Town of Winthrop : Record of Deaths 1913-1915, Part 95

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 95


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).


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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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