USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 130
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1 PLACE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH
State of
Massachusetts
Registered No.
Village
or
City
maso
o Post Hospital, Ist. Banksomos.
Ward)
[If death occurred in a hospital or Institution, give Its NAME Instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED.
OR DIVORCED
( Write the word)
16 DATE OF DEATH
FATH September 27
(Month)
(Day)
1918 (Year)
17
I HEREBY CERTIFY, That I attended deceased from
20.ª Scht
191_X __ , to
SA 27
1918-,
that I last saw hkznalive on
Soft 27
1918
and that death occurred, on the date stated above, at/a.m.
The CAUSE OF DEATH * was as follows: Influenza acute
Fallrod by Pneumonia
(Lobar)
(Duration)
yrs.
mos.
ds.
10 NAME OF
FATHER
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or country)
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS,
OR RECENT RESIDENTS)
At place
In the
of death
yrs.
-. mos.
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 Elanastag N. Vici
DATE OF BURIAL
191
20 UNDERTAKER
C.R. Bunun
ADDRESS
Wouldn't
-
11-3184
7
Contributory.
(SECONDARY)
(Duration)
yrs. ..
mos. ds.
(Signed)
Scaft 28
191-2
(Address)
7 Banks
M. D.
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS OF INJURY ; and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
EB Nods/dico
(Address)
JaBank
Fliod
191
REGISTRAR
(Day)
(Year)
7 AGE
24
yrs.
11
mos.
2
1
ds.
If LESS than
1 day, ____ hrs.
or ____. min. ?
S OCCUPATION
(a) Trade, profession, or
particular kind of work
Soldier
(b) General nature of industry.
business, or establishment in
which employed (or employer)
U. S. army
9 BIRTHPLACE
(State or country)
(Month)
6
1893
6 DATE OF BIRTH
Oct
(No.
Gard maxwell
2 FULL NAME
County
Josi Hospital
Fort Banks muss
Township
or
Winthrop
X
ONIONIA HOJ MARGIN RESERVED
REVISED UNITED STATE'S STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
Statement of occupation .- Precise statement of occupation 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 houschold only (not paid Housekeepers who receive a definite salary ), may be entered as Housewife, Housework, 0" At home, and children, not gainfully employed, as At school or At home. Care should bo 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 DEATHI, 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 CAUS- ING 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 "Epidemic cerebrospinal mnenin- gitis"); Diphtheria (avoid usc of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualificd, is indefi- nite); Tuberculosis of lungs, meninges, peritonaeum, etc., Car- cinoma, Sarcoma, etc., of - (name origin; “Can- cer" is less definite; avoid use of "Tumor" for malignant neoplasıns); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The con- tributory (secondary or intercurrent) affection need not be stated unless important. Example : Measles (disease causing deatlı), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mcre symptoms or terminal condi- tions, such as "Asthenia," "Anaemia" ( merely symptom-
atic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inani- tion," "Marasmus," "Old age," "Shock," "Uraemnia," "Weakness," etc., when a definite discase can be ascer- tained as the cause. Always qualify all diseases result- ing from childbirth or miscarriage, as "PUERPERAL septi- chaemia," "PUERPERAL 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 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." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
NoTE .- Individual offices may add to above list of undesirable terms and refuse to accept certificates containing them. Thus the form in use in New York City states: "Certificates will bo returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, haemorrhage, gangrene, gastritis, erysipelas, meningitis, miscarriage, necrosis, peritonitis, phlebitis, pyaemia, septichaemia, tetanus." But general adoption of the minimum list suggested will work vust improvement, and its scope can be extended at a later date.
11-3184
N. B .- WRITE PLAINLY, WITH UNFADING 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,
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE OF DEATH
County.
State
Registered No.
Township
Winthrop, Pask or Village.
City
No.
St., Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number ) Clarke
2 FULL NAME
(a) Residence.
No.
(Usual place of abode)
Length of residence in city cr town where death occurred
years
mooths
days.
How long io U. S., if of foreigo birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR DIVORCED fwrite the word)
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
6 DATE OF BIRTH (month, day, and year)
7 AGE
Years
Months
ing. 82, , 8% Pays 27
If LESS than 1 day, ....... hrs. or ........ mio.
8 OCCUPATION OF DECEASED
(a) Trade, professioo, or newspaper
particular kind of work
(b) General nature of industry, husiness, or establishment io which employed (or employer) (c) Name of employer
Postar Part
9 BIRTHPLACE (city or town).
P.s Framing ham
(State or country)
10 NAME OF FATHER
11 BIRTHPLACE OF FATHER (city or town) wehland (State or country) mass (Sigoed)
12 MAIDEN NAME OF MOTHER
Julia ,villam 929, 19 18Adres)
13 BIRTHPLACE OF MOTHER (city or town) Varmouth (State or country) 2.0
14
Informant
6. V. Park
(Address)
15 Filed
, 19
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
19/8
17 I HEREBY CERTIFY, That } attended deceased from
19 .. 1. 8.
that Mast saw h.x. alive on ,19.12.
and that death occurred, on the date stated above, at 1a m.
The CAUSE OF DEATH* was as follows :
Lotar Pneumonia
.(duration) yrs .. ... mos ... . ds.
CONTRIBUTORY
(SECONDARY)
.(duration) .... yr ..... 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 ?.
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
ichland, mase
DATE OF BURIAL
dept 32018
20 UNDERTAKER
D. R. Gennisan
ADDRESS
Winkerak
or
Helena
.St.,
.Ward.
(If non-resident give city or town and State)
22
PARENTS
of certificate.
[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 ina- terial worked on may form part of the second statement. Never return "Laborer," "Forcman," "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 Ilousekeepers 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, ctc., 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," "Comna," ""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 discases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- P'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 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, 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.
N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See Instructions on back of certificate.
The Conunonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(No/ 0)
Pauline
St. ;................. Ward)
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Tilhon-180 Pricelist
...... Registered No.
PERSONAL AND STATISTICAL PARTICULARS
& SINGLE
MARRIED dacord
WIDOWED,
OR DIVORCED
(Write the word)
12
1838
17
... . (Year)
If LESS than I day ......... hrs .!
or ....... min. ?
9 BIRTHPLACE
(State or country)
Hope, Mais
10 NAME OF
FATHER
Enoch Philbrook
12 MAIDEN NAME
OF MOTHER
Sarah Parken
18 BIRTHPLACE
OF MOTHER
(State or country)
Hoke mar.
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Address) 180 /Pauline S
15 Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
7
(Month)
(Day)
191
(Year)
I HEREBY CERTIFY that I attended deceased from
191
to ...
191
that I last saw h(?
alive on
Sept-15
1918
and that death occurred, on the date stated above, at
m.
The CAUSE OF DEATH* was as follows :
Myocarditis
arterio Sclerosi
(Duration)
.yrs.
............. mos.
ds.
Contributory
(SECONDARY)
(Duration)
yrs.
............
.mos. .............
ds.
(Signed)
M.D.
Sept27, 1918.
Address)
Willh 2op
......
* If death followed injury or violence the certificate of death must he made 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.
.........
Where was disease contracted, If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL Mithrop Cead 9-30, 1918
UNDERTAKER
ADDRESS
.
Vue Stroace
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Viola 3 Lou ett
Philbrick-Hethou-1.
27
....
2
(Month)
(Dây)
1 PLACE OF DEATH
Iputhop
? FULL NAME
$ SEX
4 COLOR OR RACE
W
* DATE OF BIRTH
7 AGE
80 yrs. 7 mos
.....
& OCCUPATION
(a) Trade, profession, or
(b) General nature of industry,
business, or establishment
which employed (or employer) ....
11 BIRTHPLACE
OF FATHER
(State or country)
Hope Ma.
PARENTS
(Informant)
Parker Coveth
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
particular kind of work
@8 home
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
ONIONIG OR OHAHASAH NISHYN-
Sept . 27, 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, 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 inaterial 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 House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gaill- 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 oceu- 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 (lefinite synonym is "Epidemie 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, 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," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE
OF DEATH
County
Suffolk
State
Mass
Registered No ...
Township
Winthrop
or Village
City
No.
3.5., Eat.es ... Ave ..
(If death occurred in a hospital or institution, give its NAME instead of street and number)
U
2 FULL NAME
HAROLD AGUSTUS BOYMAN
(a) Residence.
No.
35 Pates Ave.
(Usual place of abode)
Length of residence in city or town where death occorred
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Male
White
Single
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year Dec. II, 1890
7 AGE
Years
Months
Days
If LESS than 1 day, ........ brs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
Moving Picture Operator
(h) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
9 BIRTHPLACE (city or town)
Cambridge
(State or country) Mass.
10 NAME OF FATHER Hubert
PARENTS
11 BIRTHPLACE OF FATHER (city or town) ...
(State or country) Nova Scotia
12 MAIDEN NAME OF MOTHERMary J, Burgess
13 BIRTHPLACE OF MOTHER (city or town) ... Charlestown (State or country) Mass
* State the DISEASE CAUSING DE YTH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE SUICIDAL, or HOMICIDAL. (See reverse side for additional space stress
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
St. Pauls Arlington
9/30/1
19
ADDRESS
15 Filed , 19
REGISTRAR
16 DATE OF DEATH (month, day, and year) Saft 27 1918
17
I HEREBY CERTIFY, That I attended deceased from
Sept 20
1918, to.
Self 2 1
.1918.
that I last saw
here alive on
Seft 27
19.1.1.
and that death occurred, on the date stated above, at m. The CAUSE OF DEATH* was as follows : Double Soban Pneumonia
(duration)
yrs ...............
mos.
/
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs ...
mos.
ds.
18 Where was disease contracted
if not at place of death ?
X
Did an operation precede death ?
no
Date of
X
Was there an autopsy ?
200
What test confirmed diagnosis ?
X
(Signed).
, 19
(Address) 123 (Nemelugh St
-
I.I.D.
14
Informant. Mary J. Bowman
(Address)
35 Pates Ave.
of certificate.
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
Winthrop
or
St.,. Ward
St., ...
.. Ward.
(If non-resident give city or town and Stato)
27
16
MEDICAL CERTIFICATE OF DEATH
20 UNDERTAKER
John ". IL maker
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 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 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 spceification, 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- eifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, ete. 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 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- toneum, ete., Carcinoma, Sarcoma, etc., of _.
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