Town of Winthrop : Record of Deaths 1916-1918, Part 54

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 54

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 DISEASE 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 definito 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 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. Examplo: 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 septieaemia," " PUERPERAL 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 determine definitely. Examples: Accidental drowning; Struck by railway train - accident ; Revolver wound of head -homicide ; Poisoned by carbolic acid - prob- ably 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 provisions of chapter 24 of the Revised Laws deaths under the following conditions must be roferred 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, ctc.

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.

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)

12 MAIDEN NAME

OF MOTHER

Joins Satter

13 BIRTHPLACE

OF MOTHER

(State or country)

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Ahund@Hidadm)

(Address)

# 20 Charles St

Filed

191 .....

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

3 SEX

Female

' COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Langle

· DATE OF BIRTH

(Month)

(Day)

(Year)

7 AGE

If LESS than

1 day, 6hrs.

.. yrs.

mos.

ds.

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

& OCCUPATION

(a) Trade, profession, or

particular kind of work

2 2000

(b) General nature of industry,

business, or establishment f

which employed (or employer).

22000

Premature berth

6 hrs.

.(Duration)

... yrs.

.. mos.

da.

Contributory

(SLCONDARY)

(Duration)

............. yrs.

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

de.

(Signed)

Inf. Partes

M.D.

af 3, 1017 (Address)

Wanthoto.

*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.

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 7

DATE OF BURIAL

191

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

.......

20 UNDERTAKER

ADDRESS

424 Brady

Events.

1912

(Day)

(Year)

I HEREBY CERTIFY that I attended deceased from

akr. 2d

1912 ... , to

Con. 34

191.2.6

that I last saw her

alive on

abr. 2d

1917

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

26m.

The CAUSE OF DEATH* was as follows :

.......

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

(No 20 tolandes St.

_St.

..... Ward)

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

2 FULL NAME

toheld of Itoward & Hodydown

...

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

20 tokru St

16 DATE OF DEATH

abril

(Month)

......

9 BIRTHPLACE

(State or country)

20 ccharles St

10 NAME OF

FATHER

......

HOO34 RMANENT WH3H Y SI SIHL-XNL DNICYJNO HUM VINIY PLAN

april 3,1917

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 occupation 3 a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil cngincer, 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 naturc 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 "Laborcr," "Forcman," "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 houschold 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 Scrvant, 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 DEATHI (the primary affection with respect to time and causation), using always the same accepted term for the samc discase. Examples: Cercbro-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," unqualificd, is indefinite); Tubcr

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 (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 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.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH 1 PLACE OF DEATH Minthadi Beach (No. 18 Rencon

...... St. ;................... Ward)

? FULL NAME ..

Cathrinest. faltou

[If married or divorced woman or widow give maiden name, also name of husband.] . felton Daschle n. facton aRESIDENCE /8 Baren st Withcoke Beach.

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

* SEX

COLOR OR RACE

white

& SINGLE,

Married

WIDOWED,

OR DIVORCED

(Write the word)

$ DATE OF BIRTH

(Month)

(Day)

(Year)

7 AGE

If LESS than

i day ........ hrs.

cost ..... yrs. ......... ......

.... mos.

.......

ds.

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

* OCCUPATION

(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)

acland

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

"Island

12 MAIDEN NAME

OF MOTHER

1ª BIRTHPLACE OF MOTHER (State or country) Lockand

" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Erschla De factoin

(Address) 18 Mintis. Ben el.

Filed

191

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

18 DATE OF DEATH

april

1917 ....

(Month)

(Day)

(Year)

I HEREBY CERTIFY that I attended deceased from

Sept

191.)

april 3, 197

.......

that I last saw her

alive on

april 2

191.2 ....

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

15 m.

The CAUSE OF DEATH* was as follows :

Carcinoma of Stomach

(Duration)

.........

..... yrs.

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

ds.

Contributory.

Inquisition

(SECONDARY)

(Duration). .... yrs. .......

.... mos. ................ ds.

1 .

(Signed)

M.D.

april 3. 197 (Address)

200 Pleasanth.

....

* Yf 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.

.......

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

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

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

Holy Cross falder

DATE OF BURIAL

ethelt. 5. 1919

20 UNDERTAKER lors. A Heron

ADDRESS 58 5

-1

(City or vown.)

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

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

10 NAME OF

FATHER

LSUHEXAL DNIAVAND. FL

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 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 dutics of the household only (not paid House- kccpers 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 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, 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, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (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, 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, ctc.

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

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

Dawson.

13 BIRTHPLACE

OF MOTHER

(State or country)

"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant).

John Mc Naught-

(Address)

36 Places aus

Filed 191

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Year)

(Day)

9, 1917

........

I HEREBY CERTIFY that I attended deceased from

1914

191

., to afml 9 1917. that I last saw ....... alive on 1917 and that death occurred, on the date stated above, at 5.20 Pm. ...... .m. The CAUSE OF DEATH* was as follows : strangulation inguinal

(Duration)

............ yrs.

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

ds.

Contributory.

(SECONDARY)

(Duration)

.yrs.

www.mos.

...........

ds.

(Signed)

at 9, 19) (Address)

... M.D.

* 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.

......

In the

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

Winthrop Cement H-12 19/

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

Many

Grey Mihaugh

Grey - alex Me mangel- ...... [If married or divorced woman ør widow give maiden name, also name of husband.J @RESIDENCE Winthrop, 36 places av.

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

$ SEX

4 COLOR OR RACE

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Undourd

$ DATE OF BIRTH

9 (Month)

(Day)

182017 (Year)

7 AGE

If LESS than

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

.yrs.

7 mos.

4 ds.

.... min. ?

a OCCUPATION

(a) Trade, profession, or

particular kind of work

affrom

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

9 BIRTHPLACE

(State or country)

Being. St. Johns 413.

mos.

10 NAME OF

FATHER

Edward frey

11 BIRTHPLACE

OF FATHER

(State or country)

Eng.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

I PLACE OF DEATH

(No

Plan

.. Ward)

WHOO38 INANYWHIJ Y SI SIAL-

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, 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 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: 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 synonyın 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, peritoneum, etc., Carcinoma, Sar- coma, ctc., of .. ...... ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms); Measles; Whooping cough; Chronic valvular heart discase; 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 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.

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

Winthrop

(No

49 . Lucy Costi

Ward)

(City or town.)

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

andrew Dimock

? FULL NAME

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

Winthrop 49 Licy avz.

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

5 SINGLE,

WIDOWED,

OR DIVORCEDOU

(Write the word)

real

· DATE OF BIRTH

(Month)

1828

(Day)

(Year)

7 AGE

If LESS than

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

88 yrs. 11

.....

mos.

14 ds.

Or ........ min. ?

& OCCUPATION

(a) Trade, profession, or

particular kind of work ....

Quer. Show Tip Co.

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

9 BIRTHPLACE

(State or country)

Rocky Hill Coun.

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

Rocky Hill Corn

12 MAIDEN NAME

OF MOTHER

Butter

1ª BIRTHPLACE

OF MOTHER

(State or country)

Con

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant).

H.J. Manuel

(Address)

Filed. 191

REGISTRAR

16 DATE OF DEATH

(Month)

(Year)

(Day)

14, 1917

....

I HEREBY CERTIFY that I attended deceased from Chr 8, 1917.

1912 ..... that I last saw her alive on ahr 13. .... 191.7 ... / ..... and that death occurred, on the date stated above, at 20 m The CAUSE OF DEATH* was as follows :

acute Bronchitis Capillary)

(Duration)

yrs.

ds.

Contributory.

(SECOND

.(Duration)

.yrs.

mos. . ......

ds.

(Signed)

QWv.16. 1917. (Address)

Ministros, Man.

* 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.

de.

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 4-17-1917

20 UNDERTAKER

W.C. Skaggs

ADDRESS Winthrop

M.D.

mos.

10 NAME OF

FATHER

Good &. Divock

IN AMIQYANO-H

AHOJ JU INANYWHY Y SI SIHL-ANI

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 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 stateinent; 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 laborcr, Laborer - Coal minc, 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 domestie service for wagcs, 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 110 occu- pation whatever, write None.

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Town of Winthrop : Record of Deaths 1916-1918, Part 54

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

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