USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 36
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Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing eonditions 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 eircumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1916.
CITY OF BOSTON.
FULL NAME
JENNIE L. IRELAND
Registered No,
10778
Place of Death and Residence
Boston
Date of Death
NOV . 5
1916.
Age
years
months days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
SIN.
Maiden Name
RAR'S
Husband's Name
UT Primary (Doraton}
=
&FICE
2 YRS
Birthplace
BOSTON
Name of Father
ROBERT D. IRELAND
Birthplace of Father ENGLAND
Contributory · (Duration)
ASTHMA
Maiden Name of Mother
LETITIA MC TAVISH
Birthplace of Mother -N.B.
Occupation AT HOME
NOV. 5 1916
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
QUINCY ( MT . WOLLASTON)
Undertaker
L.JONES & SON
Usual Residence
WINTHROP(30 MYRTLE AVE)
Filed
NOV.8 1916.
A true copy.
Attest :
Registrar.
PATRIHI
S. SIT;
ORGANIC HEART DIS. (DILATATION)
CITY
BOSTONIA
COMUNITAA
A. 182
8 SREG
DONATA A
STON. MASS.
(Signed)
W.J.PORTER M. D.
Informant
I HEREBY CERTIFY that I attended deceased during last illness,
1916, from 1916, to 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 :
55'
-0. 5 1916 ENT RECORD.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OFDEATH Amtlich (No. Metcalf Hospital
Ward)
(City or town.) {If death occurred in a hospital or institution, give its NAME instead of streat and number.]
.....
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
marriedle
17
1887
17
I HEREBY CERTIFY that I attended deceased from
(Year)
Och. 31ch
,196
to
(Day)
If LESS than
( day ......... hrs.
19 ds.
„min. ?
9 BIRTHPLACE
(State or country)
Horcastor Space
10 NAME OF Timothy@Gomor
12 MAIDEN NAME OF MOTHER mary hornhan
14 THE ABOVE /IS TRUE TO THE BEST OF MY KNOWLEDGE
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
10 DATE OF DEATH
noo
6 M
1916 ....
(Month)
(Day)
(Year)
noo. 6th
1916.
that I last saw hole. alive on
nov. 6th
1916
and that death occurred, on the date stated above, at
m.
The CAUSE OF DEATH* was as follows :
acute Pyeletes
(Duration)
......... yrs.
mos.
ds.
Contributory
aauto nephritis
(SECONDARY)
... (Duration)
yrs.
mos.
4/
ds.
A.S. Porter
M.D.
(Signed)
non. 6th
198 ........
(Address).
Winthrop, Mars.
* 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
DATE OF BURIAL
191
6
20 UNDERTAKER
John . O maley Monthof
WRITE PLAINLT, WITH ONFADING INK - THIS IS A PERMANENT RECORD.
Mary agnes Oblomov Roche
2 FULL NAME
[If married or divorced woman es widow
give maiden name, also name of husband.Y.
@RESIDENCE
180 Rud Road
3 SEX Female ' COLOR OR RACE Muito $ DATE OF BIRTH mar (Month) 7 AGE 29 .. yrs. 7 mos. .... & OCCUPATION (a) Trade, profession, or (b) General nature of industry, business, or establishment in which employed (or employer). 11 BIRTHPLACE or Veland OF FATHER (State or country) PARENTS 13 BIRTHPLACE OF MOTHER Acando (State or/country) (Informant) om Alocho important. See Instructions on back of certificate. (Address) 180 Guard Filed. 191 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 particular kind of work At Home
......
......
3
1 7
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engincer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional linc is provided for the latter statement; it should be used only when needcd. 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, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- 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. - 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 usc of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (sccond- 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 septicacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
vorces tor
(Noncres ter State (s )italst. ; .... . ......... „Ward)
WORCESTER.
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
" FULL NAME ( ) Darnes
{If married or divorced woman or widow give maiden name, also name of husband.] wife of Amos L. Barnes
@RESIDENCE
Winthrop,
100 Cliff .ve.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
& SEX Female
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word) Married
· DATE OF BIRTH
Dec. 12, 1844
(Month)
(Day)
(Year)
TAGE
If LESS than I day ......... hrs.
71
10
yra.
mos.
24
ds. or ........ min. ?
* OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment i
which employed (or employer).
9 BIRTHPLACE
(State or country)
vestfielg,
PARENTS
11 BIRTHPLACE OF FATHER (State or country)
- - - -
12 MAIDEN NAME
OF MOTHER
-
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Jennie G. MCIntosh
(Address) Worcester Stato ilosyital
16 Filed. v. 13- 1916 REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Nov. . G
191.6
....
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
April 28
191.
Ci to.
Nix. G
1916.
that I last saw her
alive on
Nov. 5
1916
and that death occurred, on the date stated above, at. 15 Am
The CAUSE OF DEATH* was as follows :
Chronic Myocarditis
Coronary Sclerosis
(Duration) ............... yrs. ................ mos. .............. ds.
Contributory
Senile Dementia
(SECONDARY)
(Duration) ............. yrs.
+
(Signed)
Jennie G. McIntosh
M.D
Nov. 6
191.L .... (Address)
worcester
* 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
8
mos.
8
In the
ds.
State.
......
.yrs.
mos.
ds
Where was disease contracted,
If not at place of death ?...
Former or
100 Cliff.
.n.h
usual residence ..
h .... ٧٢٠٠ Winthrop
LI CITAROMALCR REMOVAL winthrop
DATE OF BURIAL
NOV. 8, 1916
20 UNDERTAKER 11/211
ADDRESS
WORCESTER
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
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
Housewife
10 NAME OF
FATHER
mos. ds,
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 occupation 3 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 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," "Dcaler," 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. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port "Typhoid pneumonia"); Lobar puernonia; Broncho- proumonia ("Pneumonia," unqualified, is indefinite) ; Tube ..
culosis of lungs, meninges, peritonacum, etc .; Carcinoma, Sar- coma, etc., of ... .(name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (discasc causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Conia," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage,". "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septicacmia," "PUERPERAL peritonitis," cte. 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 duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
1 18. 3.'16. 10,000.
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
11 BIRTHPLACE
OF FATHER
(State or country
Newburyport. me
12 MAIDEN NAME
OF MOTHER
Phoche Thurlow
13 BIRTHPLACE
OF MOTHER
(State or country)_
) Stonington me
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
angie
(Address)
87 Park ave Printich Hicks
16 Filed 191.
......
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Choo
,1916
........
....
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
nov. 7th
nor. 7 th
., 1916,
to
....
... ,
1916.
that I last saw het .... alive on
.......
8-10 m.
The CAUSE OF DEATH* was as follows :
ovarian
Makequant Ceret. Jabdommat
(Duration)
2.
„yrs.
mos.
ds.
Contributory
artera-sclerose
(SECONDARYY
Indef.
... yrs.
... mog.
ds.
(Signed)
Millianal: Portes
M.D.
Nov. 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
of death.
yrs.
.mos. ............ ds.
State.
......
.. yrs.
mos.
In the
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Stonington me
20 UNDERTAKER
arthur F. Douglas
(City or town.)
[If death occurred in a hospital or institution, give its NAME ·nstead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
' COLOR OR RACE
White
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Hallowed
· DATE OF BIRTH april
(Month)
(Day)
22
1886
(Year)
7 AGE
If LESS than [ day ........ hrs ..
80
„yrs.
6
mos.
16
ds.
or ......... min. ?
8 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)
Stonington me
10 NAME OF
FATHER
Peter Tyler
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH 1 PLACE OF DEATH, Mithrof mars (No. 87 Park ave Smithrafa, Hilde Ward) (No.
? FULL NAME
Sarah & Hifield
[If married or divorced woman or widow give maiden name, also name of husband.]. @RESIDENCE Stonington Je.
Sarah & Tyler Johnf. Fifield
non. 7th
, 191.2.
and that death occurred, on the date stated above, at.
......
DATE OF BURIAL
nov 11, 1916
ADDRESS
chekra marz
7 1116
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oceu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engincer, Civil engineer, Stationary fireman, cte. 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," ete., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, ete. 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 faet may be indicated thus: Farmer (retired, 6 yrs.). For persons who have 110 oeeu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- DASE 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 ecrebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite); Tuber-
culosis of lungs, meninges, peritonacum, cte., Carcinoma, Sar- coma, ete., 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 eausing 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," cte.), "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 Ajseases 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 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
.... inthrop
(No.
57 Cutler St.
.......
......
.St.
......... Ward)
[If death occurred In a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
' COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
( Write the word)widow
16 DATE OF DEATH
November
(Month)
Day)
7. 1916.
(Year)
$ DATE OF BIRTH
May
24
1819
(Month)
(Day)
(Year)
TAGE
If LESS than I day ......... hrs.
07
.. yrs. 5 mos. I.2 „ds.
or ....... min. ?
$ OCCUPATION
(a) Trade, profession, or
particular kind of work
At Home
(b) General nature of Industry,
business, or establishment
which employed (or employer).
9 BIRTHPLACE
(State or country)
Halifax N. S.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Scotland
12 MAIDEN NAME
OF MOTHER
Unknown
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Flizabeth Lind
(Address)
FM
Antler at
..............
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
nov, 1th
191
6 to
Nov. 7th
1916.
that ! last saw her alive on
Nov. 6 .
1916.
and that death occurred, on the date stated above, at
610
m.
The CAUSE OF DEATH* was as follows :
arteriosclerosis
.. (Duration) .
........... yrs. ........
... mos. ..............
ds.
Contributorg.
Bronchitis
(SECONDARY)
.(Duration)
.......... yrs. ................ mos.
7
ds.
(Signed)
Mr. R. Parter
M.D.
Nov. F. 196 (Address)
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
In the
At place
of death.
.......
.yrs.
mos. ............. ds.
State ............ yra. ............ 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
No.v ........ Į 0 , 1916
Moly Hood Cem. Frockline
ADDRESS
20 UNDERTAKER John F. 0' Naley
Tinthrop
(City or town.)
2 FULL NAME
Elizabeth Goodbrand Molloy
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
EN Cutler St
.......
Female
white
Filed 191
10 NAME OF
FATHER
Unknown
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oecu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engincer, Civil engineer, Stationary fireman, etc. But in 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 forin 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.
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