USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 119
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Statement of cause of death. - Nainc, 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 ecrebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- purumonia ("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 ncoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, cte. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pncumonia (secondary), 10 ds. Never report niere symptoms or terininal conditions, such as "Asthenia," "An- armia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., when a definite discase 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. 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 head 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. Deathis 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- posurc, etc. .
3. Sudden deaths of persons not disabled by recognized discase, 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.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
SALEN
(City or town)
State
mas.
Registered
455
or Village No. Nach Sha Babus Hospital
or
St.,.
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and numher)
2 FULL NAME.
arthur
Cakes
(If in the Army or Natvy of the United States, give rank, organization, etc.r
(a) Residence.
No.
41 bank
St.,
WaWinthrop-
(If non-residentgive city or town and State)
months
days
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
If LESS than I day, ........ hrs. or ........ min.
10 NAME OF FATHER James Qales
11 BIRTHPLACE OF FATHER (city or town)
(State or country)
Ireland
annie Worley
13 BIRTHPLACE OF MOTHER (city or town). (State or country) Ireland
14 Mas anne Clarker
(Address)
41 Banks H. Wirithink
15 Fil Seth 7, 1918 Clifford Estinal
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
1918
17
I HEREBY CERTIFY, That I attended deceased from
aug. 31, 1918
to
Sept.7. 1918
that I last saw her
and that death occurred, cn the date stated above, at
630G,
m.
The CAUSE OF DEATH* was as follows :
(duration)
.. yrs ..
2
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.
Was there an autopsy ?.
What test confirmed diagnosis ?
L'Sipel Lamerne Kendall Kelle
, 19/8 (Address) Mnot There 03 abs Hasselt
.,
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 Holy form, Malden
DATE OF BURIAL Jeff 8 19
18
20 UNDERTAKER John J. 0' Maly
ADDRESS Wintherk
:
HIVHIM NO
1 PLACE OF DEATH
County
Essex
Township
City
Salem
(Usual place of abode)
Leogth of residence io city or towo where death occurred
years
3 SEX
4 COLOR OR RACE
Male
white
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year)
Months
Days
3
7
7 AGE
Years
8 OCCUPATION OF DECEASED
(a) Trade, professioo, or
particular kind of work.
(b) General oature of industry,
business, or establishment in
which employed (or employer)
(c) Name of employer
9 BIRTHPLACE (city or town)
Winthrop
12 MAIDEN NAME OF MOTHER
PARENTS
Informant
of certificate.
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 country)
man,
mooths
days.
How long in U. S., if of foreign birth ?
years
alive on
Segh 7
, 1918
REVISED UNITED STATES STANDARD CERTIFICATE 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 agc. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architeet, 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 have no occupation whatever, write None.
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 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.
(naine 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," "Ancmia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions,"""Debility" ("Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "'Weakness," ete., when a definite discase 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
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, 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.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PHYSICIAN.
R 15. 1-'18. 20,000.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1918.
CITY OF BOSTON 8795
Registered No.
PETER BENT BRIGHAM HOSPT.
Place of Death and Residence
Boston
Date of Death
SEPT.8
1918,
Age
17
years
months 15
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
M
W
S
Maiden Name
Husband's Name
R
BOSTON
Birthplace
Name of Father
OTIS S.DEUSCH
Birthplace of Father BOSTON
Maiden Name of Mother
EMMA REED
Birthplace
of Mother
QUINCY
(Signed)
M.D.
SEPT.8 1918
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
IN HOSPT.2 DAYS
Place of Burial or removal
FOREST HILLS
Usual Residence
WINTHROP ( 17 QUINCY AVE)
Filed
SEPT .11
1918.
A true copy.
Attest :
ErMSlenen
Filed Dec. 18, 1918
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'
LOBAR PNEUMONIA -- 7 DAYS
CITY
T PATRIBV& Primary , (Duration) BUBIS OFFICE
SELVLLAL
BOSTONIA CONDETA A
A. 1822.
OSTON 1831. 8 EGTMINE DONATH D MASS.
Contributory : (Duration)
1
G.H.STONE
Occupation
STUDENT
Informant
Undertaker
J.S.WATERMAN & SONS
Registrar.
7
1
HERBERT R. DEUSCH
FULL NAME
Sept. 8 1918 T
NIU NU
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.
14
Informant
felix Vergona
(Address)
540 Summer St. E.B.
15
Filed
............ ........ 19
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
Tule
4 COLOR OR RACE
Wtute
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
MItarried.
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
-Mary J. Russo
6 DATE OF BIRTH (month, day, and year)
7 AGE
Years
74
Months
29
Days
If LESS than 1 day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, professioo, or
Retired
particular kind of work
(b) General oature of iodustry,
business, or establishment in
which employed (or employer)
(c) Name of employer
Fruit Dealer
9 BIRTHPLACE (city or town).
Russo
(State or country)
Italy
10 NAME OF FATHER
PARENTS
11 BIRTHPLACE OF FATHER (city pr, town)
(State or country)
italy
12 MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (city or town)
(State or country)
Mikenous
* State the DISEASE CAUSING DEATHI, or in deaths from VIOLENT CAUSES, Estate (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
Sh Michael?
DATE OF BURIAL
Deter // 1918
20 UNDERTAKER M. Y. Kelly
Winthrop BOSTON
(City or town)
1 PLACE OF DEATH
County.
Suffolk
Township
Winthrop
City.
BOSTON
No. 79
or Village ..
Cliff
A-12 SE.
Ward
(If gcath occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Felice Russo
:
(a). Residence. No.
79 Cliff
(Usual placc of abodc)
Leogth of residence io city or towo where death occurred
years
months
days.
How loog io U. S., if of foreign birth ?
years
months
days
16 DATE OF DEATH (month, day, and year) Sehrq 19/8
17
I HEREBY CERTIFY, That b attended deceased from
aug 28
,1917
to ..
18
19.
that I last saw him
alive on
18
and that death occurred, on the date stated above, at 9,30a .m. The CAUSE OF DEATH* was as follows :
(duration)
1
.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 ?
(Sigoed).
M.D.
9/10,19/5 (Address)
144 varatactual
....... ....
State
Massachusetts
Registered No ... .......
.or
PERSONAL AND STATISTICAL PARTICULARS
Ward.
(If non-resident give city or town and State)
(
...... ......
ADDRESS
11 Meridian St.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
ONIOVANA HLMANNIVIA BLIUM-EL'N
REVISED UNITED STATES STANDARD CERTIFICATE 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 term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, 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 faet 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 DEATH (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- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Surcoma, 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- toins or terminal conditions, such as "Asthenia," "Anemia" (mcrely 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 canse. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for whichi 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
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, 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.
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY
PHYSICIAN.
R 15. 2-'18. 100,000.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE OF DEATH
County. Jutfolk
Township
Winthrop
or Village
.or
City No.
St., ...
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number )
Leg Klein
2 FULL NAME
(If in the Army or Navy of the United Stites, give rank, organization, etc.)
(a) Residence. No.
(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
3 SEX
male
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)
7 AGE 3
Years
Months
2
Days
If LESS than 1 day ......... hrs. or ........ min.
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
9 BIRTHPLACE (city or town).
Chelsea
(State or country)
10 NAME OF FATHER Joseph m Klein
11 BIRTHPLACE OF FATHER (city or town)
(State or country)
Russia
13 BIRTHPLACE OF MOTHER (city or town)
(State or country)
Russia
14
Informant Samuel Klein
(Address) 166 Haver St & Boston
15
Filed , 19
REGISTRAR
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Nahum helacok
20 UNDERTAKER
Jacob Stanetsky
DATE OF BURIAL Sep 12 19/8
ADDRESS
... ..
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,
of certificate.
WIHIL I LAINLI, WIIN UNPAVING INK - THIS IS A PERMANENT RECORD. Every item of information should be
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) Supr=11
19 / ₺
17
I HEREBY CERTIFY, That I attended deceased from
Sept
11ª
,1918, to
Sept 11- 1918
that Vlast saw him
alive on
Sept. 11th,9
and that death occurred, on the date stated above, at
4P
.... m.
The CAUSE OF DEATH* was as follows :
Lobar Premmonica
(duration) .yrs .. mos ............ ds.
CONTRIBUTORY
aute intestinal obstruction
fecal
(SECONDARYhardening 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 ?
no
What test confirmed diagnosis ?......
(Signed)
12 MAIDEN NAME OF MOTHER
Bessie Francis
, 19
(Address)
26 Princeton Sy 23
M.D.
* State the DISEASE CAUSING DEATHI, 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.)
PARENTS
-
243
Shirley
St.,
Ward.
winthrop
(If non-resident give city or town and State)
State
mass.
Registered No.
A SI
STH.L MNI UNIQYJNO HUMAINIVIBLUMEN
KLYISED UNITED STATES STANDARD CLKTIL ILAIL OI ULALI [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 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 Hlousekcepers 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 liave no occupation whatever, write None.
Statement of cause of death .- Name, first, 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 "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" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," " "Debility" ("Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," etc., wlien a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- l'ERAL 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
under the lead of "Contributory."
( Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
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