USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 171
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
2 FULL NAME
Angelina Melillo
(a) Residence.
No. 1 Johnson Terrace St.
(Usual place of abodey
Length of residence in city or town where death occurred
1
years
months
days.
How long in U. S., if of foreign hirth ?
35
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female White
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Widow
56 If married, widowed, or divorced
HUSBANDOf
(or) WIFE of
Emanuele Melillo
1849
6 DATE OF BIRTH
(Month)
(Day)
(Yedry
If LESS than
Years
72
Months
Days
X
1 day, ........ hrs.
or ....... min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
Domestic
(h) Name of employer
9 BIRTHPLACE (City)
(State or country)
South America
10 NAME OF
FATHER
Unknown
11 BIRTHPLACE OF
FATHER (City)
Italy
(State or country)
12 MAIDEN NAME
OF MOTHER
Unknown
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
14
Informant.
Jennie galassi (Daughter
(Address)
15
Game 29 1921
(Month) (Day) (Year)
wirthrax mass .......... REGISTRAR
21 / HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
S.a. mowy
Official . position.
i Health Office Date of issue icevol permit. June 15 No. 288
roston
Permit
5,000. Y'XM.
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 and extracts from the laws on back of certificate.
PARENTS
What test confitmed diagnosis ?
Stethoscope +
(Signed) JOTack Egglangdon.
M.D.
(Address).
7 Central tape Boston
Date.
Jane
14
1924
Year)
( Month)
( Day)
DATE OF BURIAL
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
7 Holy Cross - Malden
Cemetery
(City or town)
20 UNDERTAKER
Angelo Jannini
mos.
1 ds.
(SECONDARY)
yrs ....
(duration)
.......
.mos ..
16
-ds .
18 Where was disease contracted
if not at place of death ?
FOROSHAT?
Did an operation precede death ?.
to Date of
Was there an autopsy ?
no.
.
m.
The CAUSE OF DEATH was as follows:
acute Dilatation of Heart.
13 th 1921-
(Day)
-
17
HEREBY
CERTIFY, That
attended deceased from
June 3
21
June 13
1921
...
?
thanI last saw
alive on
June 12
1. 21.
and that death occurred, on the date stated above, at
C
x
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
Winthrop- Mass
BOSTON
(City or Town)
Winthrop - Mais
....
(If in the Army or Navy of the United States, give rank, organization, etc.)
Ward.
(If non-resident give city or town and State)
16 DATE OF DEATH
Donne
7 AGE
CONTRIBUTORY
acute Bronchitis
(dur Gon)
June 15= 1921
ADDRESS
215 North 82
10
June 13, 1921 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 cachi and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, o. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, 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 necded. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Forcman," "Manager," ""Dcaler," etc., without more precise specification, as Day laborer, Farm laborcr, Laborer -- Coal mine, ete. Women at home, who are engaged in the duties of the house- hold only (not paid Hlousekccpers who receive a definite salary), may be entercd 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 CAUSINO 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 discasc. Examples: Cere- brospinal fever (the only definite synonyni is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, 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 (discase causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely 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 diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.
State cause for which surgical operation was undertaken.
(Recommendations on statement of cause of death approved by Com- inittec 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, erysipeias, 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 discasc of which he died [defined so that it can be classified under the international classification of causes of death], where contractcd, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 522.
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 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 pcr- mit is so given and the physician who certifies to the cause of death shall thereafterfurnish 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 Laws, 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 dicd, 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 Laws, Chap. 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 discase 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, tho sudden deaths of persons not disabied by recognized disease, and those of persons found dead.
R-302
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
Chelsea
(City or town)
Registered No.
353
(Place of death)
93
Registered No.
(Place of résidence)
St.,
Ward
( If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
George P. Packard
(a) Residence. State.
Lass.
City or Town.
Winthrop
(If in the Army or Navy of the United States, give rank, organization, etc.)
(Usual place of abode)
Length of residence in city or town where death occorred
years
months
days
How long io U. S., if of foreign hirth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Ma le
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
marr 10 c
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
jlice Tackaro
6 DATE OF BIRTH (month, day, and year) Auf . 27'1868
7 AGE
Years
52
Months
9
Days
18
If LESS thao I day, ........ hrs. or ........ min.
7
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, professioo, or
particular kiod of work
Builder
(b) Name of employer
9 BIRTHPLACE (city or town)
Ro unton
(State or country) MEB3.
10 NAME OF FATHERGeorge W. Packard
PARENTS
11 BIRTHPLACE OF FATHER (city or town fast on
(State or country)
Mass.
12 MAIDEN NAME OF MOTHER Elizabeth Norris
So . Boston
13 BIRTHPLACE OF MOTHER (city or town)
(State or country)
Mass.
14
Ralph H. Hanaford
Informant
(Address)
497 Pleasant St. ,winthrop
15
Filed June 15,21 200. Registrar of city or town where death occurred Firea une 24, 19 21
Registrar of city or town where deceased resided
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
June 14
17
I HEREBY CERTIFY, That I attended deceased from
Juno 11
19
June 14
21
21
to
19
that I last saw h.
im alive on
Ture 14
19
and that death occurred, on the date stated above, at
2.202.
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.)
Centrenous appendix.
General Peritonitis.
(duration)
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 ?.
Ve S Date of
June 11'21
Was there an autopsy?
What test confirmed diagnosis ?.
(Sigoed)
Harvey. Kelly
M.D.
, 19
(Address)
200 Tle asant
St. Winthrop
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Testville, Taunton
DATE OF BURIAL
June 16
19
21
20 UNDERTAKER J. S. Waterman & 3018
ADDRESS
ostor
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 statement 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,
of certificate.
3-'19. 25,000
1 PLACE OF DEATH
County
Suffolk
State. Mass.
City or Town
......
Chelsea
.No.
Frost Hospital
No.
497 Pleasant
St.
21
19
14, 1971 73
1 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 cngincer, Civil engincer, 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, Laborer - Coal minc, 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 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 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 neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection necd not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broneho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Ancmia" (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, 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 (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 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, Homieide, 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 street, 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.
M R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County.
Suffolk
City or Town ... Winthrop
State Massachusetts.Registered No.
St., ....... Ward
No.3.0.
Atlantic:
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Harriet Spofford Martin
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No. 30 Atlantic
( Usual place of abode)
Length of residence in city or town where death occurred
I3 years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
widow
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Lorenzo D. Martin
(Month)
(Day)
(Year)
7 AGE
Years
Months
Days
If LESS than
1 day, ........ his.
n
28
If STILLBORN, enter that fact here
or ...... min. Rectal Carcinoma,
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Name of employer
9 BIRTHPLACE (City)
Rockland
(State or country)
Wring
10 NAME OF
FATHER
Taaah. D. Ulaan
11 BIRTHPLACE OF
FATHER (City) ....
(State or country)
12 MAIDEN NAME
OF MOTHER
Mary Hosmer
13 BIRTHPLACE OF
MOTHER (City)
Camden
(State or country)
Maine
Informant
Frank .E ....... Martin
(Address) 11Q Brighton
Ave. Allston
15
June 29,1991
(Month) (Day) (Year)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
17
(Day )
192%. (Year)
17
I HEREBY CERTIFY, That I attended deceased from
may 20
, 19.26,10
Same 1.7
, 192./ ...
that I last saw
alive on
/ , 1921. and that death occurred, on the date stated above, at 10:302 m. The CAUSE OF DEATH was as follows :
(duration)
yrs ....
6
mos ......
ds.
CONTRIBUTORY.
(SECONDARY)
(duration)
.. yrs h
mos.
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?..
200
Date of
Was there an autopsy ?
200.
What test confirmed diagnosis ?.... Willandloy, , M.D. (Signed)
(Address)
34 Princeton R.
6.72óta
Date Samme 17
( Month)
( Day)
1921.
(Year)
DATE OF BURIAL
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Woodlawn Cemetery
(Cemetery)
Everett
(CRv or town)
20 UNDERTAKER
Horace i Ente ved.
ADDRESS
Cambridge
nie.
21 I HEREBY CERTIFY that a satisfactory stan- Ward certificate of death was bled with me BEFORE the burial or transit permit was issued ... J. K. Maury
Oficial Leabel Officer
Date of issue 6/18/21
Permit
No. 289
3 SEX Female 6 DATE OF BIRTH PARENTS 14 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH 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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD. Every item of information 33
. 20,000.
(City or Town)
94
.St.
. Ward.
(If non-resident give city or town and Statc)
20
T833
74
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 age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cascs, 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 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, ete. 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 domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSINO 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 "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, 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 .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Ancmia" (merely 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 diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.
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 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, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.
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.