USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 6
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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: Cerc- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never rsport "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indsfinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of .......... (name origin; "Cancer" is less dsfinits; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. Ths 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," "Ansmia" (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 diseasss resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.
State cause for which surgical operation was undertaken.
(Recommendations on statsment 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 dicd [defined so that it can bs classified under the international classification of causes of death], where contracted, the duration of his last illness, when last scen alive by the physician, and the date of his death. . . . - Reviscd Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.
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 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 required 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 lisu 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 physician 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 Laws, Chap. 78, Sec. 38.
Medical examiners shall, in all cases, certify to the city or town clark or to the city registrar in the place where the deceased died, his name and rssidsnce, 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 practics:
(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 disd without recent medical attendance or whose physician is absent from home when the certificate of death is necded.
(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 dissase resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1919.
CITY OF BOSTON
FULL NAME
FRANK ALDEN
Registered No.
1540
Place of Death
Boston
Date of Death
JAN.27
1919,
Age
57
years
months days
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
M
Maiden Name
Husband's Name
Birthplace
VINEYARD HAVEN
Name of Father
JOHN ALDEN
Birthplace of Father MIDDLEBORO
Maiden Name of Mother
HEPSEY PEASE
Birthplace of Mother VINEYARD HAVEN
(Signed)
E.P.HOWARD M.D.
1919
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
WINTHROP
Undertaker C.R.BENNISON
Date of Burial
WINTHROP
Usual
Residence
WINTHROP (22 HARVARD ST)
Filed
JAN.30
1919.
A true copy.
Attest :
EumSeinen
Registrar.
MARGIN RESERVED FOR BINDING.
PHYSICIAN'S CERTIFICATE.
1919, I HEREBY CERTIFY that I attended deceased during last illness from 1919, to 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:
R
A A
Is Primary
R
8.0B18
SOFFICE
BOSTONIA CONDITA A
4. 1822
1650.
GIMINE DONATA D
STON.
MASS.
Contributory : (Duration )
ACUTE PERITONITIS-DAYS
CITY
( AUTOPSY )
CARCINOMA STOMACH -1 MONTH
Occupation
WATCHMAN
Informant
PETER BENT BRIGHAM HOSPT .
Jan. 27, 1919
Form R-302
The Commamuralth of Massachusetts
MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
(ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTER 24)
County
Suffolk
State
mass
Registered No ..
City or Town
Winthrop
.. 1
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Ward
2 FULL NAME.
angus Mac Donald
(If in the Ariny or Navy of the United States, give rank, organization, etc.)
St.,
Ward.
(If non-resident give city or town and State)
Length of residence in city or town where death occurred
years
months
days
How long in U. S., if of foreign birth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
White
5 SINSLE, MARRIED, WIDOWED, OR
DAVORCED (writgthe word)
Single
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
(Month)
('Day)
(Year)
7 AGE
Years
Months
Days
If LESS than
1 day ........ brs.
or ....... min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
Silverplated.
Waltham
9 BIRTHPLACE (City)
(State or country)
mass.
10 NAME OF
FATHER
James ?
PARENTS
11 BIRTHPLACE OF
FATHER (City)
(State or country) Nova Scotia
12 MAIDEN NAME
margaret Normal
OF MOTHER
13 BIRTHPLACE OF
MOTHER (City)
Ochener goch.
(State or country)
14 Sarah Holland.
Informant
(Address)
100 manhall St Machen
15
Filed ..
(Month) (Day) (Year)
REGISTRAR
21 Burial permit
issued by
Official position
MEDICAL CERTIFICATE OF DEATH
Four Paws
28
(Day)
1919
(Year)
17
I
HEREBY CERTIFY, That I have investigated the
death of the person above-named and that the CAUSE AND MANNER
thereof are as follows :
asphyxiation by drowning.
Presumably accidental.
7
(Scc reverse side for additional spacc)
18 Where was injury sustained
if not at place of death?
(Signed)
W 8 Watters
M.D.
(Address)
80E. Concord St
Medical Examiner for
Suffolk County
Date
4, au. 29.
1919
( Yeary
(Month)
(Day)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Calvary Waltham
20 UNDERTAKER
John + Oj maley
22 Date of issue
DATE OF BURIAL
/ 29 1919
(Month) (Day) (Year)
ADDRESS
Winthrop
See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
should be carefully supplied. AGE should be stated EXACTLY. MEDICAL EXAMINERS should state CAUSE OF
MARGIN RESERVED FOR BINDING N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information 0- 10. 10,000.
9243
Ingleside PR Playground St.
(a) Residence. No. Ao marshalli St.
(Usnal place of abode)
16 DATE OF DEATH
(AI onth)
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 stand- ard 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.
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 elerk 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 containing the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate 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 vio- lence, the medical examiner only shall make such certificate. . . . The person to whom the permit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary infor- mation which can be obtained as to the deceased, or as to the manner or eause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.
Medieal examiners shall, in all cases, certify to the city or town elcrk 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 sup- posed 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 duting 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 discase 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 supposably 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.
STATEMENT OF CAUSE OF DEATH
For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head-homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) should also be stated.
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have come to his death by violence, until a permit in writing, signed by the Medical Examiner, has first been obtained. - Revised Laws, Chap. 24, Sec. 20.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
Jan. 28, 1919
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(City or town)
A
1 PLACE OF DEATH
County
State
Registered No .....
Township
or Village
.or
No. 5%,
If death occurred in a Hospital or institution, give its NAME instead of street and number)
2 FULL NAME Elheren
Galina
If in the Army or Navy of the United States, give rank, organization, etc.)
Ward.
(If non-resident give city or town and State)
months days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Chile
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
6 DATE OF BIRTH (month, day, and year)
7 AGE
Years
Months
Days
If LESS than 1 day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or particular kind of work /1.04
(b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
9 BIRTHPLACE (city or town)
(State or country)
10 NAME OF FATHER HER Michael Jahin
PARENTS
11 BIRTHPLACE OF FATHER (city of town)
(State or country)
12 MAIDEN NAME OF MOTHERE Chemme Hanne
13 BIRTHPLACE OF MOTHER (city or town) ... (State or country)
14
Informant
(Address)
15 Filed 2-31 19
U
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) ( an ) c 19/2
17 I HEREBY CERTIFY, That I attended deceased from 50 1919, to 7 30 19.17.
-
that I last saw h . alive on
30
, 19 19 17
and that death occurred, on the date stated above, at
10.300 m.
The CAUSE OF DEATH* was as follows:
Cardiac dilatation
(acute)
(duration)
yrs.
mos.
/2 ds.
CONTRIBUTORY
Double Mitral Cesion
(SECONDARY)
(duration)
20
.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 ?
1
What test confirmed diagnosis?
(Signed)
M.D.
1/3/19/9 (Address) 362 Shaben So Will
* 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
DATE OF BURIAL
1919
20 UNDERTAKER
Yes.
ADDRESS
$0.201.1
MARGIN RESERVED FOR BINDING
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.
City
Ward
(a) Residence. No .. (Usual place of abode) Length of residence in city or town where death occurred years
months
days.
How long in U. S., if of foreign birth ?
years
102
13
YISED UNITED SIP DIATES 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 healthifulness 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 enginecr, 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 ina- 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 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 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 need not be stated unless important. Example: Measles (disease causing death), 29 Gs .; Broneho- pneumonia (secondary), 10 ds. Never report mere syinp- 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,""Tremia," ," "Inanition," "Maras- mus," "Old age," "Shock," "Weakness," ete., 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," ete. State cause for which surgical operation was undertaken. For VIOLENT DEATIIS 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, 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 street, or onc 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. 1-'18. 100,000.
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.
14
Informant
(Address)
726 Santos
86 Boston
15
File Jeb. 10., 1919.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and ycar)
19 19
3 SEX
F
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
W-
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Zom L. Sweeney
6 DATE OF BIRTH (month, day, and Fear) Nov. 1301854
7 AGE
Years
64
Months
2
Days
19
If LESS than
The CAUSE OF DEATH* was as follows :
1 day, ........ hrs. or ........ min. Chrome Endo carditis
1
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
at Home
. (duration)
3
yrs.
.. mos ..
ds.
CONTRIBUTORY
Cliente articular
Rheumat
(duration)
2
mos.
ds.
............... yrs ...
9 BIRTHPLACE (city or tout
6. Boston
(Statc or country)
mare
10 NAME OF FATHER
George & Shimmer
11 BIRTHPLACE OF FATHER (city or town
(State or country)
une
12 MAIDEN NAME OF MOTHERSauch E. Hanlay
13 BIRTHPLACE OF MOTHER (city or town)
(State or country)
Lass,
Salen
* 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
Harmony Grove i'm
Salem
DATE OF BURIAL
Feb2/ 2019
20 UNDERTAKER
O.g. Rolling
ADDRESS
6. Boatin
MARGIN RESERVED FOR BINDING
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
....
(City or town)
1 PLACE OF DEATH
County
- 4
State
mare
Registered No .....
Township
City
No. 40
,
or Ville
River Road
St.,
Ward
or
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Fannie K. Sweeney
(a) Residence.
No ..
40 Riverroad &
St.,
Ward.
(Usual place of abod. . )
Leogtb of residence io city or town where death occorred
-
years
months -
days.
How long in U. S., if of foreign birth ?
years
mooths
days
17
I HEREBY CERTIFY, That I attended deceased from
Out
1
19 18, to
Fib
,19 ... 19
that I last saw h
alive on
Feb
1
19 .. ₺ 9.
and that death occurred, on the date stated above, at
SP
m.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ? ho
Date of ..
Was there an autopsy ?
ho
What test confirmed diagnosis ?
Sounds-Inlayment
I.I.D.
Fil 2 1919
dress) 726 Saralaya Sp
(Signed) .....
Portland
PARENTS
(b) Generaloature of industry, bosiness, or establishmeot in which employed (or employer) (c) Name of employer
-
PERSONAL AND STATISTICAL PARTICULARS
(If non-resident girc city or town and State)
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 healthifulness 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- ilor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, ete. 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 ina- terial worked on may form part of the second statement. Never return "Laborer,"
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