USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 140
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19 PLACE OF BURIAL, CREMATION, OR REMOVAL
St Pauls Arl
DATE OF BURIAL
Oct 2/ 1918
ADDRESS
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,
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Withwoh (City or town)
1 PLACE OF DEATH
County.
State
Registered No.
Township
Winterak
or Village.
or
City.
No.
14
mermaid
St.,
.Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Florence
Deonline
(a) Residence.
No.
14 mermaid Art
.St.,
......
.. Ward.
(If non-resident give city or town and State)
(Usual place of abode)
Leogth of resideoce in city or town where death occurred
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH (month, day, and ycar)
19 15
17
I HEREBY CERTIFY, That I attended deceased from
west.
19.
18 to Out. 15
. 19
that I last saw h
Lavalive on
. 19.6
.. .
. .
and that death occurred, on the date stated above, at
com.
The CAUSE OF DEATH* was as follows :
Listerio
(duration)
.....
.yrs.
.......
.mos.
.ds.
9 BIRTHPLACE (city or town)
heland
(State or country)
10 NAME OF FATHER Thomas Donahue
PARENTS
11 BIRTHPLACE OF FATHER (city or town) ...
(State or country)
Udland
12 MAIDEN NAME OF MOTHER index
13 BIRTHPLACE OF MOTHER (city or town) .....
(State or country)
-
20 UNDERTAKER
Simittig St Jeanchy
REVISED
DED UNTIED SIAIES SIANDARD 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 cinployments, 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 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, 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, cte. 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 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- ficd, 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), "Atroplıy," "Col-
(“Con- lapse," "Comna," "Convulsions," ""Debility" "Exhaustion," genital," "Senile," etc.), "Dropsy,"
"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 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 PIIYSICIAN.
-
R 15. 2-'18. 100,000.
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,
of certificate.
14
Informant
Zabud. dallow
(Address)
156 Hairview
15 Filed Sch 30, 1918
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
OCT 19
17 I HEREBY CERTIFY, That I attended deceased from Och. 14 1915 to. Och. 19, 1918.
that I last saw h
alive on
, 19
Och. 18
18
and that death occurred, on the date stated above, at
5€
m.
The CAUSE OF DEATH* was as follows :
.(duration)
yrs.
.mos ..
3
.ds.
CONTRIBUTORY
Influenza
(SECONDARY)
.(duration)
................ yrs ...
mos.
5
.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?
MR. Parte
(Signed)
10/20. 19 (Address)
Minchrono.
* 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
DATE OF BURIAL
10-21-1018
ADDRESS
20 UNDERTAKER
W.C.Skaggs
.......
Registered No ..
Township
City
Winthrop
.. or Village.
No. 56, Atau View
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
Dorothy B. Ballour
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No. 54 J amila
St., Ward.
(Usual place of abode)
Length of residence in city or town where death occurred
23 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
w
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)
9/26/1895
7 AGE
Ycars
Months
Days 23
If LESS than I day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
Bookkeeper
(b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
9 BIRTHPLACE (city or town)
Muethiop
(Statc or country)
10 NAME OF FATHER
mark
John S. Ballow
11 BIRTHPLACE OF FATHER (city or town)
(State or country) Mark.
Norton
12 MAIDEN NAME OF MOTHER Martha@ levia
Gloucester
13 BIRTHPLACE OF MOTHER (city or town) ..
(State or country)
Mann
The Commonwealth of Massachusetts
WINTHROP
STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE OF DEATH Suffolk
County
State
or
(If non-resident give eity or town and Stat?)
23
PARENTS
M.D.
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 caclı 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 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 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 discase. 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- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sareoma, 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, ete. The contributory (secondary or inter- eurrent) affection need not be stated unless important. Example: Measles (disease eausing death), 29 Gs .; Broncho- pneumonia (secondary), 10 ds. Never report incre symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatie), "Atrophy," "Col- lapse," "Coma," ""Convulsions,"""Debility" ("Con- genital," "Senilc," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease ean be ascertained as the causc. 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, 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. 2-'18. 100,000.
15 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. N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIENS should state PARENTS
1 PLACE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH Massachusetts
State of
Registered No.
[If death occurred In
Ward)
a hospital or Institution, give its NAME Instead of street and number.]
2 FULL NAME
Cornelius O Til
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED.
OR DIVORCED
( Write the word)
Pingle
6 DATE OF BIRTH
February 27
1891
(Month )
(Day)
(Year)
7 AGE
27
yrs.
8
mos.
ds.
If LESS than
1 day :____ hrs.
or ____. min. ?
8 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)
Massachmento
10 NAME OF
FATHER
Damil Mil
11 BIRTHPLACE
OF FATHER
(State or country)
Irland
12 MAIDEN NAME
OF MOTHER
Katherine Murphy
13 BIRTHPLACE
OF MOTHER
(State or country)
Яквалев.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
24 Lean St. Roxbury
Filed
Och. 30 ., 1918
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
TH aloher 22
(Month)
(Day)"'
191
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
Det12
191
Clef. 22
8
-- , to
191.
that I last saw h_AM alive on
Oct. 22
1918
and that death occurred, on the date stated above, a
6.30Am.
The CAUSE OF DEATH * was as follows:
Lobar
Vwhe iii
(Duration)
yrs.
mos.
ds.
Contributory
(SECONDARY)
Influenza ,
(Duration)
yrs.
mos.
10
ds.
(Signed)
G. L.@ Pase
Caff Lu.c., M. D.
Det 22
1918 ._.
(Address)
Int Banks Mass
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, stato (1) MEANS OF INJURY ; and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS)
At place
of death
yrs.
mos.
ds. State
In the
mos.
ds.
Where was disease contracted,
If not at place of death ?
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL.
DATE OF BURIAL
191.
20 UNDERTAKER
ADDRESS
Winthrop
11-3184
County
Fosthospital
Fort Banks
Township
or
Winthrop
Village
or
City
Mass.
(No
Puestospital Fort Brauchst
8
3
yrs.
REVISED UNITEU STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Ilealth Association]
Statement of occupation .- Preeise statement of occupation 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, etc. But in many 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) 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., withcut 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 & definite salary), may be entered as Housewife, Housework, 0" .16 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 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 oceupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUS- ING DEATH (the primary affection with respect to time and eausation), 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," unqualified, is indefi- nite); Tuberculosis of lungs, meninges, peritonaeum, etc., Cur- cinoma, Sarcoma, etc., of (name origin; “Can- cer" is less definite; avoid use of " Tumor" for malignant neoplasms); 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 death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal condi- tions, such as "Asthenia," "Anaemia" ( merely symptom-
atie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inani- tion," "Marasmus," "Old age," "Shock," "Uraemnia," "Weakness," ete., when a definite disease ean be ascer- tained as the cause. Always qualify all diseases result- ing from childbirth or miscarriage, as "PUERPERAL septi- chaemia," "PUERPERAL peritonitis," etc. State eause 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 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 abovo list of undcsirablo terms aud refuse to accept certificates containing them. Thus the form in use in New York City states: "Certificates will be returned for additional Information which give any of tho following diseases, without explanation, as tho sole causo of death: Abortion, cellulitis, childbirth, convulsions, haemorrhago, gangrene, gastritis, erysipelas, meningitis, miscarriage, necrosis, peritonitis, phlebitis, pyacmia, septichaemia, tetanus." But general adoption of the minimum list suggested will work vast improvement, and Its scopo cau be extended at a later date.
11-3184
R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
(City or Town)
Registered No ..
273
.. Ward
St ...............
(If death occurred in a hospital or institution, give its NAME instead of street and number)
William P. Nelligan Corp. C.B. 101 stift
( If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No.
( Usual place of abode)
Length of residence in city or town wbere death occurred
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
24
1918
(Day)
(Year)
17 I HEREBY CERTIFY, That I attended deceased from
, 19. ... , to ............. , 19
that I last saw h.
alive on
19
and that death occurred, on the date stated above, at
m. The CAUSE OF DEATH was as follows :
(duration)
yrs.
mos ..
dg.
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 ?
(Signed)
M.D.
( Address).
Date
( Month)
( Day)
(Year)
14 Mrs. minnie Kollegan
Informant
(Address )
15 Narcisten das (Boston)
15
Filed (Month) (Day) (Year)
REGISTRAR
19 PLACE OF BURIAL, CREMATION, OR REMOVAL It toschi Costow (Cemetery) (City or town)
DATE OF BURIAL 2
wat00,01
ADDRESS
4
21 1 HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued. S.C. Maury
Date of issue
Official balthe price of permit position .....
10/27/21
Permit No ... L.
341
000
City or Town 2 FULL NAME 3 SEX Male 7 AGE Years If STILLBORN, enter that fact here 9 BIRTHPLACE (City) (State or country) 11 BIRTHPLACE OF FATHER (City ). (State of country) 13 BIRTHPLACE OF MOTHER (City) PARENTS (State or country) instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH 28
4 COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Minnie Nelligan
6 DATE OF BIRTH
Het.
(Month)
1 (Day)
1890
(Year)
If LESS than I day, ........ brs. or ....... min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
(b) Name of employer
Soldier
Tignich
10 NAME OF FATHER Sohn l.
P.S.J.
12 MAIDEN NAME OF MOTHER Mary A. Sandrahan
V
The Commonwealth of Massachusetts
1 PLACE OF DEATH
County.
france
State
No.
Calling
St., ..
.....
.Ward.
(If non-resident give city or town and State)
Months 8
Days
11
9.18
20 UNDERTAKER
REVISED UNITED STATES 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 Plonter, Physicion, Compositor, Architect, Locomotive engineer, Civil engineer, Stationory firemon, ete. Butin 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) Solesmon, (b) Grocery; (a) Foreman, (b) Automobile foctory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Doy laborer, Farm laborer, Loborer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold 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 indicated 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: Cere- brospinal fever (the only definite synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. 's indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ..... .. (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic volvulor heort 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 .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," ete.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemio," "PUERPERAL peritonitis," etc.
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