Town of Winthrop : Record of Deaths 1916-1918, Part 122

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 122

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under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature 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 FURTHER STATEMENTS BY

PHYSICIAN.

R 15. 1-'18. 100,000.

WINIL TLAINLI, WIIR UNFAVING INK - THIS IS A PERMANENT RECORD.

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.

15-'17-XXM |

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

' PLACE OF DEATH Winthrop (No. 26 Wave Way Dve Ward)

Winthrop BOSTON

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

2 FULL NAME

Still Born - Becker

[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 26 Wave Way Que

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX I COLOR OR RACE

5 SINGLE,

MARRIED.

WIDOWED,

OR DKORCED

(Write the word)

jingle

DATE OF DEATH Sept. 14 1918 ....

(Month)

(Day)

(Year)

" DATE OF BIRTH

Sujet 14

(Month

(Day)

.. 19/8 (Year)

7 AGE

If LESS than i day ......... hrs.

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)

Winthrop Mass

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

austria

12 MAIDEN NAME

OF MOTHER

annie Briefes

18 BIRTHPLACE

OF MOTHER

(State or conntry)

Austria

" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Father

(Address)}.

26 Wave Way Que

Filed

REGISTRAR

I HEREBY CERTIFY that I attended deceased from Sept. 14 191 8 Seht 14 191. to

191. that I last saw her ativo en Sept . 14 , 8 and that death occurred, on the date stated above, at .......... m. The CAUSE OF DEATH* was as follows :

Still Born

Did a surgical operation precede death ? si

Date

.. (Duration)

.. yrs.

............... mos.

ds.

Contributory (SECONDARY)

(Duration)

.......

yrs ..

mos.

(Signed) George Colton moore M.D. Sept.15, 1918 (Address) 496man. Ihre

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

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

At place of death. .. yrs. mos. .......

In the

ds.

State ............ yrs.

mos.

...... ds ............. Where was disease contracted, If not at place of death ? Former of usual residence

19 PLACE OF BURIAL OR REMOVAL Per

Wolven, Betty Joseph

DATE OF BURIAL Sept 15, 1918 .

20 UNDERTAKER

Jacole Stanetalen

ADDRESS Boston

10 NAME OF

FATHER

Adolph Recker

× m.yrs. x mos. ds.

Registered No.

Sept

14 1118

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 applics 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 enginecr, Civil engincer, 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 cxamples: (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 laborcr, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- 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 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 indicated thus: Farmer (rctired, 6 yrs.). For persons who have no occu- pation whatever, write Nonc.

Statement of cause of death. - Name, first, the. DIS- EASE CAUSING DEATHI (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebro-spinal fevcr (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- mcumonia ("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) ; Mcasles; Whooping cough; Chronic valvular hcart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd 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" (mercly 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 discases resulting from childbirth or miscarriage, as "PUER- PERAL scpticacmia," "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 discasc, 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, ctc.

R. 15. 1-'17. 100,000.

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 Withsopp (No 98. Somerset alors ... Ward)

John Richardson

2 FULL NAME ......

[If married or divorced woman or widow give maiden name, also name of husband.] RESIDENCE 98 Somerset avr. Winthrop

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

& SINGLE,

MARRIED. U

WIDOWED,

OR DIVORCED

(Write the word)

Widowed

16 DATE OF DEATH

5-30-a.m. 9

(Month)

17, 1918

(Year)

(Day)

$ DATE OF BIRTH

1830

(Month) (Day)

(Year)

7 AGE

88 %

.yrs. mos. ds.

or ........ min. ?

8 OCCUPATION

(*) Trade, profession, or

particular kind of work

Butter

(b) General nature of industry, business, or establishment in which employed (or employer).

9 BIRTHPLACE

(State or country)

England

10 NAME OF

FATHER

John @ Richardson

PARENTS

12 MAIDEN NAME

OF MOTHER

13 BIRTHPLACE

OF MOTHER

(State or country)

England

"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Tuo. John Richardson

(Address)

88 Somenet Ou2.

Filed 191

REGISTRAR

I HEREBY CERTIFY that I attended deceased from

May

1918

Left 17

191.

that I last saw h was alive on

Left 16

1918

and that death occurred, on the date stated above, at.

5:00m. m. The CAUSE OF DEATH* was as follows : Echtecania following Chiara Cystitis

(Duration) .

7 yrs ..

2 mos. × ds.

Contributory.

article salesoss

(SECONDARY)

.yrs. mos .- ............

ds.

(Signed)

Quelle E. Holmesone

.M.D.

4 17, 1918 (Address) Mivelof Mass)

......

* 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. ............ d ............

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

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

DATE OF BURIAL Nauthropo Cunt 9 -19- 1918

20 UNDERTAKER W.C. Skaggs

ADDRESS

Winterote

(City or town.)

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

MEDICAL CERTIFICATE OF DEATH

If LESS than

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

11 BIRTHPLACE OF FATHER (State or country) England

STANDARD CERTIFICATE OF DEATH. 1

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 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 "Laborcr," "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 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. - Namc, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the saine disease. Examples: Cerebro-spinal fever (the only definite synonyın 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; Chronie 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- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," ctc., 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.

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 discase, 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.

City 2 FULL NAME 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 country) of certificate.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Winthrop (City or town)

County

VENTILfolle

Township

Manthrow

or Village

63 Bucannan

No.

St.,

Ward

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

Stillborn Lavoie

(a) Residence.

No.

63 Bucaman

St.,.

.. Ward.

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

(Usual place of abode)

Length of residence in city or town where death occurred

years

mooths

days.

How long in U. S., if of foreign birth ?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Formale Write

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Viale

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

sigle

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

7 AGE Years

Months

Days

If LESS than 1 day, ........ krs. 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 (eity or town)

Finition

Ideg.

10 NAME OF FATHER Eduard Chuvaca

11 BIRTHPLACE OF FATHER (city or town) (State or country)

12 MAIDEN NAME OF MOTHER Rose Lucier

13 BIRTHPLACE OF MOTHER (city or town) Haverecei (State or country) maxi

14 Eduardbotavoir

(Address)

6,3 Bucannan Iti

15 Filed 19

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year)

Seft 17

19 by

17 I HEREBY CERTIFY, That I attended, deceased from

, to ..

Seat 17'

1918.

that I last saw

alive on

Sept 17

1918.

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

6 PM m.

The CAUSE OF DEATH* was as follows : Prematurebirth

(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.

Was there an autopsy ?.

What test confirmed diagnosis ?

Horace Soul

(Signed)

M.D.

/17, 1918 (Address) 180 Wridetron St.

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

- inchack Cemetery

DATE OF BURIAL Карч/б 1918

20 UNDERTAKER

ADDRESS

Ministerof

State

mass

Registered No.

4 COLOR OR RACE

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 terin 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 ina- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without inore 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, Houscwork, 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 domnestie 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 "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fcver (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); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Mcasles (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- 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 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 hcad - 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.)

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, 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. 100,000.

of Robert G. Mitchell, Q thinkdomitted these . facto;

Length of residence in city or town where death occurred 1 year . I mo . 4 days How long in U.S. if foreign birth 30 years. Respectfully Edith L. Smith. Que't Town Clerk.

THIS SIDE OF CARD IS FOR ADDRESS ONLY

CARI

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Lunenburg,

(City or town)

1 PLACE OF DEATH

County Worcester.

State

Mass.

Registered No.

25.

Township

Lunenburg.

·Village. or

St.,. ......... .Ward

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

2 FULL NAME

Robert G. Mitchell

(a) Residence. No 53 Park Ave

St., ...... Ward. Winthrop Maas

(Usual place of abode)

Length of residence in city or town where death occurred 1 years 1 months 4

days. How long in U. S., if of foreign birth ? 50 years

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male.

4 COLOR OR RACE

White.

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married.

16 DATE OF DEATH (month, day, and year) Sept. 16, 1918.

I HEREBY CERTIFY, That I attended deceased from

18 Sept. 15.

19.18.

that I last saw

him

alive on Sept. 15,

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

5.10 Am.

The CAUSE OF DEATH* was as follows :

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

8 OCCUPATION OF DE el Clerk of New York,

(a) Trade, profession, or

particular kind of work

New Haven R. R.

(b) General nature of industry,

business, or establishment in

which employed (or employer)

Railroad.

New York, New Haven R.R.

9 BIRTHPLACE (city or town)

Scotland

(State or country)

10 NAME OF FATHER William Mitchell.

11 BIRTHPLACE OF FATHER (city or town)

Scotland.

(State or country)

12 MAIDEN NAME OF MOTHER Anne Palmer.

13 BIRTHPLACE OF MOTHER (city or town).

(State or country)

Scotland.

* 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. (Sce reverse side for additional space.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Boston,Mass.

DATE ChLuvaI. Sept. 161918

20 UNDERTAKER

H. L. Sawyer, &Co.

ADDRESS

Fitchburg.

Mass.

N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. 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.

Informant Mrs. R. G. Mitchell

(Address) 53 Park Av. ,Winthrop Mass.

Filed Sept 18, 1918. Edith L. Smith REGISTRAR

(duration)

yrs ..

.........

.. mos ..

ds.

CONTRIBUTORY (SECONDARY)

(duration)

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

.dg.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death ?

NO. Date of

Was there an autopsy ?..

No.

What test confirmed diagnosis? Physical exam & sputa

(Signed)

Robert A. Rice.

., I.I.D.

, 19 (Address) 12 Frichard St. Fitchburg.

PARENTS

Years

Months

Days

October 23, 1864

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

7 AGE

Elizabeth Watkeys Mitchell, Aug. 12.

5a If married, widowed, andivorced

HUSBAND of

(or) WIFE of

MEDICAL CERTIFICATE OF DEATH

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

City

No.

KEYISEU UNLIEU SIAIES JIANVAND CALIFICAIE US VEAIII [Approved by U. S. Census and American Public Health Association]

" Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer -Coal minc, etc. Women at home, who are engaged in the duties of the household only (not paid Housckeepcrs 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 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

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Town of Winthrop : Record of Deaths 1916-1918, Part 122

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

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