USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 14
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culosis of lungs, meninges, peritonaeum, 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, 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" (mcrely symptomatic), "Atrophy," "Collapsc," "Coma," "Convulsions," "Debility" ("Congenital," "Senilc," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all discases 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 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 dcad, etc.
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
PLACE OF DEAT~ Metcalf Hospital 174 Winthrop Wirthof
........
(City or lown.) ---
St.
......... Ward)
[If death occurred In a hospita· or institution, give its NAME instead of street and number.]
Virginia E. Newton.
' FULL NAME
{If married or divorced woman or widow
give maiden name, also name of busband.]
@RESIDENCE
15 Cross St Wieethiopi
PERSONAL AND STATISTICAL PARTICULARS
& SEX
4 COLOR OR RACE
w
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
5-
' DATE OF BIRTH
4
(Month)
(Day)
...........
19/6
(Year)
7 AGE
If LESS than
I day ......... hrs.
mos. 2 ds.
... in .?
& 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)
(Duration)
„yrs. .............
2
ds.
Contributory
(SECONDARY)
.. (Duration)
mos.
....... ds.
(Signed)
....
afry 19, 1916
....
(Address)
winshop
....
* 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.
2 ds.
State.
......... yrs.
......
In the
mos. ....
2 days
Where was disease contracted,
If not at place of death ?.
Former or
usual residence.
X
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
4-18-1916
(Address) 15- Class St. Wirthok Winthrop Cerve.
16
Filed 191
...
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
4
18, 1916
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from Why 16 : 1916 .,
to
apr 18
1916
that I last saw him alive on
april 18
1916
.
and that death occurred, on the date stated above, at
12 Am
The CAUSE OF DEATH* was as follows :
Hammershage of new Born
.......
10 NAME OF
FATHER
Harry a. Newton
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
(3) Charlestown: mars
12 MAIDEN NAME
OF MOTHER
Reach Gilmore
1ª BIRTHPLACE
OF MOTHER
(State or country)
Milcose mars
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
H. G. Newton
18-
.... Registered No.
20 UNDERTAKER
I. C.Skagen
ADDRESS
1
M.D.
apr 18,1916
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Prceise statement of occu- pation 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 oceupations 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 inany eases, 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 sceond statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal minc, 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 home. Care should be taken to report specifically the occupations of persons engaged in domestie service for wages, as Servant, Cook, Housemaid, ete. If the oceupation 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 indieated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write Nonc.
Statement of cause of death. - Name, first, the DIS- CASE CAUSING DEATH (the primary affeetion with respcet to time and eausation), 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, peritonacum, 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 intereurrent) affection need not bo stated unless im- portant. Example: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age,". "Shoek," "Uraemia," "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 eause 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 Mcdieal Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, ete.
2. Deaths supposedly eaused by violenee, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, ete.
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 eireumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
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
(No.
72
St. ; Ward)
[If death occurred in a hospital or institution, give its NAME instead
na Campbell Mac Quar
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
72
.
Nunchuck Id Winter
Registered No.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
abril
(Month)
18, 1916
(Year)
(Day)
17
to
I HEREBY CERTIFY that I attended deceased from
april 10th
1916,
aler 18th
1916
that I last saw have alive on
apr. 17
1916.
...
5
and that death occurred, on the date stated above, at
.. m.
The CAUSE OF DEATH* was as follows :
-
arteriosclerosis
(Duration)
.yrs.
mos.
......
ds.
Contributory.
Pelucauary Dedeeun-
(SECONDARY)
.(Duration)
.. yrs. ................ mos.
ds.
(Signed)
Xxl Partir
M.D.
* 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 Piclon n.S.
DATE OF BURIAL
4/22
.......
20 UNDERTAKER
ADDRESS
Filed
., 191
REGISTRAR
1848 (Year)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Male-
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
$ DATE OF BIRTH
april
(Month)
(Day)
7 AGE
68
yrs.
mos.
ds.
& OCCUPATION
Aclient
(a) Trade, profession, or
particular kind of work
(b) General nature of Industry.
business, or establishment
which employed (or employer).
11 BIRTHPLACE
OF FATHER
(State or country)
PARENTS
WRITE PLAINLT, WITIT ONFADING INK ITIS DO A PERMANENT NEvonD.
9 BIRTHPLACE
(State or country)
Picton n.S.
If LESS than I day ........ hrs.
or ........ min. ?
10 NAME OF
FATHER
George, Mac Quar
Pieter
Ihr. 18. 2016 (Address)
Wenstrop, Thanx
12 MAIDEN NAME
OF MOTHER
Sarah Wwwon
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
(Address)
15
(City or town.Y
C
ONIC
JaNIE
ARGIN RESERVED FOR
MAR
ahr. 18, 1916
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 engincer, Civil engineer, Stationary fireman, etc. But in inany cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) 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 laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- kccpers who receive a definite salary), may be entered as Housewife, Houscwork, 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. - 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: Cercbro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never rc- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuher-
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: Mcasles (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," "Scnile," 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 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 discase, 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.
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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Whichcop. Nasz.
(No. 22
Vince Ave
St. ;.
........
Ward)
Stillman& Snow
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
RESIDENCE 22 Iunie Ave Winthrop
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
1
· DATE OF BIRTH
March 18
(Month)
(Day)
1
(Year)
7 AGE
54
.. yrs.
mos.
ds.
or ..... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Stock Brocker
(b) General nature of industry, business, or establishment In which employed (or employer)
9 BIRTHPLACE
(State or country)
") Harwichfort Mark.
PARENTS
12 MAIDEN NAME
OF MOTHER
Cahoon
1ª BIRTHPLACE
OF MOTHER
(State or country)
Harwichpor Mass
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
22 Vine Ave
1&
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
april
201
(Month)
(Day)
1916
(Year)
17
I HEREBY CERTIFY that I attended deceased from
to
19 15
191
apr 20
1916,
that I last saw hw alive on
af 14 .
191 6
........
and that death occurred, on the date stated above, at.
125Am.
The CAUSE OF DEATH* was as follows :
Tuberculosis 1 bangs
1
(Duration)
1 yrs.
............... mos. ...............
ds.
Contributory.
(SECONDARY)
.(Duration) yrs.
mos.
......
ds.
(Signed)
...... M.D.
3 2
1916 (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).
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 Winchester Mase
DATE OF BURIAL
7/2K
1916
20 UNDERTAKER E. G. Brown tin
ADDRESS
East Hostin
1
-
(City or town.Y {If death occurred in a hospital or institution, give its NAME instead of street and number.]
3 SEX
Kale
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
If LESS than
! day ......... hrs.
......
10 NAME OF
FATHER
Stillman W. Snow.
11 BIRTHPLACE
OF FATHER
(State or country)
Harwichporn Mass
apr. 20, 1916
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 material 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 dutics 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 ill 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 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, etc., of .. „(name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; 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 symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Dcbility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old agc," "Shock," "Uracmia," "Weakness," etc., when a definite disease can be ascertaincd 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, 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 duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
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.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
4
5
12 MAIDEN NAME
OF MOTHER
4
18 BIRTHPLACE
OF MOTHER
(State or country)
n
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
15
Filed
191 PRESTON B. Church, 11
(t.a.) REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
mal
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1834
(Month)
- (Day)
(Year)
7 AGE
8/
€
yrs.
mos.
20
ds. or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer) ..
៛
Audet. .(Duration) .......
.yrs.
.......
mos. .........
ds.
Contributory.
Organic Heart Descone
(SECONDARY)
(Signed)
Ml Para
.(Duration)
.yrs.
M.D.
apr. 21., 1916. (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).
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.
12 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL 4/22 1916
J'aurais Camely Checopia
20 UNDERTAKER
C.R. Bunun
ADDRESS Wundert
)01
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No ....
86 Jaganna Core
Chandler Pulling
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
86 Japan
nive are Worthoghered No.
....
Ward)
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
2
191. .
(Month)
(Day)
(Year)
· DATE OF BIRTH
16 DATE OF DEATH
april
17
I HEREBY CERTIFY that I attended deceased from
april 10th
191.
6
to
april Noth 196.
.....
that I last saw h Leu alive on
april 18, 1916;
and that death occurred, on the date stated above, at
10.a.m.
The CAUSE OF DEATH* was as follows :
mos. ....
ds.
9 BIRTHPLACE
(State or country)
Nocesta Muss
10 NAME OF
FATHER
If LESS than day ......... hrs.
PERSONAL AND STATISTICAL PARTICULARS
(City or town.)
)
apr. 20, 1916
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oecu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to eaclı 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, Architeet, 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 linc 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 forin 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 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. - 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 "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.
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