Town of Winthrop : Record of Deaths 1916-1918, Part 16

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

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 16

Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).

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 discase. 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, peritonaeum, etc., Carcinoma, Sar- coma, etc., of ................... ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Measles; Whooping cough; Chronie 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 .; 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," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "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 septieaemia," "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, Homieide, 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 dead, etc.

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

important. See Instructions on back of certificate. 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

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

PLACE OF DEATH

(No 15 Great are. „St. ..... „Ward)

(City or lown.)

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

PERSONAL AND STATISTICAL PARTICULARS

$ SEX

COLOR OR RACE

6 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Widowed

$ DATE OF BIRTH

5 (Month)

(Day)

18/64

(Year)

? AGE

If LESS than

! day ......... hrs.

51 .. yrs. 11 .. mos. .......

Tds.

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

& OCCUPATION

(a) Trade, profession, or

particular kind of work

(b) General nature of industry

business, or establishment

which employed (or employer).

9 BIRTHPLACE

(State or country}

NewHaven Cape Butan

PARENTS

12 MAIDEN NAME

OF MOTHER

Isabel Hellen

13 BIRTHPLACE

OF MOTHER

(State or country)

Scotland

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant).

Ims. S. A Growing

(Address)

16 Create ala.

Filed 191

- REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

April

(Month)

(Day)

1916 (Year)

....

I HEREBY CERTIFY that I attended deceased from

Mares

april 29, 196

1916

that I last saw her

alive on

april 27 5, 196

and that death occurred, on the date stated above, at 8 %m.

The CAUSE OF DEATH* was as follows :

Chrome Myrcarditis

(Duration)

mos ..

ds.

Contributory.

(SECONDARY)

Shual Master Paralysis

(Duration)

.yrs.

2 mos. ds.

(Signed)

P. Forafet Mumay

M.D. Chul 29, 1916 (Address) 147 Harvard At. Desolution

* 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

In the

of death

.yrs.

mos.

ds.

State

......

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

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

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

New Haven Cape Bit

DATE OF BURIAL

191

.......

20 UNDERTAKER

.C. Skaggs

ADDRESS

' FULL NAME

Gathering macloud

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

Winchester-15 Create aerc.

Hellen - Hector Mackocol

Registered No.

10 NAME OF

FATHER

воизра Нен

11 BIRTHPLACE

OF FATHER

(State or country)

CapaBilacia

apr. 27, 14/6 STANDARD CERTIFICATE OF DEATH.

Farmer or Planter, Physician, Compositor, Architcet, Loeo- 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) 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- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employcd, as At school or At home. Care should be takeu to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation lias 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 Nonc.

Statement of cause of death. - Name, first, the DIS- CASE 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 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 (discase 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," "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 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 discasc, as A death upon the street, or one supposed to be due to Alcoholism, ctc.

4. Deaths under circumstances unknown, as A person found dead, etc.

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

important. See Instructions on back of certificate. 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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

I PLACE OF DEATH

Winthrop

(No. 304 Winthrop St. St. : Ward)

............

? FULL NAME. Charles Joseph Harvey [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 304 Winthrop Ct.

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the wordMarried

Nale

White

· DATE OF BIRTH

(Month)

(Day)

(Year)

7 AGE

If LESS than

1 day ......... hrs.

.yrs. .....

mos. .ds.

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

$ OCCUPATION

(a) Trade, profession, or

particular kind of work

Petired

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

9 BIRTHPLACE

(State or country)

Waltham Mass.

10 NAME OF

FATHER

John Harvey

PARENTS

12 MAIDEN NAME

OF MOTHER

Mery MoCullagh

13 BIRTHPLACE

OF MOTHER

(State or country) Treland

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

C. Joseph Farver

(Address)

Winthrop

Filed

191

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

| 16 DATE OF DEATH

april

........

(Month)

. 191

(Day)

(Year)

17 I HEREBY CERTIFY that I attended deceased from L 1916, to april 27. 1916 that I last saw him alive on april 27, 1916 and that death occurred, on the date stated above, ato. +830 Pm. The CAUSE OF DEATH* was as follows : Inanition

(Duration)

.......

yrs.

mos

.ds.

Contributory.

Carcinoma of Esophagus

(SECONDARY)

(Duration)

yrs.

.mos. ds.

(Signed)

Harry astella

M.D. 4,282, 1916 (Adress) 200 Theasantos

* 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.

.......

In the

.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 Salavany St. Hersy Waltham

DATE OF BURIAL

April30

191

.......

... .

ADDRESS

20 UNDERTAKER

John F. ? 'Valey

Winthrop

(City or town.)

[If death occurred in a hospita! or institution, give its NAME Instead of street and number.]

11 BIRTHPLACE OF FATHER (State or country) Ireland

0 apr. 27, 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 applics to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architcet, 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 nceded. 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 Nonc.

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: Ccrebro-spinal fever (the only definite synonym is "Epidemie cercbro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never rc- 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," "Hacmorrhage," "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, Fatts, 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.

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

important. See instructions on back of certificate.

PARENTS

12 MAIDEN NAME

OF MOTHER

18 BIRTHPLACE

OF MOTHER

(State or country) Wo Ireland

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Justas Calderon

(Address)

Tegnes. St. With 6.

Filed

...... 191

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

1$ DATE OF DEATH

man

+ (Month)

(Day)

1916

(Year)

17 I HEREBY CERTIFY that I attended deceased from

........

16 , 1916, to Mars

1916

that I last saw h.z.z ..... alive on

may '1

1916

and that death occurred, on the date stated above, at 2

m. The CAUSE OF DEATH* was as follows : Inanition

Persistant vomiting

(Duration)

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

.......

da.

Contributory.

(SECONDARY)

(Duration)

........ yrs. ................ mos. ................ ds.

(Signed)

R. B. Tanken

M.D.

may

1916 (Address).

Winthrop hears

............

......

* 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. .

ds.

State ............ yrs. ............ mos.

In the

.........

ds .............

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

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

WriThing Count

20 UNDERTAKER W.C. Skaggs

ADDRESS

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

2 FULL NAME

Mary G. Coldiron

[If married or divorced woman or widow

give maiden name, also name of busband.]

@RESIDENCE

Winthrop

.... Registered No.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

' COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

· DATE OF BIRTH

(Month)

(Day)

1916

(Year)

7 AGE

If LESS than

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

..... yrs.

mos.

23 ds.

„min. ?

$ OCCUPATION (a) Trade, profession, or C

particular kind of work

(b) General nature of industry,

business, or establishment In

which employed (or employer).

9 BIRTHPLACE

(State or country)

Winthrop

10 NAME OF

FATHER

Fanno Coldcion

11 BIRTHPLACE

OF FATHER

(State or country))

Campton Ky

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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

' PLACE OF DEATH Winthrop

(No ..................... )

argyle

St.

............. Ward)

DATE OF BURIAL

5-3- 1916

,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 cach and every person, irrespective of age. For many occupations a single word or terin on the first line will be sufficient, c. 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, ctc. 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 "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never rc- 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) ; Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ctc. 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" (mercly symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ctc.), "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 one supposed to be due to Alcoholism, etc.

4. Deaths under circumstances unknown, as A person found dead, etc.

may

ONIONIS

FOR

aJAJASON NISH

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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH Wintherof

.(No.

5.8 Winchnot

St. ;.

Ward)

Eidson

Dwight Gaylord

2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE

58 Wintherof the Willing Registered A

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

Male

' COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Married

· DATE OF BIRTH

7 AGE 80

mos.

ds.

If LESS than ¿ day ......... hrs.

& OCCUPATION

(a) Trade, profession, or

particular kind of work ....

.........

Dentist

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

410

9 BIRTHPLACE

(State or country)

Mangabuck Com

10 NAME OF

FATHER

Lucher Maylord

11 BIRTHPLACE

OF FATHER

(State or conntry)

12 MAIDEN NAME

OF MOTHER

Lande Juncal

13 BIRTHPLACE

OF MOTHER

(State or country)

" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

(Address)

Filed 191

..........

REGISTRAR

16 DATE OF DEATH

Man

(Month)

(Day)

, 191.

I HEREBY CERTIFY that I attended deceased from

Len 14

191.5 ... , to

191

...

........ .

that I last saw h .......... alive on

may 2

and that death occurred, on the date stated above, at2 Pm.

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

The CAUSE OF DEATH* was as follows :

accidental tripped over rug

(Duration)

....... yrs.

.mos. ds.

Contributory

auto Solemio

(SECONDARY)

(Duration)

.........

.... yrs.

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

ds.

(Signed)

....... M.D.

,1916

(Address).

218 hunnit ures

* 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.

ds.

mos.

Where was disease contracted, If not at place of death ?

Former or usual residence

19PLACE OF BURIAL OR REMOVAL

But auchin Cambridge

DATE OF BURIAL

5/4

1916

20 UNDERTAKER

C.R. Qermun

Wunetuch

.....

(City ortowTr.)

fif death occurred in a hospital or institution, give its NAME instead of street and number.]

........... (Year)

(Month)

(Day)

1825 (Year)

PARENTS

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

important. See instructions on back of certificate.

ADDRESS

2020

2, 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, ctc. 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, Houscwork, or At home, and children, not gain- fully employed, as At school or At homc. Care should be taken to report specifically 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 indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write Nonc.

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Town of Winthrop : Record of Deaths 1916-1918, Part 16

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

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