Document YDqN2X5e5KVkzMGjqJwYj6XQy

UNITED STATES STANDARD CERTIFICATE OF DEATH ----------------------------- i Statement of occupation.--Precise statement of occupation is very important, so that the relative healthfulncss of various pursuits can be known. Make some entry in this section for every persomjLS^ 10 years or over. If the occupation has been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a. woman whose occupation was that ofhome housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper--private family, cook--hotel, etc. For a person who had no occupation whatever write none. To be complete, an occupation return must state: | 8.--The trade, profession, or particular kind of work done. 9,--The industry or business in which the work was done. 10.--The month and year the deceased last worked at the occupation., 11.--The number of years the deceased followed the occupation. In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the particular kind of work done and return that, as spinner, weaver, etc. In stating the industry or business, avoid the use of sush general terms as "store," "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc. Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, milling engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic," but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk. _ _. Statement of cause of death.--Cause of death means the disease, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and anyimportant complication of the principal cause. Under contributory causes of importance not related to principal cause, name otherimportantdiseases or injuries. Examples: EXAMPLE I EXAMPLE II The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis Date of onr.fl 1915 The principal cause of death and related causes Dale of oawt of importance in order of onset were as follows: Attack of epilepsy I week ago Chronic interstitial nephritis 1921 linn over by street car 1 week ago Cerebral hemorrhage July 5,1927 Peritonitis 3 days ago - Contributory causes of importance not related to principal cause: Fracture of arm Contributory causes of importance not related to principal cause: Influenza 6 weeks ago Automobile accident May 3.1927 . In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in each of the above examples happens to be the second cause given. ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN RESERVED FOR B IN D IN G m-i -d Sn3 '"*3 O Ww z Q oos u1 esu id W !* 33 2 (A - "i s^ ,,XJ id W "3 . * T3 g !!! I jag> *o- Ho 1 S 6* S2 gW X c o- O <-s a <*! Up B*iJ 5 Ha z 3 1 < W .1 HO < "H, & fe5 c G > ft o u U id - eos -2 <sg2 .5 u H m 1. PLACE OF DEATH County cf. Chariebton Township of.,,... ................. ...... or Citv of Charleston. S. r ....................................... ...... Standard Certificate of Death STAT^DF SOUTH CAROLINA BifulrTeeaaiu of Vital Statistics State Board of Health 9A c Rgi"*ifan District No---------(No.Hoper.HoBp^al 2. FULL NAME Bernhard D. Garvee Registered No (For use o! Local Registrar.) (If death occurred to ............Ward) u Hospital or iojutudon give its NAME 152 Spri^&tr*61 *"d Imn GiAitmyi ztu. . .^io*.......K. .Day* PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH Sex COLOR OR RACE 5. Single. Married, Widowed. 21. DATE OF DEATH (month, day, and yeJs$-TCh 17 *, 1?34 Male White 5a, II married widowed, or divorced r Pfrffi&Woijf" Wnrd) 22. I HEREBY CERTIFY. That I attended deceased from . jff. if. Ji HUSBAND of Ann! e Durham l lust saw hA?Llive ...^.fdrath is said (or) WIFE of? 6. DATE OF BIRTH (Month, day. and yearV HUB J.OY O to have occurred on the date stated above, at------ --.............Tn* * 7. AGE # Years 57 Months 9 Days 8 If ->lleeasss Ttthn, aa"nfnlT:O-h--ie-m---e-pt.riw-n--ec--ri-pe--a---nl-s- cafoulslo-e--w-o--s-f-; death and related causes of importance in order ' Cus.fr of - 1 day,---------- hrs or--------------*r*ai*n. - .. Puimbharjr^ ibros1 b w*i wk^dow, as^ spinnergeneral Opera t oar P in wiginaxyTuh ereiutXoa1 a 9. Industry' or business in which work was done, us silk mill, saw mill. Kink, etc-------------- ID, Date deceased last worked at this occupuiaiu (month and year) . XUOO- ...-- 11. Ttwo..taal tmimf--e_ y(y---e---a---r--s,)s spent in this occupatii * 1' '~ |.......................... < .M .....i.i _U1 ,,IU| ..- ,jjn , ^Contributory causes oi importauce not related la principal cauc - 12, BIRTHPLACE (city or town)....GhfcXl^E. 1.011 (State nr country) _____________________________________________ 12. NAME John Garvc-s H. BIRTHPLACE (city or town). (State or country) AJinleis. maiden name Germany.. Meyera .... 1 W---------- "2^--Tjsr Name of operation-....... ......---`7?*------ .----Dale What test confirmed, dia^hoaia?-- 23. If death waa^t^To Wk.i there.______ lioleucetwHl,in als^dRrTfollowing: Accident, suicide, or injsrytL"-------- 19 "... 16. BIRTHPLACE (city or town)........ ............. G^Xi;T3y _______(State or country) Where did injnry^ggu: or town, and state) Specify whether injury OC<Jirred jo inmistry. in home, or in public place. INFORMANT (Address) Manner of injury- 18. BPiUne3RIAfLo, Bgff"BU!ijt^&rch 19. T9. UNDERTAKER (Address) .______ ,,iUta 77-35? Was diacaiBtor injury in any way related to occupation of Specify.--7A.7 soestoB voider t/W20. FILED.. 19-23T 4 Leon Registrar. (Signed)----- - 72 Society St. (Address) D.