTHPLACE


(State or country)


England


10 NAME OF


FATHER


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


England


12 MAIDEN NAME


OF MOTHER


Harriett


Stanfield


13 BIRTHPLACE


OF MOTHER


(State or country)


England


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Mrs Charles H Whitney


(Address)


Mar 20 Gawardel Saker REGISTRAR


I HEREBY CERTIFY that I attended deceased from


Mar 14


191.5., to


Mar


.. 1.9


191.5 ......


that I last saw h ..... @.X alive on


Mar


19


191.5 .... ,


and that death occurred, on the date stated above, at ... 9 .. 50 pm


The CAUSE OF DEATH* was as follows :


Cystocele, Prolapse of Uterus


Operation for


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


mos. ds.


Contributory


(SECONDARY)


Minutes


(Duration)


.. yrs.


mos. ds.


(Signad)


Frank


A


Pemberton


M.D.


191


Mar 19


5


(Address).


Brookline


* 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


In the


of death.


yrs.


mos.


ds


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


Winthrop Mass


DATE OF BURIAL


Mar 22, 191.5.


16 Filed


20 UNDERTAKER


Chas R Bennison


ADDRESS


Winthrop


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


Brookline


(City or town.)


3 SEX


Female


4 COLOR OR RACE


White


28


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Widow


Joseph Booth


Pulmonary Embolism


.......


.. mos.


ds.


Stato ........


... yrs.


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to 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 cngincer, Civil engineer, Stationary fircman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when 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 laborcr, 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," unqualificd, 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 discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (mcrely 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 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 deathis 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 duc to Alcoholism, etc.


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


1


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


important. See instructions on back of certificate.


PARENTS


12 MAIDEN NAME


OF MOTHER


not Ofnouns


13 BIRTHPLACE


OF MOTHER


(State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Zuro, U.S. Barton


(Address)




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.