USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 31
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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 "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, cte., Carcinoma, Sar- coma, etc., of .. .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, ete. 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 symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," ete., when a definite disease ean 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 Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly eaused 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.
.
A
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
[12-'15-XXM.]
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH At Sea .......
(No.Steamship Melrose St. ;.... Ward)
BOSTON .....
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Ernest Anderson
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE Edgar Terrace, Winthrop, Mass.
Registered No.
22338
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
₴ SEX
Male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED.
OR DIVORCETried
(Write the word)
16 DATE OF DEATH
ana, 18
1916
(Month)
(Day)
(Year)
· DATE OF BIRTH
April 11. 1852
(Month)
(Day)
(Year)
PAGE
If LESS than
I day ......... hrs.
or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Chief Office
(b) General nature business, or establishment which employed (or employer) .. .....
iSteamship Melrose
Did a surgical operation precede death ?
Date
(Duration)
.yrs.
.. mos.
............ ds.
Contributory
(SECONDARY)
(Signed)
M.D
191
(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).
At place
In the
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
Winthrop, Mass.
DATE OF BURIAL
Aug. 2 7
1916
(Address)
15 Filed
191 ....
REGISTRAR
17 I HEREBY CERTIFY that I attended deceased from
191.
, to.
...........
191
that I last saw h
alive on
...... 191
and that death occurred, on the date stated above, at.
......... m
The CAUSE OF DEATH* was as follows :
Aneurisma de Jemoral arten
9 BIRTHPLACE
(State or
Goth, Germany
10 NAME OF FATHER Unknown
PARENTS
11 BIRTHPLACE
OF FATHER
(State
Unknown
12 MAIDEN NAME
OF MOTHER
Johanne Anderson
13 BIRTHPLACE
OF MOTHER
(State or country)
Unknown
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
20 UNDERTAKER
Terman x Jous
ADDRESS
Boston
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
(Duration)
............. yrs.
mos.
ds.
....
.......
64
................ yrs.
4
....... mos.
. ......
ds.
aug. 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 agc. 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 fircman, 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 cxamples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager,' er," "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 reccive 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 discase. 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 indefinitc); Tuber-
culosis of lungs, meninges, peritonaeum, ctc., 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," "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 one supposed to be due to Alcoholism, etc
4. Deaths under circumstances unknown, as A person found dead, ctc.
*
1 . ARTMEN 1
R .:: 15-8-'15.5 100,000.
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
(No.
42 Sargent Sr
St. :. .Ward)
John@Fracc
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
42 Sargent It. Mouthrole. Ma Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
$ SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
Hi lowed
· DATE OF BIRTH
Jefer.
(Month)
4th
(Day)
1916
(Year)
7 AGE
If LESS than [ day ......... hrs.
83
.yrs.
11
mos.
17
ds.
or ...
... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Ritirid
(b) General nature of industry, business, or establishment in which employed (or employer).
S BIRTHPLACE
(State or country)
Lewarttil 972.76
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
acworth. 10th
12 MAIDEN NAME
OF MOTHER
Maria Pettengill
13 BIRTHPLACE
OF MOTHER
(State or country)
acworth, n.H.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs. Mc Cartney daughter
(Address)
15 Filed
191. .......
REGISTRAR
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
-- At place
of death ..
......
In the
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
DATE OF BURIAL
Vtvadlacon aug. 23ml
6
20 UNDERTAKER a. V. Sanborn.
ADDRESS
River.
... 4 A. m. The CAUSE OF DEATH* was as follows :
Senility
.(Duration)
.......
.yrs. ...........
ds.
mos. . ............
Contributory
.... (SLCONDARY)
.. (Duration)
................ yrs.
...........
mos. ................ ds.
(Signed)
Williams (, Newton
M.D.
Rua 22. 1916 (Address)
Revue quais
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
17
I HEREBY CERTIFY that I attended deceased from
aug 19
1916, to Cura 21
191
1916
that I last saw humalive on
Curl 20
6
and that death occurred, on the date stated above, at
6.
(Month)
(Day)
...... .
(Year)
16 DATE OF DEATH
arequest. 21"
191
(City or town.)
[If death occurred In a hospital or institution, give its NAME instead of street and number.]
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
10 NAME OF
FATHER
U ang. 21, 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, Architeet, Loco- motive engincer, 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 necdcd. 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 gaill- 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 DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmcr (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 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; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber
culosis of lungs, meninges, peritonaeum, ete., 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, ete. The contributory (second- ary or intereurrent) 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 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 Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
R. 15-8-'15. 100,000.
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
12 MAIDEN NAME
OF MOTHER
Vannak Hurler,
1ª BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUS TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
16 Filed 191
........
REGISTRAR ...
MEDICAL CERTIFICATE OF DEATH
DATE OF DEATH
August 25 1916
(Month)
(Day)
191
(Year)
17 I HEREBY CERTIFY that I attended deceased from Aug 15 1916, 191 , to Aug 23 1916 191 ..... ....... . that I last saw him. alive on Aug ..... 25 .... 1916 .. ..... , 19 1 ....... and that death occurred, on the date stated above, at ....... P ..... m. The CAUSE OF DEATH* was as follows : Acute Gastro-intestinal Catarrh
with general Poritonitis.
(Duration)
yrs. 8 ..... Daya
ds.
Contributory ... Sudden collapse
(SECONDARY)
1/2 -Hour
.(Duration)
yrs.
ds.
(Signed)
M.D.
Aug 24 1916 (Addres
151 Washington Ave
......
* If death followed Injury or violoptekgrefgateMideath 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.
In the
ds.
State ............ yrs.
mos.
..........
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL Woodlawn Cenaly,
DATE OF BURIAL
8/25
1916
.................
20 UNDERTAKER C.R. Bunun
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
South Lincoln Por ..... 2 FULL NAME
[ If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
115 Quant Dod Workout
Registered No.
PERSONAL AND STATISTICAL PARTICULARS ,
Thale
' COLOR ORORACE
Mute
& SINGLE,
MARRIED,
Marcel
$ DATE OF BIRTH
(Month) (Day)
1 (Year)
If LESS than ! day ........ hrs.
230 Èds. or ........ min. ?
$ OCCUPATION
(a) Trade, profession, or
particular kind of work
Retext
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Robuston me
10 NAME OF
FATHER
Henry Por
11 BIRTHPLACE
OF FATHER
(State or country)
The Conunomwealth of Massachusetts
1 PLACE DE DEATH
STANDARD CERTIFICATE OF DEATH 6 15Chant RX
Ward)
ADDRESS Wirelles
7 AGE
WIDOWED,
OR DIVORCED
(Write the word)
2
1
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, 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 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 re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of ... ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," 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," ete. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dcad, 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.
[12-'15-XXM.]
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
Ł
(No Hospital
St. ;.................. Ward)
BOSTON
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
...
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
Single
· DATE OF BIRTH
(Month)
(Day)
....
1
(Year)
7 AGE
54
.. yrs.
mos.
ds.
or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Retired
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
Mellesleg
PARENTS
12 MAIDEN NAME
OF MOTHER
Bridger ORiley
13 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mary Shabby
(Address)
38 Sturgis St Vom
16 Filed 191
REGISTRAR ....
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
ang
29
(Month)
(Day)
1916
(Year)
17
I HEREBY CERTIFY that I attended deceased from
afrl 14
1916
., to
ay 29"
... ط 191
that I last saw him
alive on
191.6
.......
10pm.
and that death occurred, on the date stated above, at
The CAUSE OF DEATH* was as follows : Caramma of Intestines
Perforation of Plomodenum Did a surgical operation precede death ? yes Date by W/c
.(Duration)
4 mas. 16
ds.
mos.
Contributory
(SECONDARY)
.. (Duration)
......... yrs.
mos.
ds.
(Signed)
(31)melcall
M.D.
ay 3/7, 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).
At place
4
of death ...
.yrs.
mos.
16 da.
In the
2
State
......... y:s.
.......
mos.
.ds .............
Where was disease contracted,
If not at place of death ?..
Former or
usual residence.
19 PLACE OF BURIAL OR REMOVAL tick Hitatricks bem,
DATE OF BURIAL Menti, 1916
30 UNDERTAKER
ADDRESS 120 Have East Boston
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
1 PLACE OF DEATH Metcalf IN.
Mary (, Kitch
2 FULL NAME [If married or divorced women or widow give maiden name, also name of hysband.] @RESIDENCE 38 turgis fr Winthrop
Registered No.
.............. yrs.
..........
10 NAME OF
FATHER
Thomas Fitch
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland
If LESS than
[ day ......... hrs.
aug .24 1716
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, 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 necded. 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," "Forcman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid 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.
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