USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 152
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STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Wint
William
Burton B. abbott.
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
56 Moore St, Winthrop
Registered No. 7125
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Juale
4 COLOR OR RACE
cotuto
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
16 DATE OF DEATH
December 26, 1918.
(Day)
(Year,
(Month)
6 DATE OF BIRTH
may
(Month)
(Day)
18 1863
(Year)
7 AGE
If LESS than 1 day, ....... hrs.
.. yrs.
mos.
8
ds.
Or ....... min. ?
8 OCCUPATION Harman
(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)
10 NAME OF
FATHER
PARENTS
12 MAIDEN NAME OF MOTHER Seasie Michlowold
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
120 Scandito 5 hlas
16 File Jan. 2, 1919 Eulalie Churchill asit REGISTRAR
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (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
.yrs.
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
..
198
ADDRESS
20 UNDERTAKER Jeu FV Lunaups 942 Hadley
17 I HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows : Internal injuries with
resulting general
Caused by
a ste railwad
aec
ds.
trains)
canion (SECONDARY)
(Duration)
.yrs.
mos. ...
ds.
Burger Man,
M.D.
(Signed)
See 28.69
(Address)
MEDICAL EXAMINER
11 BIRTHPLACE OF FATHER (State or country)
10,216
Wintera (City or town.) [lf death occurred in e hospital or institution, give its NAME instead of street and number.]
(No. Chetcall Hospital St. ................... .Ward)
Dec 26, 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 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, 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 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 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 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; Broneho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonacum, etc., Careinoma, Sar- eoma, etc., of ... ......... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronie 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 .; Broneho-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," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by earbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suieide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, E.c- 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.
R 16. 10-'17. 10,000.
R-301
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
County.
H Sufalle
State
Registered No.
City or Town
No.
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Fred & Auston
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No.
281
Mann
St.,
Ward.
( Usual place of abode)
Leogth of resideoce ia city or towo where death occurred
20
years
months
days.
How long io U. S., if of foreigo hirth ?
years
mooths
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Singles
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
7
6 DATE OF BIRTH
( Month)
(Day)
2
1898
( Year)
7 AGE 20 Years
Months 25 Days
If LESS thao
If STILLBORN, enter that fact here
If STILLBORN, state period of oterogestatioo.
mcs.
I day,
hrs.
or ........ mio.
8 OCCUPATION OF DECEASED
(a) Trade. profession, or
particular kind of work.
(h) Georrai oature of iodustry,
business, or establishment io
which employed ( or employer).
Home
(c) Name of employer
Docks
9 BIRTHPLACE (City)
(State or country)
mana
10 NAME OF
chas PH. Presten
FATHER
11 BIRTHPLACE OF
FATHER (City ) ....
(State or country)
M.H.
12 MAIDEN NAME
OF MOTHER
Somersby (Car )
13 BIRTHPLACE OF
MOTHER (City).
(State or country)
Elesurtek
14 Char R. N. Derlin
Informant
(Address)
291 main St
15 Dec. 30,1918 Eulalie Churchill
Fil (Month) (Day) (Year)
ant REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issoed
21221 2.5 V
Official position.
22 Date of issue of borial A20.27/1918 or transit permit
HITSICIANS Should state CAUSE OF DEATH
in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See
instructions and extracts from the laws on back of certificate. N. B. - WRITE PLAINET, WTTTT UNFADING DLAUR INK ITIS TO A TERMALTIDLUUALLTINHA PARENTS
. 1,000.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
(Day)
(Year)
17
2/
I HEREBY CERTIFY, That I attended deceased from
Der- 20
,19, to
, 19 ./ .. . ...
that I last saw h
alive on
., 19
and that death occurred, on the date stated above, at
12.15
Im.
The CAUSE OF DEATH was as follows :
Bimcho, men
.. (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 ?.
2
Date of
Was there an autopsy ?
What test confirmed diagnosis ?
(Signed)
, M.D.
( Address)
3
Date
( Month)
(Day)
(Year)
19 PLACE OF BUDAL, CREMATION, OR REMOVAL
DATE OF BURIAL
(Cemetery) (City or town) 1992-29 1919
20 UNDERTAKER W.e. Skaggs
/
7
ADDRESS Wieethiop
...
(If non-resident give city or town and State)
27
Dec. 27, 1918
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 Planter, Physician, Compositar, Architect, Locomotive engineer, Civilengineer, 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) Gracery; (a) Foreman, (b) Autamabile factary. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day labarer, Farm labarer, Labarer - Caal 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 schaal or At hame. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Coak, Hausemaid, 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 Nane.
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 "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumania; Branchapneumonia ("Pneumonia," unqualified, is 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; Whaoping caugh; Chranic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (discase causing death), 29 ds .; Branchopneumania (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "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 septicemia," "PUERPERAL peritonitis," etc.
State cause for which surgical operation was undertaken.
(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)
Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convuisions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or otlier authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.
No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent, . . . or .. . from the clerk of the city or town in which the person died; . . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . a satisfactory written statement con- taining the facts required by iaw to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shail upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. ... The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.
Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as fuli as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to ali deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electricai agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1918.
CITY OF BOSTON
FULL NAME
Place of Death
Boston
Date of Death
DEC.28
1918,
Age
51
years
4
months 3 days
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV
M
W
M
Maiden Name
Husband's Name
NEW YORK.N. Y.
Birthplace
Name of Father
JOSEPH M.WALSH
Birthplace of Father
Maiden Name of Mother
- -- -
Birthplace of Mother
(Signed)
H.W. HERSEY M.D.
1918
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
WINTHROP (WINTHROP CEM) Usual
Residence WINTHROP ( 17 CUTLER ST)
Undertaker
W.C.SKAGGS
Filed
JAN.2.1919
1918.
Date of Burial
WINTHROP
A true copy.
Attest :
Registrar.
ONIONIS YON CHAMASAN NIONYIN
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness
from
1918, to
1918, that to the best of my knowledge and belief death occurred, on the date stated above, and that the CAUSE OF DEATH was as follows: IR
AR Primary
T PATRIBIS
(Durationy
ROOFFICE
BOSTONIA
CONDITA A.
A. 1822
TMINE DONAM
STON
MASS.
Contributory : (Duration)
RIGHT INGUINAL HERNIA-4 DYS ~
IRELAND
Occupation
RETIRED
Informant
JOSEPH W. WALSH
Registered No.
17052
MASS. GEN.HOSPT.
? MESENTERIC THROMBOSIS
CITY RE
Dec. 28, 1918
.. ..
·
1
1
State of Rhode Island.
CHAPTER 121, GENERAL LAWS 1909. OF THE REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES.
SEC. 20. The clerk or registrar of each town and eity shall on the first day of each and every month make a certified copy of all births, marriages and deaths recorded in the books of said town or city during the previous month, whenever the parents of the child born, or the bride or the groom, or the deceased person, were resident in any other town or city in this State or in any other state at the time of said birth, marriage or death; and shall transmit such certified copies to the clerk or registrar of the town, city or state in which such parents of the child born, the bride or the groom, or the deceased, were resident at the time of said birth, marriage or death, stating in case of a birth, the name of the street and number of the house, if any, where such parents resided, the place of birth of such parents and the maiden name of the mother, whenever the same can be ascertained; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording births, marriages and deaths. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the state board of health.
COPY OF THE RECORD OF A DEATH
recorded in the books of the ..... City .... of .... Providence (Town or City.)
during the month of
December
1918
1. Date of Death
2. Name in FULL
Dec 29
-
19 18
Myra.Fidelia Waitt
3. Date of Birth Aug ... 28 .... 1858
Age 60
.. yrs.
4
.mos
1
.. dys
4. Place of Death City or Town Providence
5. St. or Road & No. 155 Medway St
6. Usual Residence Winthrop Mass
7. Sex .. Female Color ... White
Single, Married,
9. 3 Widowed or Di- ( vorced. Widow
10. Name of Husband or Wife Willis H Waitt
11. Occupation of decedent. None
12. Place of Birth CrownPoint.NY
13. Father's Name Ruben H. Cobb
14. Mother's Name Nancy M Allen
15. Parents' Birthplace Fa ..
N H Fort Ann N Y
16. Where to be Buried Taunton Mass
17. Cause of Death Arterio Sclerosis Cerebral Hemorrhage Name of Physician S Newell .Smith
Name of Informant Edwin .D. Nerney Son-in-law
Name of Undertaker Charles E Barber & Co
I certify that the foregoing is a true copy.
Attest,
JAN 16 1919 19
City Registrar
Clerk .-
(Town or City.)
Mo.
260 myra Fidelia Waitt. Dec. 29, 1918
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Cambridge
(City or town)
1 PLACE OF DEATH
County.
Mid.
State
Mass.
Registered No .....
2655
or Village
Cambridge
No.
Charlesgate Hosp.
St.,.
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Clarence A. Horton
(a) Residence. No.
(Usual place of abode)
Length of residence in city or town where death occorred
years
mooths
days.
How long io U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
W
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
M
5a If married, widowed, or divorced
HUSBAND of
(01) WIFE of
Lena E.
6 DATE OF BIRTH (month, day, and year) -
Years
55
8 OCCUPATION OF DECEASED
(a) Trade, profession, cr
particular kind of work
Machinist
(b) Geoeral nature of industry, business, or establishment io which employed (or employer) (c) Name of employer
Boston, Mass .
9 BIRTHPLACE (city or town)
10 NAME OF FATHER
William
11 BIRTHPLACE OF FATHER (eity or town)
(State or country)
Vermont
12 MAIDEN NAME OF MOTHER
Sarah Fisher
13 BIRTHPLACE OF MOTHER (eity or town).
(State or country)
New Hampshire
Informant
(Address)
15
Filed Jan. 2/19
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
Dec. 30/18
17
I HEREBY CERTIFY, That I attended deceased from
Dec . 14/18
19
Dec. 30/18
to.
that I last saw h
alive on
Dec. 30/18
19
and that death occurred, on the date stated above, at
m.
If LESS than The CAUSE OF DEATH* was as follows : 1 day ......... hrs. cr ........ min. Exhaustion following bed
sores from cross paralysis of
spine due to tumor .
2-
3 mos .
(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 ?
Albert H. Tuttle
(Signed
, 19 - Address)
Charlesgate Hosp.
* State the DISEASE CAUSING DEATII, 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 Winthrop, Mass.
DATE OF BURIAL
Jan. 2/19
19
ADDRESS
Filed Jan 4 900
71 Bucnanan
St.,
........... Ward .--
Winthrop
(If non-resident giro elly or town and Stato)
Township
City.
.....
2 FULL NAME
3 SEX
7 AGE
PARENTS
14
of certificate.
so that it may be properly classifled. Exact statement of OCCUPATION is very important. See instructions on back
(State or country)
N.B .- WRITE PLAIN
20 UNDERTAKER
C. R. Bennison, Winthrop
EI.D.
Months
7
Days
27
V 1717
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, 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 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 reccive 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.
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- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, etc., of _.
(naine origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection necd not be stated unless important. Example: Measles (disease causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toins or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Comna," "Convulsions,"" "Debility" (“Con-
genital," "Senile,"
ete.), "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 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. Deathis under circumstances unknown, as A person found dead, etc. .
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PHYSICIAN.
R 15. 1-'18. 20,000.
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