USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 102
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Statement of cause of death. - Name, first, the DISEASE CAUSING DEATII (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenin," "Anemia" (merely symptomatic), "Atrophy," "Col-
lapse," "Coma," "Convulsions,"""Debility" (“Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremnia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine 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
fenda tions on statement of cause of death approved by Committee on Noinenelature of the American Medical Association.)
Casas for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following 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, Exposure, 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.
ADDITIONAL SPACE
FOR FURTIIER STATEMENTS BY
PHYSICIAN.
R 15. 1-'18. 100,000.
--
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1918.
CITY OF BOSTON
FULL NAME
ALFRED GORHAM
Registered No.
5795
MASS.GEN.HOSPT.
and Residence 5
Boston
Date of Death APRIL 22
1918,
Age
64
years
months
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
M
W
UNK
Maiden Name
Husband's Name
Birthplace
Name of Father
- -GOR HAM
Birthplace of Father
Maiden Name of Mother --
Birthplace of Mother
PAINTER
Occupation
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness, from 1918, to
1918, 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:
STRAR
PATRIC
Primar (Duration)
SUBIS
L'OFFICE
BOSTDNIA
CONDITA AL
18 80.
S
+Contributory : (Duration)
--
H.W.HERSEY M.D.
(Signed) MAY 20 1918
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
IN HOSPT. 19 DAYS
Place of Burial or removal
MT . HOPE
Undertaker
K.T .GOOD
MAY 29
Filed
1918.
A true copy. Attest :
Registrar.
R
CITY
CARCINOMA OF LARYNX - I YR.
A. 1872
EGIMINE DONATA A ON. MASS
Usual Residence
WINTHROP (44 BUCHANAN ST)
Place of Death l
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE OF DEATH
County.
Middlesex
State
Mass.
Registered No ..
Township
Reading
or Village
or
No ..
Mt Vernon St Hospital
St.,.
.Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Ralph W. Bich
(a) Residence.
No ..
144 Court SK Nuittrop Mass, St.,
... Ward.
(Usual place of abode)
Length of residence in city or town where death occurred years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
6 DATE OF BIRTH (month, day, and year)
Years
Months
Days 9
If LESS than 1 day, ........ hrs. pr ........ min.
8 OCCUPATION OF DECEASED
9 BIRTHPLACE (city or town)
(State or country)
Reaching
Mass.
10 NAME OF FATHER Floyd E. Rich
11 BIRTHPLACE OF FATHER (city or town) Provincetown (State or country) Mass
12 MAIDEN NAME OF MOTHER Laura W. Hoyde
13 BIRTHPLACE OF MOTHER (city or town).
Reading
(State or country)
Mass .!
Informant
load E. Rich
Winthrop Mars
Filed. May 4, 1918 Millard F. Charles
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) for 24 -
19/8
17
I HEREBY CERTIFY, That I attended deceased from
apr 15
1918
....
to
apr 24℃
1918.
that I last saw hu alive on
Ce/pr 23º
1918.
and that death occurred, on the date stated above, at
6 a
m.
The CAUSE OF DEATH* was as follows :
Convulsous
(duration)
yrs.
mos.
1
ds.
CONTRIBUTORY
Mennigetis
.(duration)
.... yrs ...
.........
.. mos ...
......
.ds.
18 Where was disease contracted if not at place of death?
Did an operation precede death ?
No
Date of
Was there an autopsy ?
10
What test confirmed diagnosis ?
(Signed)
Sweat D, Richmond
M.D.
4/241918 (Address)
Reading Mass.
n * State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE, OF BURIAL, CREMATION, OR REMOVAL
Laurel Hill Can
Reading Mass.
DATE OF BURIAL afor 25 1918
20 UNDERTAKER
Frank Lo, Edgarley
ADDRESS
Readura
4
City 3 SEX 7 AGE (a) Trade. profession, or particular kind of work (c) Name of employer PARENTS 14 (Address) 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. 15 N. B. - WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD. Every item of information should be (b) General nature of industry, business, or establishment in which employed (cr employer)
(If non-resident give city or town and State)
(SECONDARY)
Convulsions
[Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Preeise statement of oeeupa- 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, Compos- itor, Architcet, Locomotive engineer, Civil engineer, Stationary fireman, cte. 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) Salesman, (b) Grocery; (a) Forcman, (b) Automobile factory. The ma- terial worked on may form part of the sceond statement. Never return "Laborer,"
"Foreman," "Manager," "Dealer," cte., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, cte. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- eifieally the oceupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, ete. If the occupation has been changed or given up on aceount of the DISEASE CAUSING DEATH, state oceupation at beginning of illness. If retired from business, that fact may be indi- catcd thus: Farmer (retired, 6 yrs.). For persons who have no oceupation whatever, write None.
Statement of cause of death .- Naine, first, the DISEASE CAUSING DEATH (the primary affeetion with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, ete., of_
(name origin; "Caneer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affeetion need not be stated unless important. Example: Measles (disease eausing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions,"" "Debility" ("Con-
genital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shoek," "Uremia," "Weakness," etc., when a definite disease ean be ascertained as the eause. Always qualify all discases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ete. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably sueh, if impossible to de- termine 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
nendations under the head utoly . on statement of cause of death approved by Committee on Nomenelature of the American Medical Association.)
Casos for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following 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 caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, 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, ete.
4. Deaths under eireumstances unknown, as A person found dead, ete.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS
BY
PHYSICIAN.
R 15. 1-'18. 20,000.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1918.
CITY OF BOSTON
FULL NAME
BLANCHE NICKERSON
Registered No.
4708
Place of Death } and Residence S
Boston
Date of Death
APR.25
1918,
Age 5
years 10
months
8 days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
VJ
S
Maiden Name
Husband's Name
Birthplace WINTHROP
Name of Father ARTHUR S. NICKERSON
Birthplace of Father SO.HARWICH
Maiden Name of Mother
JEANNIE MC CRENDLE
Birthplace of Mother LIVERPOOL.ENG.
Occupation
Informant
(Signed) S.A.CLEMENT M.D.
APR.25 1918
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
IN HOSPT.4 DAYS
Place of Burial or removal
WINTHROP . WINTHROP CEM Usual
Residence WINTHROP ( 41 BELCHER ST)
Undertaker
C.R.BENNISON
Filed
APR.30
1918.
WINTHROP
1
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that i attended deceased during last illness, from 1918, to
1918, 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:
R
AR
Gary
R
CITY
HOBIS
OFFICE
BOSTONIA
CONDITAA.
0. 1822.
REGIMINE DONAM A
STON.
MASS.
ACUTE TOXAEMIA
Contributory: (Duration)
SEPTIC DIPHTHERIA - 7 DAYS
Registrar.
A true copy. Attest :
MASS .HOMEO.HOSPT .
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Winthrop BOSTON (City or town)
1 PLACE OF DEATH
County.
Suffolk
State
Massachusetts ....... Registered No.
Township
Winthrop
.or Village
or
St.,
.Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Ella J. Thomas.
(a) Residence.
No ..
43 Lewis Ave.
.St.,
Ward.
(If non-resident give city or town and State)
Length of residence io city or town where death occurred
months
days.
How loog in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word),
married.
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Richard Thomas.
6 DATE OF BIRTH (month, day, and yeaMay 1 1854.
7 AGE
Years
63
Months
11
Days
28
If LESS than 1 day, ....... hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, professinn, or
particular kind of work
none
(b) General nature of industry, business, or establisbmeot in which employed (or employer) (c) Name of employer
(duration)
yrs ...
mos ...
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
......
18 Where was disease contracted
if not at place of death ?
Did an operation precede death?
200 Date of
Was there an autopsy ?
FOR WHAT ?
What test confirmed diagnosis ?
(Signed)
Cunha
L
M.D.
£5,19+ { (Address)
6
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Forest Hills
DATE OF BURIAL
May 1
19
Informant
43 Lewis Ave.
(Address)
15
Filed , 19
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year,
April 29 1918
19
17
I HEREBY CERTIFY, That I attended deceased from
2 /ml 2x
.19.4.f
- 29
to
19.7
2
that I last saw h (v alive on , 19 ..
and that death occurred, on the date stated above, at
2.314
m.
The CAUSE OF DEATH* was as follows :
.yrs.
............... mos .....
.ds.
9 BIRTHPLACE (city or town).
Hopkinton N.H.
(State or country)
10 NAME OF FATHER
Oliver N. French.
PARENTS
11 BIRTHPLACE OF FATHER (City
HennekerN.H.
(State or country)
12 MAIDEN NAME OF M
Julia A. Perry
13 BIRTHPLACE OF MOTHER (city or town)
(State or country) New Bedford Mass
14 H. O. Thomas
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
of certificate.
20 UNDERTAKER
Gratinman Dons
ADDRESS
boston
carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,
City
BOSTON
No.
43 Lewis Ave.
(Usual place of abode)
10
years
IDED UNITED O U DIAILS STANDARD CERTIFICAIL OF DEATH [Approved by U. S. Census and American Public Health Association]
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 cach and every person, irrespective of age. For many occupations a single word or terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive cngincer, Civil engineer, Stationary fircman, etc. But in inany 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobilc factory. The ma- terial 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 Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically 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 DEATII, state occupation at beginning of illness. If retired from business, that fact may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write Nonc.
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 discase. Examples: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid
fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (inerely symptomatic), "Atrophy," "Col-
lapse," "Coma," "Convulsions,"""Debility"
(“Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Slock," "Urcinia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de-
-
termine 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 (c. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committe on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following 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, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strect, or onc supposed to bc due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN.
,
.
R 15. 2-'18. 100,000.
The Commonwealth of Massachusetts
BOSTON
STANDARD CERTIFICATE OF DEATH
(City or town)
County.
Suffolk
Township
Winthrop
State
Massachusetts
Registered No
or
City
BOSTON
No.
.or Village,
26, Enfield Road
St.,
.. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Helen Mulcahy
(a) Residence.
No ..
26 Enfield Road
St., .....
......
... Ward.
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) May por 1918
17 I HEREBY CERTIFY, That I attended deceased from april 26, 1918, to May 1" 1918.
that I last saw her alive on
May 1º
1918.
and that death occurred, on the date stated above, at
5 pm
............ m.
The CAUSE OF DEATH* was as follows :
If LESS than 1 day, ....... hrs. or ....... min. Leukemia
(duration)
yrs.
mos ..
ds.
CONTRIBUTORY
(SECONDARY)
__ (duration)
. yrs ..
.. mos.
ds.
18 Where was disease contracted
if not at place of death?
Did an operation precede death?
„Date of.
FOR WHAT ?
Was there an autopsy ?..
What test confirmed diagnosis ?
(Signed)
Modestino diana
May 21918 (Address)
419 Haurve HT-
M.D.
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL St. Pauli Arlington May 3- 1018
Filed
.................... ,19
REGISTRAR
20 UNDERTAKER
ADDRESS
m. g. Kelly 11 mindiansh
of certificate.
1 PLACE OF DEATH
3 SEX
4 COLOR OR RACE
Demai, musíte
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
7 AGE
Years
Months
2
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer)
(c) Name of employer
PARENTS
Informant
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
(State or conntry)
mass
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
6 DATE OF BIRTH (month, day, and year) Sehr 21" 1915
Days
10
9 BIRTHPLACE (city or town) ..
Winthrop
10 NAME OF FATHER Thomas & Mulcahy
11 BIRTHPLACE OF FATHER (city or town)
(State or country)
Com
Winsted
12 MAIDEN NAME OF MOTHER Helen A Burke
13 BIRTHPLACE OF MOTHER (city or town) Gest Boston (State or country) mass.
14 Ulice D, Burke
(Address)
26 Enfield Road
15
(If non-resident give city or town and State)
.
JIANURAD CERTIFIGRIL OF DERILI
[Approved by U. S. Census and American Public Health Association]
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, Compos- itor, Architect, Locomotive engineer, 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial 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 Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At homc, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- eifically 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATII (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, etc., of ..
(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial ncphritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy." "Col- lapse," "Coma,' 1." "Convulsions,"" "Debility" (“Con-
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