USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 80
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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 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 onc supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Winthrop
(No.
199, Bartlett Rd
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
$ SEX
4 COLOR OR RACE
W
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Singles
' DATE OF BIRTH
5
2.5
(Month)
(Day)
., 1917
(Year)
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)
Winthrop Mars.
PARENTS
12 MAIDEN NAME
OF MOTHER
Elizabeth Collina
18 BIRTHPLACE
OF MOTHER
(State or country)
Winthrop, Mars
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Ralph H. Baker
(Address)
199 Bartlett Rl
16
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
1ª DATE OF DEATH
17
Dec. 11th
1911-
I HEREBY CERTIFY that I attended deceased from
Due. get, 1912
to
that I last saw
or alive on
Alea. 11th
..... .
1917,
and that death occurred, on the date stated above, at
SP
m
The CAUSE OF DEATH* was as follows :
Cerebro spinal menugatos,
.(Duration)
.... yrs.
mos.
2
ds.
Contributory
acidora
(SECONDARY)
(Duration)
yrs.
............... mos.
...........
2/
ds
(Signed)
Not. Parter
M.D
Nec, 13,1917 (Address)
Winehof
....
* 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. dı. State ..... .. yrs. .mos. ........................... Where was disease contracted, If not at place of death ?.... Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL So. Dennis
DATE OF BURIAL
19-14. 1917
20 UNDERTAKER
2h.C. Skagas
ADDRESS
WinThropo
191/
.........
(Month)
(Day)
(Year)
TAGE
If LESS than
[ day ......... hrs.
7 yrs ..
6 mos.
16 da.
10 NAME OF
FATHER
Ralph Af. Bake
11 BIRTHPLACE
OF FATHER
(State or country)
West Dennis
Elizabeth T. Bake
"FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop 192 Bartlett Rd
Registered No.
Dec. 11,1917
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 occupation 3 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 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 spceification, 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, Hlousework, 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, Ilousemaid, 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, 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 intereurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-pneumonia (sccondary), 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 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, 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.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1917.
CITY OF BOSTON
FULL NAME
LOUISE C. FREDERICKS
Registered No.
11911
Place of Death l and Residence
Boston
Date of Death
DEC.11
1917,
Age
58
years
months days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
W
S
Maiden Name
Husband's Name
Birthplace
BOSTON
Name of Father
WILLIAM FREDERICKS.
Birthplace of Father
GERMANY
Maiden Name of Mother
LOUISE TAYLOR
Birthplace of Mother GERMANY
Occupation AT HOME
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during fast illness, from 1917, to
1917, 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:
ISTRAR
"Primary UT PATRIBE -(Duration
SOBIS
OFFICE
CTV BOSTONIA CONDITAA.
.D. 1822
STON
Contributory : (Duration )
MYOCARDITIS
(Signed)
G.H.GORHAM M. D.
DEC.11 1917
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial
or removal
BROOKLINE (HOLYHOO)
Undertaker
J.D.FALLON
Usual Residence
WINTHROP(24 GIRDLESTONE RD)
Filed
DEC.14
1917.
A true copy.
Attest :
Registrar.
CHRONIC NEPHRITIS
CITY
1831. SREOIMINE DONATA MASS.
54 STURGIS ROAD
L NANVWS3
7
V SI
H.
WRITE PLAINLY, WITH UNFADING INK-
Dec 11, 1917
WHILE TLAINLI, WIEN UNPAVING INVA - IRIS IS A PERMANENI KECURD.
important. See instructions on back of certificate. N. B. - Every item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should stato CAUSE OF DEATH In plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
(5-'17 XXM ]
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH
(No. 72
Marsel
'FULL NAME [If married or divorced woman or widow give maiden name, also game of busband.] @RESIDENCE 72 Pleasant et
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
: SEX
thale
4 COLOR OR BACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
' DATE OF BIRTH
(Month)
(Day)
1
(Year)
' AGE 20
... 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)
Leland
1
PARENTS
12 MAIDEN NAME
OF MOTHER
Catherine M Cathy
13 BIRTHPLACE
OF MOTHER
(State or country)
Teland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
nt) FranciaA Kanett
(Address)
12 Pleasant of
18
Filed 191
REGISTRAR RAR
1ª DATE OF DEATH
1 vez
,
(Month)
(Day)
191
(Year)
17 I HEREBY CERTIFY that I attended deceased from
191 ....... , to
191
..........
that I last saw h wwalive on
191
and that death occurred, on the date stated above, at.
m
The CAUSE OF DEATH* was as follows :
cretrat
Did a surgical operation precede death ?
Date
...... .... (Duration) .. yrs.
mos.
......... ............. ds.
Contributory
riteri
(SECONDARY)
(Signed)
M.D
....
191 ........ (Address).
1
* 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. ........
mos.
ds .............
Where was disease contracted,
If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL Harly ford
DATE OF BURIAL
Dec 16 1917
20 UNDERTAMER
ADDRESS
1409 Staships
...... ......
(Duration)
yrs.
................ mos.
ds.
11 BIRTHPLACE
OF/FATHER
(State or country)
Ireland
BOSTON
(City or town.) [If death occurred In a hospita or institution, give its NAME instead of street and number.]
St. : ... .............. Ward)
Registered No.
10 NAME OF
FATHER
Lehr Barrett
If LESS than
1 day ......... hrs.
A PERMANENT RECORD.
Dec. 15, 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 applics 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, Architect, 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) 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," ctc., 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 oceu- 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 diseasc. 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, peritoneum, 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; Chronie interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (discase 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 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, ctc.
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.
Oth Til
Illanson
R.15. 1-'174100,000.
610
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.
(5-'17-XXM.]
The Commonwealth of Massachusetts -
STANDARD CERTIFICATE OF DEATH
(No ... 17 Juniode Que
Clinico Lillian Jenkeine
? FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.]. a RESIDENCE 252 Folsom Que Muchos
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
10 DATE OF DEATH
Dec
(Month)
16 .. 1917
(Year,
(Day)
17 I HEREBY CERTIFY that I attended deceased trom Dea. 14, 1917. to. Des 16., 1917
that I last saw h alive on Dec. 16. ........ . 1917 and that death occurred, on the date stated above, at 40 m m. The CAUSE OF DEATH* was as follows :
aceder
Did a surgical operation precede death ?
Date
(Duration)
.........
.yrs. .............
.. mos.
2
ds.
Contributory
(SECONDARY)
(Duration)
yrs.
.mos. ............
ds.
(Signed)
MI Partir
M.D.
Des. 16.
191 ... .... . (Address)
Winthrop
* 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. ..
In the
nos. ...
ds .............
Where was disease contracted, If not at place of death ?. Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL Woodlawn
DATE OF BURIAL
DEC 18.
1917
16 Filed
191
REGISTRAR
Wintherof BOSTON
(City or town.) [If death occurred In a hospital or institution, give its NAME instead of street and number.]
3 SEX
Female White
4 COLOR OR RACE
6 SINGLE,
MARRIED.
WIDOWED,
-OR DIVORCED
(Write the word)
Single
21
(Month)
(Day)
11
, 19/3
(Year)
If LESS than 1 day ......... hrs.
....... yrs.
......
mos.
25
ds.
Or ......... min. ?
9 BIRTHPLACE
Viet Barnstable Mars
10 NAME OF
FATHER
Fred S fenbeing
11 BIRTHPLACE OF FATHER (State or cobury) Sametable
12 MAIDEN NAME OF MOTHER Mances Kellough
13 BIRTHPLACE OF MOTHER (State or country) Everett Mass
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address) 252 HoleonCherche.
20 UNDERTAKER
John F. O'malley
ADDRESS
Winthrop
......
=
Ward)
Registered No.
· DATE OF BIRTH 7 AGE $ OCCUPATION (a) Trade, profession, or particular kind of work. (b) General nature of industry, business, or establishment In which employed (or employer). PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very 4 .yrt.
2
4
Dec. 16,1917
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 eaclı and every person, irrespective of age. For inany 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) Forcman, (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 - Coul 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 homc. 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., Careinoma, Sar- coma, etc., of ... ...... .... (namo origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular hcart discasc; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd not bo 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- 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 disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL scpticaemia," "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 deathis 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. 1.'17. 100,000.
important. See instructions on back of certificate.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Clear york
12 MAIDEN NAME
OF MOTHER
Soplica Roder
1ª BIRTHPLACE
OF MOTHER
(State or country)
Chathur it
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Oraac b. Hall
(Address) 52 Colante St Withney 2
16
Filed 191
....
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
§ SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1,
· DATE OF BIRTH
15
(Day)
1848 7
(Year)
? AGE
If LESS than
1 day ......... hrs.
69 yre. 1
mos.
ds.
min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment
which employed (or employer)
Diabetes
Cancer 7 stomach
0
.(Duration)
1 yrs.
Contributory
(SECONDARY)
.(Duration)
a.yrs.
.. mos.
ds.
(Signed)
31 metcal
...... M.D.
luc 17, 1917 (Address)
Wiishop
* 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. .
.. 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
12/18.
... , 191.Z
20 UNDERTAKER
ADDRESS
warten,
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 Winthrop (No metcalf Hospital
St. :
1
......
....
Ward)
Miss Ella & Parker
? FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband. ] @RESIDENCE
Buchanan Si
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH
De
16, 1917
....
(Month)
(Day)
(Year)
I HEREBY CERTIFY that I attended deceased from
to
1916
191
Dec. 16
1917
that I last saw her
alive on
the 15th
1917.
and that death occurred, on the date stated above, at
12.15 Am
n.
The CAUSE OF DEATH* was as follows :
Chimie Indicar ditis
.............. mos ..
...........
ds.
9 BIRTHPLACE
(State or country)
Chelsea Mass
10 NAME OF
FATHER
Gilman & Parker
.......
(Month)
1000 16,1917
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 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 gaill- 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 None.
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