Town of Winthrop : Record of Deaths 1919-1921, Part 9

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 9


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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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, 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 disease unrelated to any form of injury.


(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 sgents, 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.


N. B .- Every Item of information should be carefully supplied. AGE should be stated EXACTLY, PHYSICIANS should stato PARENTS


1 PLACE OF DEATH


DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS


STANDARD CERTIFICATE OF DEATH


State of "Maxta , hugill,


Registered No.


Dx Betal


Ancexs Maxst .;


farcis


PERSONAL AND STATISTICAL PARTICULARS


Niciple


28 1886


(Day)'


(Year)


If LESS than


1 day .____ hrs.


or .___. min. ?


7C. S. Truy


10 NAME OF


FATHER


Unknown


13 BIRTHPLACE


OF MOTHER


(State or country )


Unknown


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


Flied


Feb. 14, 1919 Eulalie Churchil


aset


REGISTRAR


11-3184


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


7.G


(Month)


(Day) (Year)


17 I HEREBY CERTIFY, That I attended deceased from Le b. 8 191_2., to


7.G.


9


1914,


that I last saw h.Lus alive on 191.2 and that death occurred, on the date stated above, at 2:00Pm.


The CAUSE OF DEATH* was as follows: cApendicitis acute Outputive Renforts, fennel ricute


(Duration)


yrs.


mos.


ds.


Contributory ..


Brancho pneumonia


(SECONDARY)


(Duration)


yrs.


ds.


mos.


(Signed)


ed) Caff 13 m Latta MICH, D.


Sens, 1919.


(Address)


7+13 and man


* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS OF INJURY ; and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS)


At place


of death


yrs.


mos


___ ds. State


In the


. yrs,


mos.


ds.


Where was disease contracted,


if not at place of death ?


But man


Former or


usual residence ..


19 PLACE OF BURIAL OR REMOVAL DATE OF BURIAL Thathref Lean, fornals Het, 14, 199


20 UNDERTAKER


ADDRESS


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


County


Juffor 1


Township


or


Village


or


City


(NO .- +


2 FULL NAME


3 SEX


4 COLOR OR RACE


Tthite


male.


5 SINGLE,


MARRIED.


WIDOWED.


OR DIVORCED


( Write the word)


6 DATE OF BIRTH


(Month)


7 AGE


yrs.


8 OCCUPATION


Lo Coli


(a) Trade, profession, or


particular kind of work


(b) General nature of Industry.


business, or establishment in


which employed (or employer)


9 BIRTHPLACE


Mo.


(State cr country)


11 BIRTHPLACE


OF FATHER


(State or country)


12 MAIDEN NAME


OF MOTHER


(Informant)


Service fee


(Address)


15


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very


32


9


mos.


11


ds.


important. Soe instructions on back of certificate.


[If death occurred in a hospital or Institution, give 'ts NAME Instead of street and number.]


Ward)


1914


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 ean be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, 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) Forcman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," " Dealer," etc., withcut more precise specification, as Day laborer, Farm laborer, Luborer-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, 0" 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, ete. 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 oceupation whatever, write None.


Statement of cause of death .- Name, first, the DISEASE CAUS- ING DEATHI (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 synonyın is "Epidemie_cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefi- nite); Tuberculosis of lungs, meninges, peritonaeum, etc., Car- cinoma, Sarcoma, etc., of . - (name origin; “Can- cer" is less definite; avoid use of " Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The con- tributory (secondary or intercurrent) affection need not be stated unless important. Example : Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal condi- tions, such as "Asthenia," "Anaemia" ( merely symptom-


.


atie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inani- tion," " Marasmus," "Old age," "Shoek," "Uraemia," "Weakness," ete., when a definite disease can be ascer- tained as the cause. Always qualify all diseases result- ing from eliildbirth or miscarriage, as "PUERPERAL septi- chaemia," "PUERPERAL peritonitis," etc. State eause 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 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) 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. )


NOTE .- Individual offices may add to above list of undesirable torms and refuse to accept certificates containing them. Thus the form in uso in Now York City states: "Certificates will be returned for additional information which give any of tho following discases, without explanation, as tho sole cause of death: Abortion, cellulitis, childbirth, convulsions, hacmorrhage, gangrene, gastritis, erysipelas, meningitis, miscarriago, necrosis, peritonitis, phlebitis, pyacmia, septichaemia, tetanus." But general adoption of the minimum list suggested will work vast Improvement, and its scope cau be extended at a later date.


11-3181


-


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1919.


CITY OF BOSTON


FULL NAME


STANLEY S.RIGG


Place of Death


Boston


Date of Death


FEB. 10


1919,


Age


13


years


months


11


days


STATISTICAL DETAILS.


SEX.


COLOR


SINGLE, MARRIED, WID., DIV.


M


W


S


Maiden Name


Husband's Name


Birthplace


FORT WARREN


Name of Father


ASAAC H.RIGG


Birthplace of Father


BELMONT . ILL.


Maiden Name of Mother


ETHEL CRUMMERS


Birthplace of Mother


GREENBAY.WIS.


Occupation AT SCHOOL


Informant


Place of Burial or removal


MALDEN (FORESTDALE )


Undertaker


W. C. SKAGGS


Date of Burial


WINTHROP


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:


STRAR


PATRIBIS


Primo


R (Duratipro


CITY


SAOBIS 8


OOFFICE


BOSTONIA CONDITAA.


20. 1622.


TON Contributory: { GENERAL SEPTICEMIA


(Signed)


S.A.CLEMENT


M.D.


FEB.10


1919


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


IN HOSPT.12 DAYS


Usual


Residence


WINTHROP (59 LEWIS AVE)


Filed


FEB. 13


1919


A true copy.


Attest :


Registrar


SCARLET FEVER -35 DAYS


LEFT MASTOIDECTOMY JAN.31 .1919


18.30.


COMMINE DONATAA


MASS.


(Duration)


Registered No. 2 082


MASS . HOME O. HOSPT .


Tel. 10, 1919


-


.


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, N. B. - WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


BOSTON (City or town)


1 PLACE OF DEATH


County


Suffolk


State


Massachusetts


Registered No.


Township


Nawabrok


City


BOSTON


No.


or Village 14 Perking


St ...


Ward


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


2 FULL NAME


Midação. Chase


(If in the Army or Navy of then


(a) Residence.


No. 14 Jerking


(Usual place of abode y


Leogth of residence in city or town where death occurred


years


mouths


5


days.


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


years


mooths


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


W


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Single


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


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


7 AGE


Years


33


Months


3


Days


13


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


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


Sales Lady~


(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 Nevy 8 Chan


11 BIRTHPLACE OF FATHER (city or town)


Reconetocon


(State or country)


12 MAIDEN NAME OF MOTHER alma Leuning Round


13 BIRTHPLACE OF MOTHER (eity or town).


Edgecomb


(State or country)


14


Informant


14 Perkins st


(Address)


15


Filed Feb.13, 1919 Enlahp Churchill


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


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


1919


17


! HEREBY CERTIFY, ThatCP attended deceased from


Jelen


10


Jelen 11


1919.


1919


, to


that I last saw h.


alive on


Jeby 11-


19.19.


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


m. The CAUSE OF DEATH* was as follows : 1 Influenza Pneumonia


(duration)


3


,


mos ..


ds.


CONTRIBUTORY


(SECONDARY)


(duration)


.yrs ..


mos.


ds.


18 Where was disease contracted


if not at place of death?


FOR WHAT ?


Did an operation precede death ? !


Date of


Was there an autopsy ?


What test confirmed diagnosis ?


Stethoscope t


(Signed)


HorecaE Bugaon


M.D.


+11, 199 (Address)


* State the DISEASE CAUSING DEATH, or in deaths front 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


Georgetown UNE


DATE OF BURIAL 2-14 1919


20 UNDERTAKER


ADDRESS


.or


MATization, etc.)


St.,


Ward.


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


yrs.


PARENTS


Thalsou


U


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


Statement of occupatien. -- 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, Architeet, 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) 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," ete., 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- eifieally the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. It 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 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 ferer (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- hed, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, cte., of_


(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping. cough; Chronie 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 .; 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- mus," "Old age," "Shock," "Uremia," "Weakness," ete., when a defmite disease can be ascertained as the cause. Always qualify all diseases resulting from ehild- 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; Strvek 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 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 Lay's 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, ete.


2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, ete.


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.


R 15. 1-'18. 100,000.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1919.


DOUGLAS H. FULLERTON


FULL NAME


Registered No.


2236


257 EVERETT ST.


Place of Death


Boston


Date of Death


FEB . 13


1919,


Age


51


years months days


STATISTICAL DETAILS.


SEX.


COLOR


M


W


SINGLE, MARRIED, WID., DIV. DIV.


Maiden Name


Husband's Name


Birthplace


WINDSOR. N.F.


Name of Father


ASHEL FULLERTON


Birthplace of Father


Maiden Name of Mother


Birthplace of Mother


Occupation FISHERMAN


Informant


TRAR


PATRIBES Primary ( Duration


LOBAR PNEUMONIA


CITY


SICU =


SOBIS


BOSTONIA


CONDITA MA


CGIMINE DONATA


STON MASS.


Contributory: { (Duration )


INFLUENZA -- 2 DAYS


(Signed) E.E.BOWEN M. D.


1919


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


Place of Burial or removal WINTHROP (WINTHROP CEM) Usual


Residence WINTHROP(SNAKE ISLAND)


Filed 1919.


A true copy.


Attest :


FEB.17


Date of Burial


HUND 211914


Registrar.


Undertaker


F.A.MAGRATH


CITY OF BOSTON


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness 1919, 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:


A. 1822


tel. 13, 1919


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, N. 6 .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


Want


(City or town) 32 Registered No.


Township


Festboro


or Jate Hospital


or


City.


.........


No.


St ..


Ward


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


Mary V.Piper


2 FULL NAME


.55 Somerset Avo.


St.,


.Ward.


Winthrop Mass.


(a) Residence.


No.


(Usual place of abode)


(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 SEKerale


4 COLOK OR RACE


5 SINGLE, MARRIED, WIDOWED, OR MaIMMORCED (write the word)


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


-


-


1865


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


Housewife


(a) Trade. profession, or


particular kind of work


--


(b) General nature of industry,


business, or establishment in


which employed (or employer)Haverhi11


(c) Name of employer


Mass.


9 BIRTHPLACE (city a OtoWE B. Bartlott


(State or country) Nottingham


10 NAME OF FATHER N.H.


PARENTS


11 BIRTHPLACE OF FATHER (city of tooley


(State or country)


Nottingham


12 MAIDEN NAME OF MOTHER N.H.


13 BIRTHPLACEJOB MOTHER CityRecords.


(State or country)


Westbare Mass


14


Informant


(AddrSeb. 18 1919


15 mich. 5 , 1919 Eulalie Churchill asst REGISTRAR


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


L.P.Conant


Westboro 19


20 UNDERTAKER


ADDRESS


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


19


17


I HEREBY CERTIFY, That I attended deceased from


00


19.4 .... , to.Feb. 17


119


that I last saw


or


alive on


,19.


Feb. 17


19


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


6.55' *


m.


The CAUSE OF DEATH* was as follows :


Chronic Myocarditis


Chroni@interstitialos.


ds.


CONTRIBUTOREIS


(SECONDARY)


(duration)


...... yrs ..


mos.


ds.


18 Where was disease contracted


if not at place of death?


no


Did an operation precede death ?


Date of.


Was there an autopsy ?.


no


What test confirmed dignplan


(Signed)


Testboro Mass.


I.D.


, 19


Adres) 18


1919


* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, Or HOHICH E. (See reverse side for additional space.)


DATE OF BURIAL 19


1 PLACE OF DEATH


County


Worcester


State ...


Mass.


MEDICAL CERTIFICATE OF DEATH Feb 17 1919


REVISED UNITED STATES STANDARD CERTIFICAIL [Approved by U. S. Census aud 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 terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architcet, Locomotive engincer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Forcman," " Manager,' "Dcaler," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal minc, etc. Women at home, who are engaged in the dutics of the household only (not paid Housekccpers who receive a definite salary), may be cutercd 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 Scrvant, 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 tiine and causation), using always the same accepted term for the same discasc. Examples: Cerebrospinal fcver (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphthcria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, etc., of.


(name origin; "Cancer" is less definite; avoid use of "Tunnor" for malignant neoplasmns); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Mcasles (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," "Wcakncss," etc., when a definite disease can be ascertaincd as the cause. Always qualify all discases 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 suicidc. The nature of the injury, as fracture of skull. and consequences (c. g., sepsis, tetanus) may be stated


under the head of "Contributory. 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.




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