USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 124
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).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121 | Part 122 | Part 123 | Part 124 | Part 125 | Part 126 | Part 127 | Part 128 | Part 129 | Part 130 | Part 131 | Part 132 | Part 133 | Part 134 | Part 135 | Part 136 | Part 137 | Part 138 | Part 139 | Part 140 | Part 141 | Part 142 | Part 143 | Part 144 | Part 145 | Part 146 | Part 147 | Part 148 | Part 149 | Part 150 | Part 151 | Part 152 | Part 153 | Part 154 | Part 155 | Part 156 | Part 157 | Part 158 | Part 159 | Part 160 | Part 161 | Part 162 | Part 163 | Part 164 | Part 165 | Part 166 | Part 167 | Part 168 | Part 169 | Part 170 | Part 171 | Part 172 | Part 173 | Part 174 | Part 175 | Part 176 | Part 177 | Part 178 | Part 179 | Part 180 | Part 181 | Part 182 | Part 183 | Part 184 | Part 185 | Part 186 | Part 187 | Part 188 | Part 189 | Part 190 | Part 191 | Part 192 | Part 193 | Part 194 | Part 195 | Part 196 | Part 197 | Part 198 | Part 199 | Part 200 | Part 201 | Part 202 | Part 203 | Part 204 | Part 205 | Part 206 | Part 207 | Part 208 | Part 209 | Part 210 | Part 211 | Part 212
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. Deatlıs under circumstances unknown, as A person found dead, etc.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY PHYSICIAN.
-
1
1
R 303. 6.'18. 50,000.
R-302
The Commonwealth of Massachusetts
CERTIFICATE OF DEATH OF NON-RESIDENT ........
9765
(City or town)
1 PLACE OF DEATH
Registered No.
(Place of death)
Registered No.
(Place of residence)
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of strect and number)
2 FULL NAME
IRENE MC CARTHY
(If in the Army or Navy of the United States, giye rank, organization, etc.)
(a) Residence.
State
MASS.
City or Town
WINTHROP
No.
88 MAIN
St.
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
days
How long io U. S., if of foreign birth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
OCT.28
1920
3 SEX
F
4 COLOR OR RACE
W
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
MAR .
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
JOHN
6 DATE OF BIRTH (month, day, and year)
7 AGE
54
Years
Months
Days
8
24
If LESS thao
1 day, ........ brs.
or ........ min.
If STILLBORN, enter that fact bere
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particolar kiod of work.
HOUSEWIFE
(b) General nature of industry,
business, or establishment in
wbich employed (or employer).
(e) Name of employer
(duration) ..
5 yrs.
.....
... mos
.ds.
CONTRIBUTORY
ANEURYSM THORACIC AORTA
(SECONDARY)
(duration)
yrs ..
mos ..
ds.
10 NAME OF FATHER
OWEN RANSOM
18 Where was disease contracted
if not at piace of death ?
Did an operation precede death?
Date of
Was there an autopsy?
12 MAIDEN NAME OF MOTHER
What test confirmed diagnosis ?
(Signed)
C.A.RILEY
M.D.
, 19 20 (Address)
ост.29
14
Informant
(Address)
HUSBAND
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
WINTHROP (WINTHROP CEM)
DATE OF BURIAL
OCT .31
19 20
15
Filed
NOV . 2, 19 20-
Registrar of city or town where death occurred
Filed.
Nov. 13, 19 20.
Bessie 2 Dodge asst
Registrar nf city or town where deceased resided
20 UNDERTAKER
C.R.BENNISON
ADDRESS
WINTHROP
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
of certificate.
carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,
PARENTS
(State or country)
KY.
17
I HEREBY CERTIFY, That I attended deceased from
SEPT.22
19.20
to
OCT .28
19.20
that I last saw h .... R.
alive on
OCT .28
19.20
and that death occurred, on the date stated above, at
9 P. m. The CAUSE OF DEATH* was as follows :
· State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
CHR. NEPHRITIS, CHR.MYOCARDITIS
9 BIRTHPLACE (city or town).
COVINGTON
11 BIRTHPLACE OF FATHER (city or town)
(State or country)
13 BIRTHPLACE OF MOTHER (city or town)
(State or country)
County
Suffolk
State
Massachusetts
.....
City or Town
BOSTON
No.
1431 COMMONWEALTH AVE.
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association}
Statement of occupation. - Precise statement of occupa- tion 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, c. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engineer, 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on inay forin part of the second statement. Never return "Laborer,"
"Foreman," "Manager," "Dealer," cte., 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 Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically 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 DEATII, state occupation at beginning of illness. If retired from business, that fact may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write Nonc.
Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fcver (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col-
lapse," "Coma," ""Convulsions,"" "Debility" (“Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite discase ean be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ete. 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 de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (c. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following 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, Exposure, cte.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be duc to Alcoholism, etc.
4. Deaths under eircumstances unknown, as A person found dead, cte.
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY
PHYSICIAN.
..
R 303. G.'18. 50,000.
R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Winthrop (City or Town)
1 PLACE, OF DEATH Lock
County.
State
Registered No ..
157
City or Town
Wiretterch
No
10. Lovadzade are
St.,.
......
.Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Canary Wellwood
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
10 Woodside Park
St.,
.Ward.
( Usual place of abode)
Length of residence in city or towo wbere death occurred
10
years
mooths
days.
How long io U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Robert Ramsay
6 DATE OF BIRTH
( Month)
(Day)
(Year)
Years
70
Months
Days
7
If LESS thao 1 day, ........ hrs. or ....... min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
a.f. Home
9 BIRTHPLACE (City)
glascow- Scotland.
(State or country)
10 NAME OF
FATHER
John Wellwood
11 BIRTHPLACE OF
FATHER (City) ..
13 elfash
(State or country)
Meland
12 MAIDEN NAME
OF MOTHER
Margaret. Thoughson
-Glasgowa
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
Informant
véofert:
10
woodside are.
15 Nov.3.1920
Filed
(Month) (Day) ( Year)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH.
octobre
30
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
1915
oct 30
,1920
, 19
to
that I last saw h
fr
alive on
Oct 28'
, 19 ... 2.3.
and that death occurred, on the date stated above, at
2-30 A.m.
The CAUSE OF DEATH was as follows :
Diabetes
mellition
5 .yrs .. .......... .mos. .ds.
CONTRIBUTORY
(SECONDARY)
(duration)
1
yrs.
mos ...
ds.
18 Where was disease contracted if not at place of death ?
Did an operation precede death ?
no
Date of
Was there an autopsy ?
no
What test confirmed diagnosis ?
310metcall
(Signed)
M.D.
(Address) ...
DOWN.
1920
Date
(Month)
(Day)
(Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL 1100 1st 1920
(Cemetery)
'City or town)
20 UNDERTAKER
C tivo R. Sevenum
ADDRESS
21 I HEREBY CERTIFY that a satisfactory stao- dard certificate of death was fled with me BEFORE the burial or transit permit was issued. J. a. moury
Of position
Health officer
Date of issoe of permit nov. 1/20 No 193
Permit
50,000.
The Commonwealth of Massachusetts
3 SEX termale 7 AGE PARENTS 14 (Address) instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (b) Name of employer
.(duration) Drabelig Jungrene J
(If non-resident give city or town and State)
1920
21 1850
Oct. 30. 1920" 0 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
.
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of ags. For many occupations a single word or term on the first line will he sufficient, e. g., Former or Plonter, Physicion, Compositor, Architect, Locomotive engineer, Civil engineer, Stationory fireman, etc. But in many eases, 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; (o) Salesman, (b) Grocery; (a) Foreman, (b) Automobile foctory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Doy loborer, Farm loborer, Laborer - Cool mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically 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 occupation whatever, write None.
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: Cere- brospinal fever (the only definite synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobor pneumonio; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, ete., of .......... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Meosles; Whooping cough; Chronic valvulor heort disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Meosles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (msrely symptomatic), "Atrophy," "Col- lapse," "Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all discases resulting from childhirth or miscarriage, as "PUER- PERAL septicemio," "PUERPERAL peritonitis," etc.
State cause for which surgical operation was undertaken.
(Recommendations on statement of causs of death approved by Com- mittee on Nomenclature of the American Medical Association.)
Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Laws, Chop. 29, Secs. 10 and 1, as amended by Acts of 1910, Chop. 322.
No undertaker or other person shall bury a human body . . . until hs has received a permit from the board of health or its agent, . . . or . . from ths clerk of the city or town in which the person disd; . .. no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . a satisfactory written statement con- taining the facts roquired by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . .. The person to whom the per- mit is so given and the physiciau who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Lows, Chap. 78, Sec. 38.
Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Lows, Chop. 24, Sec. 8.
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observanee of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
2 FULL NAME 3 SEX m W. 7 AGE MYears 35 PARENTS 14 Informant ( Address) 15 Novel carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions on back of certificate. Filed Filed. N. D .- WRITE PLAINLT, WITH UNFADING INA THIS IS A PERMANENT DEGUNU. Every nem of information should be (b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
The Commonwealth of Massachusetts
CERTIFICATE OF DEATH OF NON-RESIDENT
1 PLACE OF DEATH
Registered No ...
(Place of death)
Registered No ..
162
City or Town
howwell
No. 5 So Franklin Of
St.,.
2
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number) Bert a. arlin berg. Ind. Co. At Banks . a. Winthe
(a) Residence. State.
(Usual place of abode)
mass.
City or Town howel No. 5 so Franklin et St .
Length of residence in city or town where death occurred
years
months
days
How long in U. S., if of foreign birth?
years
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) . 1
19 20
17
HEREBY CERTIFY, That I attended deceased from
Och. 25
1920 to haveil
1920.
that I last saw h.&t.+4., alive on
Cat. 31
192.0.
815a. m. The CAUSE OF DEATH* was as follows:
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. ( (See reverse side for additional space.) Doublehobar Pneumonia Primary
.(duration).
.... yrs ..
.. mos
T
ds.
(SECONDARY)
(duration)
.yrs.
mos.
ds.
18 Where was disease contracted
if not at place of death?
Did an operation precede death ?.
„Date of.
Was there an autopsy?
What test confirmed diagnosis ?.
1. J. mechan
M.D.
(Signed)
11-1,19 2(Address)
19 PLACE OF BURIAL, CREMAȚION, OR REMOVAL Edson, howell
DATE OF BURIAL novio 1020
20 UNDERTAKER Leo. W. Healey
ADDRESS Lowell
allov 29 19 20
Registrar of city or town where deceased resided
CONTRIBUTORY
Enteritis
3
10 NAME OF FATHERyear
glgilmanton
11 BIRTHPLACE OF FATHER (city or to wood
(State or country)
2 MAIDEN NAME OF MOTHI Adam Spinney
13 BIRTHPLACE OF MOTHER (city or town)
(State or country)
Portsmouth n.4.
Father
Registar. of city or town mere death occurred
Lou
el.
1497
County
middlesex
State
mass
4 COLOR OR RACE
tringle
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year) 17.231885
Months
81
1
If LESS than
I day, ........ brs.
or ....... min.
If STILLBORN, eoter that fact bere
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particolar kind of work.
Soldier (U.S.a.)
9 BIRTHPLACE (city or townho
(State or country)
howell
Lowell
months
(Place of residence)
(life the Army or Navy of the United States, give rank, organization, etc ma
and that death occurred, on the date stated above,
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association)
Statement of occupation. - Precise statement of occupa- tion 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, c. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive 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) Colton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Forcinan," "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 Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in doinestic 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
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 saine disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal inenin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fcver (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, etc., of_
(name origin; "Cancer" is less definite; avoid usc of "Tumor" for inalignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (discase causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report inere symp- toms or terminal conditions, such as "Asthenia,"
"Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," ""Convulsions,"" "Debility" (“Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock,"" "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Of HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the Aincrican Medical Association.)
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.