USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 95
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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
-
(No. 95% Showedrus st. .............. .Ward)
'FULL NAME
John Brennan
[If married or divorced womau or widow
give maiden name, also name of busband.1
@RESIDENCE
935 Shoredrive Withick
... Registered No.
PERSONAL AND STATISTICAL PARTICULARS
$ SEX
4 COLOR OR RACE
w
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1
$ DATE OF BIRTH
(Month)
(Day)
18/38
(Year)
7 AGE
If LESS than
I day ......... hrs.
77 yrs.
. mos.
ds.
min. ?
* OCCUPATION
(a) Trade, profession, or
particular kind of work
Retired
(b) General nature of Industry,
business, or establishment in
which employed (or employer).
· BIRTHPLACE
(State or country)
Ireland.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
1
12 MAIDEN NAME
OF MOTHER
18 BIRTHPLACE
OF MOTHER
(State or country)
1
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
)Nuco. foher Brenner
(Address)
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
april
24
1915
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
abril
24
191.S., to
april 24
1915
that I last saw him. alive on
abril 25
1915
₹ ... . and that death occurred, on the date stated above, at /045Pm. The CAUSE OF DEATH* was as follows : acute Cardine Dilatations
(Duration) ............ yrs. ......... mos. ds.
Contributory
(SECONDARY)
.(Duration)
mos.
ds.
yrs. .......
(Signed)
Trymond
M.D.
april 2. 1915 (Address) 15
..........
* If death followed tujury or violence the certificate of death must be made Yout by the Medical Examluer.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
yrs.
.......... mos. ............
ds.
Stato ...
......
.yrs.
In the
mos.
Where was disease contracted, If not at place of death ?.
Former or usual residence
1º PLACE OF BURIAL OR REMOVAL
Walnut Hils
1920 El.
DATE OF BURIAL
4-27 ..
1915-
D UNDERTAKER
I. C. Skaggs
ADDRESS
Wirellesale
...........
(City or town.) [If death occurred in a hospital or institution, give its NAME Instead of street and number.]
10 NAME OF
FATHER
Unknown
C apr. 21,1915 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, c. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, ete. But in many eases, 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, ete. 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 oecu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie eerebro-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, ete., 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 eausing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "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 aseertained as the eause. Always qualify all diseases resulting from childbirth or misearriage, 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, Homicide, etc.
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.
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) Philadelphia.
12 MAIDEN NAME OF MOTHER Susan Kite
13 BIRTHPLACE OF MOTHER (State or country) Pa.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Jums. R. V. King
(Address)
12 chistes Et2.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
25, 1915
(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. Halmontage, Spolamens acth Brain. antonio
Sclerosis
.(Duretion) .yrs.
.mos. .ds.
Contribution down death) (SECONDARY)
(Duration) yrs.
mos. ...
ds.
(Signed)
on dagmath,
,
M . D . april 26 1915 (Adress). 2. Iva, MEDICAL EXAMINER
* State the DISEASE CAUSING DEATH, or, In deaths from VIOLENT CAUSES, state (t) 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
H-2 5
3 .- 1916
ADDRESS
:0 UNDERTAKER
W. C. Staff
6852
(City or tow(.)
{If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME. Randolph V. King
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 12 Chester are.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
S SINGLE, 9
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
manuel
B DATE OF BIRTH
1 (Month)
(Day)
1 1853 (Year)
7 AGE
If LESS than I day, ........ hrs.
62 .yrs. 3 mos.
20ds.
or .... .. min. ?
8 OCCUPATION
(a) Trade, profession, or particular kind of work Cuitable
(b) General nature of industry, business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country)
Philadelphia Pa-
10 NAME OF
FATHER
Samuel Kung -
Filed , 191
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop
(No. 12 Chester Une St.
, .. .Ward)
Registered No.
m
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
apr. 25, 1915 STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many eascs, 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 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 oeeu- 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: Cercbro-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, cte., of. A.(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 intereurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptonis or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Comna," "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 eause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid -- probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the licad of "Contributory."
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, ete.
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
PLACE OF DEATH Winthrop
.............
(No
23
23 Woodside OUEst.
Stillborn Cronin
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
1 SEX male
4 COLOR OR RACE
(White
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
16 DATE OF DEATH
april
27
(Month)
(Day)
1915
(Year)
* DATE OF BIRTH
- Abril
27
1913
(Year)
(Month)
(Day)
7 AGE
If LESS than
[ day ........ hrs.
yrs.
mos.
ds.
or ........ min. ?
* OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry.
business, or establishment in
which employed (or employer).
· BIRTHPLACE
(State or country)
10 NAME OF
FATHER
ENErale & Growin.
11 BIRTHPLACE
OF FATHER
(State or countwy)
Leland.
12 MAIDEN NAME
OF MOTHER
Budget M. mation
18 BIRTHPLACE
OF MOTHER
(State or country)
1
Flanit.
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Filed
., 191
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
....
191
.... , to.
that I last saw h
alive on
191
and that death occurred, on the date stated above, at
........ m.
The CAUSE OF DEATH* was as follows :
Stell from
.(Duration)
.............. yrs. ................ mos.
...........
.ds.
Contributory
(SECONDARY)
(Durstion)
... yrs.
......
mos.
ds.
(Signed)
C.J. mahoney
M.D.
april 28, 1915 (Address)
....
* 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.
Stat ............ yrs.
mos.
Where was disease contracted, If not at place of death ?.
Former or usual residence
D' PLACE OF BURIAL OR REMOVAL Absichern Com
DATE OF BURIAL
28 1915
» UNDERTAKER
ADDRESS
(City or town.)
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
23 Hardude CAVE.
...
Registered No.
191
....
PARENTS
STANDARD CERTIFICATE OF DEATH
apr. 27, 1915
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, c. 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. Carc 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, ctc. 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 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
ISAAC S. JOHNSON
Place of Death 1
Boston
and Residence
Date of Death
APR.27
1915.
Age
72
years
-
months
10
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
M
W
MAR.
Maiden Name
Husband's Name
Birthplace
HALLOWELL.ME.
Name of Father
JOHN JOHNSON
Birthplace of Father
HALLOWELL.ME.
Maiden Name of Mother
ELIZABETH HINCKLEY
Birthplace of Mother HALLOWELL.ME.
Occupation FARMER ( RETIRED)
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 : GISTRAR'S
DriftATD. CHR. ARTERIOSCLEROSIS & MYOCAR- ( Duration)))
CTYTTATISR
DETDNIA
CNOITA A
TISREUIM !!
BOSTO
N. MASS
Contributory · - CARDIAC DILATATION - I MO.
(Signed)
E. N. LIBBY M.D.
APR.27 1915
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen! Residents.
Usual Residence
WINTHROP
Filed
MAY ! 1915
A true copy.
Attest :
Emblemen
Registrar.
O
Place of Burial or removal MT. HOPE
Undertaker F. L . BRIGGS
CITY RE
SICUT P
FICE
DITIS - YRS
1A. 1822.
1330.
: DONATA A
(Duration)
Registered No. 4271
HOME FOR AGED COUPLES
april 27, 1915
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
Winthrope
(No.
96
Bartlett Rd.
St. Ward)
Winthrope 1
BOSTON ...
(City or town.)
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
2 FULL NAME
Stillborn La Centra
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
96 Bartlett Rd,
....
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
april
24
1915
(Year)
· DATE OF BIRTH
april
(Month)
(Day)
.....
(Year)
7 AGE
If LESS than
1 day ........ hrs.
yrs.
mos.
ds.
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)
mass. Winthrope
PARENTS
12 MAIDEN NAME
OF MOTHER
Marion Gertrude Howlett
18 BIRTHPLACE
OF MOTHER
(State or country)
Inden Mask
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
Wwallin
(Address)
8 /battery et, Bustin
Filed 191
REGISTRAR
......
17
I HEREBY CERTIFY that I attended deceased from
april 29
1915
to
same
191
that I last saw h ........... alive on
191
...... )
and that death occurred, on the date stated above, at
m.
The CAUSE OF DEATH* was as follows :
Still birth - Cause and Ensure
Did a surgical operation precede death ‹
Date
(Duration).
................ yrs.
...........
mos ..
ds.
Contributory. (SECONDARY)
(Duration).
/ ..... yrs.
mos.
ds.
(Signed)
....
howaltun
M.D.
april 29, 1915 (Address)
$ Battery 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).
In the
At place
of death
.......
yrs.
mos. .......
ds.
State ............ yrs.
....
mos.
Where was disease contracted, if not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Winthrofe
DATE OF BURIAL
april 20,
191
......
1 UNDERTAKER
Porcella + Camera
ADDRESS
10 NBennett
3 SEX
Inale
' COLOR OR RACE
while
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
29
1915
(Month)
(Day)
......
10 NAME OF
FATHER
Gerard La Centra
11 BIRTHPLACE
OF FATHER
(State or country)
Italy
apr. 29, 1915
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it i ; 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 ehildren, 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 (retircd, 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 "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-
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