Town of Winthrop : Record of Deaths 1919-1921, Part 14

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 14


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).


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State cause for which surgical operation was undertaken.


(Recommendations on statement of cause 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 otlier 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 Lows, Chap. 29, Secs. 10 ond 1, as amended by Acts of 1910, Chop. S22.


No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent, . . . or . . from the clerk of the city or town in which the person died; . . . 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 required by law to be returned and recorded, which ... shali be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a ecrtifi- 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 physician who certifies to the cause of death shall thereafterfurnish for registration any other necessary information which ean 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, Chop. 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 fuli as may be, with the cause and manner of his death, and shali 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 observance 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 wili 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 ali deaths sup- posably due to injury. These include not only deaths caused dircetly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electricai 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.


CAUSE OF DEATH in plain terms, so that it may be properly classifled. 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 Commmmwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Kameleon har (No. 286 Remets


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


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


Helen, aunque. Munito ....


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


28€


Revert Urucho


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX Females


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


16 DATE OF DEATH


murer gtt


1919


(Month)


(Day)


....


(Yeár)


$ DATE OF BIRTH March 1.st- 199 (Month) (Day) (Year)


? AGE


If LESS than i day ......... hrs.


× yra


mos.


10


ds.


or ...... min. ?


· OCCUPATION


(a) Trade, profession, or particular kind of work


N


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


9 BIRTHPLACE


(State or country)


10 NAME OF


FATHER


The & Minto.


11 BIRTHPLACE OF FATHER (State or country)


Scotland


12 MAIDEN NAME OF MOTHER Ina. D. Ungus.


18 BIRTHPLACE


OF MOTHER


(State or country)


Scotland.


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant).


John Minuto


(Address)


286 RevenSet Revere


16 File 21102214. 1919


REGISTRAR


4 dias


(Duration)


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


...........


mos.


...... ds.


Contributory (SECONDARY)


(Duration) ... ... yrs.


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


- M.D.


31.1 1912 ..... (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 ............ yrs. ...


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


... ds ...


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL Wucht Mass


DATE OF BURIAL


...


1919


ADDRES6


20 UNDERTAKER


B. R. Tem


Wencheof


....


(City or town.)


WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.


PARENTS


.


17 I HEREBY CERTIFY that I attended deceased from ) march /2, 1919, to


that I last saw h ...


.- alive on


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


and that death occurred, on the date stated above, at ... .m. The CAUSE OF DEATH* was as follows : Lederus


........ (Signed) Quick & Woof TV.


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 cf tho business of 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, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the liouseliold 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 dlomestie 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 ocou- pation whatever, wiite 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 "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber- .


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, cte., 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 (disease causing deatlı), 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," "Shoek," "Uracmia," "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.


M


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.


.


County. Township City 3 SEX 7 AGE Years (a) Trade, profession, or PARENTS 14 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, .. - N. B. - WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD. Every item of information should be (b) General oature of industry, business, or establishmeot in which employed (or employer) (c) Name of employer


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


Itinchrok (City or town)


1 PLACE OF DEATH


State


Prasz


Registered No.


or Village.


or


No. 218


Summerset are


St.,


.Ward


(If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


A sage M Brockbank


(If in the Army of Navy of the United States, give rank, organization, etc.)


(a) Residence.


No. 214 SummerselGie


St.,


Ward.


(Usual place of abode)


Leogtb of residence io city or town where death occurred


2


years


mooths


days.


How long io U. S., if of foreign birth ?


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


male White


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Married


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


Beasie


6 DATE OF BIRTH (month, day, and year)


Months


Days


2.3


If LESS than 1 day, ........ hrs. or ....... min.


8 OCCUPATION OF DECEASED


particolar kind of work Great


9 BIRTHPLACE (city or town)


(State or country)


Congland


10 NAME OF FATHER Isaac Brooklands


11 BIRTHPLACE OF FATHER (city or town)


(State or country)


England


12 MAIDEN NAME OF MOTHER 6 Ginio Juavion


13 BIRTHPLACE OF MOTHER (city or town). (State or country) England


Informant Bessie, Brockbank (Adress) 2CK Summerset Come Danthon


15 Filed na , 19/


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH (month, day, and year) March 111 1919


17 I HEREBY CERTIFY, That I attended deceased from Jan 78 19.45 March 11 19 19. to


that I last saw his alive on


march


10th, 19/19.


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


The CAUSE OF DEATH* was as follows:


.


(duration)


3


yrs.


......


.


mos.


ds.


CONTRIBUTORY


(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 ?.


Chmiel


What test confirmed diagnosis ?


(Signed)


, 19/ (Address)


32 Monument My Charleston


M.D.


* 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.)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL Word Sown amatory


DATE OF BURIAL


March 14019


20 UNDERTAKER


ADDRESS


Somerville


mara


(If non-resident give city or town and State)


2.30 0 m.


[Approved by U. S. Census and American Public Health Association] U. S.


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 terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive cngincer, 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial 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 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 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 same disease. Examples: Cerebrospinal fevcr (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (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 use of "Tumor" for malignant 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 (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (inerely 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 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, or HOMICIDAL, or as probably such, if impossible to de- terinine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of hcad - homicide; Poisoned by carbolic acid - probably suieidc. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated


unluer the head of "Contributory. (Recommendations on statement of eause 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, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strcct, or one supposed to be due to Alcoholism, etc.


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


ADDITIONAL SPACE


FOR FURTHER STATEMENTS BY


PHYSICIAN.


R 15. 2-'18. 100,000.


1


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1919.


CITY OF BOSTON


3319


FULL NAME


Place of Death


Boston


NEW ENGLAND HOSPT.


Date of Death


MAR. 13


1919,


Age 29


years


months days.


STATISTICAL DETAILS.


SEX.


COLOR


SINGLE, MARRIED, WID., DIV.


F


W


M


Maiden Name


MA LONEY


Husband's Name


WILLIAM NOLAN


RE


Bus Primary (Duration)


CITY


.S


OFFICE


4 DAYS -- OPR .MAR. 7.19


Birthplace


BOS TON


Name of Father


FRANK MALONEY


Birthplace of Father


----- N. Y.


Maiden Name of Mother


MARIA T.KIERNAN


Birthplace of Mother


CHELSEA


Occupation


AT HOME


Informant


Place of Burial or removal


MALDEN ( HOLY CROSS)


Undertaker


J.F.O MALEY


WINTHROP


Date of Burial


MAR.16


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness


from 1919, to


1919, 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:


TRAR


PELVIC PERITONITIS-SEPTICAEMIA


THING. DONAT A.


S S.


Contributory : (Duration)


SEPTIC INFECTION -- 5 DAYS


(Signed)


F.S.NEWELL M.D.


MAR . 13 1919


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


WINTHROP ( 118 BARTLETT RD)


Usual


Residence


Filed


A true copy.


Attest :


MAR. 15


EumSeinen


1919


Registrar.


LLA


BOSTONIA


0.1822.


1630.


8


STON.


ANNA NOLAN


Registered No.


PATRIB


1


-


The Commonwealth of Massachusetts


CERTIFICATE OF DEATH OF NON-RESIDENT


( City or town)


1 PLACE OF DEATH


Registered No ..


(Place of death)


County


...........


Granbelin


State Muss.


- 196 Main No ..


City or Town


(If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


(a) Residence. State


(Usuai place of abode)


Length of residence io city or town where death occurred - years - months 10 days


How long Ão/U. S., if of foreign birth? years


-months


days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


ez


e


4 COLOR OR RACE


5 SINGLEZ MARRIED, WIDOWED, OR


DIVORCED (write the word)


tungle.


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


-


6 DATE OF BIRTH (month, day, and year) May 16 1912


7 AGE 4 Years / C) Months


-


If LESS thao


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


of ....... mio.


If STILLBORN, enter that fact here


8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kiod of work


(b) General nature of indostry, business, or establishment in which employed (or emplsyer) .....


(c) Name of employer


(duration).


Taxaemail


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


.. mos ........


6


ds.


CONTRIBUTORY


(SECONDARY)


(duration) ......... yrs. ............... mos. ds.


18 Where was disease contracted if not at place of death?


Did an operation precede death ?.


115 Date of


-


Was there an autopsy ?.


715


12 MAIDEN NAME OF MOTHER Many Talt Tenis What test confirmed diagnosty 0 -


13 BIRTHPLACE OF MOTHER (city or town) ...


(State or country)


(Sigoed)


M.D.


17.199(Address)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL May/2019


ADDRESS


20 UNDERTAKER tto Jamsey, Orange


of certificate.


14


Informant


Johna Mañana


(Address)


15


Registrar of city or towo where death occurred


Fil apr .7 1919


Registrar of city or town where deceased resided


16 DATE OF DEATH (month, day, and year)


19


17 I HEREBY CERTIFY, That I attended deceased from Mar 14 1919, to Mun 15, 1919. to .


that I last saw h RY alive on


May 15, 1919.


5-3500


and that death occurred, on the date stated above,


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.) if therew-


9 BIRTHPLACE (city or town)


(State or country)


10 NAME OF FATHER Allam &Mahoney


11 BIRTHPLACE OF FATHER (city of town)


(State or country)


PARENTS


N. B. - WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD. Every item of information should be so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,


Registered No.


(Place of residence)


St., Ward


(If in the Army or Nasy of the United States, giye rank, organization, etc.)


City or Town .. Minthawn 211 Court C/d


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, e. 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) Cotton mill; (a) Salcsman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may forin part of the second statement. Never return "Laborer," "Foreman," "Manager," " Dealer," ete., without inore 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 lave no occupation whatever, write None.


Statement of cause of death .- Name, first, the DISEASE CAUSING DEATHI (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (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 ucoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Mcasles (discase causing death), 29 Gs .; Broneho- 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- "Exhaustion," genital," "Senile," etc.), "Dropsy," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all discases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ctc. State cause for which surgical operation was undertaken. For VIOLENT DEATHIS 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 acil - probably suicide. The nature of the injury, as fracture of skull, and consequences (c. g., sepsis, tetanus) may be stated




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