Town of Winthrop : Record of Deaths 1916-1918, Part 117

Author: Winthrop (Mass.)
Publication date: 1916
Publisher:
Number of Pages: 1316


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 117


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CONTRIBUTORY


(SECONDARY)


(duration)


............. y rs ................. mos.


.......


ds.


18 Where was disease contracted


if not at place of death ?


Did an operation precede death ?


Date of.


Was there an autopsy ?.


What test confirmed diagnosis ?


Pu(Signed).


Seo.


I Hele


M.D.


28, 19 (Address)


Beruby


* State the DISEASE CAUSING DEATH, or in deaths from CIOLENT 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


Holy Cross Malden


DATE OF BURIAL


aug.29


19/18


20 UNDERTAKER


Join J. CO. Maley


ADDRESS


Winthrop


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


SALEM


(City or town)


1 PLACE OF DEATH


County


Essen


State mais.


Registered No.


Township


City


Salem


or Village No. North Shore Barris Hospital


St. 6


Ward


(If death occurred in a hospital or institution, give its NAME instead of street and number)


Clarke


2 FULL NAME


.(.I.f-in.the.A.riny Or/ Navy.of the United States, give.rank,organization,c+0;+


(a) Residence.


No


(Usual place of abode)


41 Bank


St.,


WarWinthrop Mass.


(If non-resident give city or town and State)


Length of residence in cily 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


17


I HEREBY CERTIFY, That I attended deceased from


July


1


19


18


to


aug. 27, 1918.


that I last saw b


"alive on


aug 27, 1918


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


UP. m. The CAUSE OF DEATH* was as follows :


indigestión


(duration)


.yrs ....


2


mos.


ds.


9 BIRTHPLACE (city or town)


Boston


(State or country) mass


10 NAME OF FATHER


James Qalar


PARENTS


11 BIRTHPLACE OF FATHER (city or town)


(State or country)


Ireland


12 MAIDEN NAME OF MOTHER Iunie Harley


13 BIRTHPLACE OF MOTHER (city or town).


(State or country)


Ireland


If LESS than 1 day, ........ hrs. or ........ min. Chimie Intestinal


3 SEX


or


TIS STANDARD L MITK ATT. OF DEATH


[Approved by U. S. Census and American Public Health Association)


Statement of occupation. - Precise statement of oeeupa- tion 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, Compos- itor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, ete. But in many cases, especially in industrial einployments, 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) Salcsman, (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 home, and children, not gainfully employed, as At . school or At home. Care should be taken to report spe- eifieally the occupations of persons engaged in domestie serviee 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- eated 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 disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphthcria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, ete., Carcinoma, Sarcoma, ete., of_


(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcaslcs; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affeetion need not be stated unless important. Example: Mcasles (disease causing death), 29 ds .; Broncho- pneumonia (sccondary), 10 ds. Never report mere symp- toms or terminal conditions, such as " Asthenia," "Anemia" (merely symptomatie), "Atrophy," "Col- lapse," "Coma," "Convulsions,"" "Debility" ("Con- genital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite discase ean be ascertained as the cause. Always qualify all diseases resulting from ehild- 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 hicad - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fraeture of skull, and consequences (e. g., sepsis, tetanus) may be stated


under the head of "Contributory."


(Recommendations


on statement of cause of death approved by Committee


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, 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 dcad, etc.


ADDITIONAL SPACE


FOR FURTHER STATEMENTS BY


PHYSICIAN.


R 15. 1-'18. 20,000.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


Sherman Baby


Nune Way With


St. ;.


.Ward)


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


I PLACE OF DEATH


melco


? FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


12


3 SEX


' COLOR OR RACE


Culite


Male.


(Month)


(Day)


7 AGE


-


...........


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General natura of industry,


business, or establishment in


which employed (or employer)


11 BIRTHPLACE


OF FATHER


(State or country)


Russia


PARENTS


Russia


1ª BIRTHPLACE


OF MOTHER


(State or country)


(Informant)


CR Benne


important. See instructions on back of certificate.


(Address)


16


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


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


mos ..


ds.


Filed


191


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


$ DATE OF BIRTH


august 29, 1918.


1


(Year)


If LESS than


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


or ...


min. ?


9 BIRTHPLACE


(State or country)


Winthrop Mass ..


10 NAME OF


FATHER


Louis Sherman!


12 MAIDEN NAME


OF MOTHER


na Pontinocity


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


17 I HEREBY CERTIFY that I attended deceased from aqui 29, 1918 , to. 1918 that I last saw h. ......... allwe ón ..... august 29, 198. and that death occurred, on the date stated above, at


The CAUSE OF DEATH* was as follows :


Fremature


(Duration)


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


.yrs.


...........


......


.. mos.


.ds.


Contributory


(SECONDARY)


(Duration)


Oyrs.


mos.


...........


ds.


(Signed)


Harry appelle


M.D.


Y ..


........


191.0 ...: (Address).


) ...


200 ceuxtemel


"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. ............ ds ............


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


Former or usual residence ..


19 PLACE OF BURIAL OR REMOVAL Tomate Waschen


DATE OF BURIAL


1910


20 UNDERTAKER


ADDRESS


1


191.


....


(Month)


29


(Day)


(Year)


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


(City or town.)


aug. 29,1918 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, ete. 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) Salcs- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborcr, Farm laborcr, 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 homc. 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 terni 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 .; 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," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "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 scpticaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


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


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicidc, 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 onc supposed to be due to Alcoholism, etc.


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


? AGE PARENTS (Informant) important. See Instructions on back of certificate. 16 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 ....


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH ...... Winthrop (No. Metcalf Hospitalor


Bely Dobrow


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


75 Walnut Dve Revere


Registered No.


MEDICAL CERTIFICATE OF DEATH


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


ORDIFORCES


(Wrike the word)


Jungle


· DATE OF BIRTH


Qua, 30 (Month) (Day)


. 9/8 7 ...... (Year)


If LESS than t day ......... hrs.


...... mos. .. X ds


or ...


min. ?


8 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)


Winthrop Moss


10 NAME OF


FATHER


SamuelDobrow


11 BIRTHPLACE OF FATHER (State or country) Russia 7


12 MAIDEN NAME


OF MOTHER


Rose Kagan


18 BIRTHPLACE


OF MOTHER


(State or country)


Russia


1


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Address)


75 Walnut Que


Filed 191


REGISTRAR


.....


16 DATE OF DEATH


(Month)


30


(Day) 1918 (Year)


-


I HEREBY CERTIFY that I attended deceased from aug 30


191K, to.


wmp 30


1915


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 born


(Duration)


yrs. ................ mos. ..............


ds.


Contributory (SECONDARY)


(Duration)


.........


... yrs.


mos. ............... ds.


(Signed)


M.D.


1cup 30


,1918 (Address)


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


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


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


At place


of death ...


. yrs.


... mos. .....


ds.


State ............ y:8. ...........


.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 Wolny Beth googling 301918


20 UNDERTAKER Lacol Planetsla Bixton


Winthrop


(City or town.)


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


PERSONAL AND STATISTICAL PARTICULARS


* SEX Unknown


.....


In the


1415


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of oeeu- 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) Salcs- man, (b) Grocery; (a) Forcman, (b) Automobile factory. The material worked on may form part of the second stateinent. 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 IHousewife, Housework, or At home, and children, not gain- fully employcd, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestie service for wages, as Scrvant, Cook, IIousemaid, 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 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, ete., of ..... ...... ....... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Mcasles; 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- acmia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "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, 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 duc to Alcoholism, etc.


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


7 AGE PARENTS of certificate. 15 I. V. WHIIL PLAINLI, WIEM UNFAVING INK - THIS IS A PERMANENT RECORD. Every item of information should be so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE. OF DEATH in plain terms, 50


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


(City or town)


1 PLACE OF DEATH


County


Township


City


or Village 0. 137 Varchar Red


St.,


Ward


(If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


Fred Waldron Swett


(a) Residence.


No. 137 Bartlett RA.


(Usual place of abode)


Length of resideoce 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


3 SEX


Mall


4 COLOR OR RACE


White


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Marvel


5a If married, widowed, or divorced HUSBAND of (or) WIFE of -


mary . a.


6 DATE OF BIRTH (month, day, and year)


Years


Months


Days


11


If LESS than 1 day, ........ hrs. or ........ min.


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


Jalesman


particolar kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer


/ Business


(c) Name of employer Machinio Salesman


9 BIRTHPLACE (city or town)


Saccaraffa


(State or country) me


10 NAME OF FATHER Martian ch. A. Swett


11 BIRTHPLACE OF FATHER (city or town) .. Topson


(State or country) me


12 MAIDEN NAME OF MOTHER abby. L. Pratt


13 BIRTHPLACE OF MOTHER (city of town) Saccaralla (State or country) me


14 mary a. S week


Informant


(Address)


137 Barkeit Road Antes


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH (month, day, and ycar) Jef. 1.


19/1


17


I HEREBY CERTIFY, That I attended deceased from


to.


mck. 1.


.8


Ref. 1.


19.


18.


,


that I last saw hlen alive on


aug. 20.


191.8.


and that death occurred, on the date stated above, at 9.5- a.m. . m. The CAUSE OF DEATH* was as follows :


Pulmonary Tuberculosis


Indek


(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 ?


200. Date of


Was there an autopsy ?


What test confirmed diagnosis ?


(Signed)


2/3. 19


(Address)


* State the DISEASE CAUSING DEATH, or in Acaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional spacc.)


DATE OF BURIAL


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


Brookdale Camely-


20 UNDERTAKER


ADDRESS


Filed ., 19


State


Mass


Registered No ...


or


Ward.


(If non-resident give city or town and State)


Paras


M.D.


REVISED UNIILD SIAILS STANDARD CLKHIFICAIL 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 each 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, Architcet, Locomotive 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) 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," 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 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 liave no occupation whatever, write None.


Statement ot cause of death. - Name, flrst, the DISEASE CAUSING DEATH (the primary affection with respect to tiine and causation), 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- 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 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- mus," "Old age," "Shock," "Uremia," "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 DEATHIS 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




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