USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1912-1913 > Part 1
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MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Chelmsford (No High St.
St. ;.
Ward)
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
Registered No.
3
PERSONAL AND STATISTICAL PARTICULARS
Married
Heb
18
1838
17
(Year)
If LESS than
I day ....
.. hrs.
or.
.. min. ?
10 NAME OF
FATHER
Hildreth P. Dutton
11 BIRTHPLACE
OF FATHER
(State or country)
Greenfield U.H.
12 MAIDEN NAME
OF MOTHER
Elizabeth . Barrett
Concord mass.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
16 Filed Janne, 16, 1912 Edward Y. Holfing
1 REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
January
13th
(Monthy
(Day)
191 2
(Year)
I HEREBY CERTIFY that | attended deceased from
Dec. 20th
1. 1911, to
Jan, 134
1912,
.. .
that I last saw her alive on Jan, 1395
.......
, 191.2.,
and that death occurred, on the date stated above, at 10P. m.
The CAUSE OF DEATH* was as follows :
Broncho - precumona
(Duration)
yrs.
mos.
3
ds
Contributory
Bronchitis
(SECONDARY)
.(Duration)
.yrs.
mos.
30 ds.
(Signed)
amasa Stoward
Jan, 15, 192 (Addres).
Chilinford, Mass
* 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).
At place
of death
yrs.
In the
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
Houtathen Com
.
DATE OF BURIAL
Jan 16, 1912
20 UNDERTAKER
Walter Perham
ADDRESS
Chelmsford.
[If married or divorced woman or widow
give maiden name, also name of husband.]
3 SEX
Herele
4 COLOR OR RACE
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
white
6 DATE OF BIRTH
(Month)
(Day)
7 AGE
73
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
athome
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Hollie n. It.
PARENTS
13 BIRTHPLACE
OF MOTHER
(State or country)
(Informant)
SwParkhurst
,cose .
(Address) Chebutol
important. See instructions on back of certificate.
N. B. - Every item of information 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
....
.yrs ..
10 mos: 26
ds.
Chelmsford 89
(City of town.)
Martha Jones Parkhurst 2 FULL NAME.
Dutton, SulParkhurst
1
M.D.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Preeise 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 ou the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, 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 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) 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," 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 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 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 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: Cerebro-spinal fever (the only definite synonym is " Epidemic 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, peritoneum, etc., Carcinoma, Sar- coma, etc., of. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronie valvular heart disease; Chronie interstitial nephritis, ete. The contributory (second- ary or iutercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing dcatlı), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatie), " Atrophy," "Collapse," "Coma," " Convulsions," " Debility " ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "Shock," " Uraemia," " Weakness," etc. when a definite disease ean be ascertained as tho cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, 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, ete.
4. Deaths under cireumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
3 SEX 4 COLOR OR RACE Female Ahito 7 AGE 8 OCCUPATION (a) Trade, profession, or particular kind of work. (b) General nature of industry, business, or establishment in which employed (or employer) .. doux PARENTS 13 BIRTHPLACE OF MOTHER (State or country) . important. See instructions on back of certificate. N. B. - Every item of information 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 yrs. mos. ......
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATHA Low North Chelunsford Mass
St. :
......... Ward)
e FULL NAME Jallian Leclaire
{If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE # North Chelmsford Mass
PERSONAL AND STATISTICAL PARTICULARS
៛ SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single.
6 DATE OF BIRTH
December 18 to
19/ 11
(Year)
(Month) (Day)
If LESS than . I day ........ .. hrs.
20
ds.
or ....... min. ?
at Home
9 BIRTHPLACE
(State or country)
Forth Chelunsford
10 NAME OF
FATHER
Louis Le claire
11 BIRTHPLACE OF FATHER (State or country) Biddeford ME
12 MAIDEN NAME
OF MOTHER
Malvina Lafrance
Canada
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Louis Leglaire
(Address)
# Ha the Chelmsford
16 Filed Sam 19/1912 durand , Robbing.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
(Day)
18
1912
(Year)
I HEREBY CERTIFY that I attended deceased from
191.
to
lang 18, 19/20
that I last saw hey alive on
Jacy 18, 19
and that death occurred, on the date stated above, at
m
The CAUSE OF DEATH* was as follows :
Cause mutuo
(Duration)
3 hours
.yrs.
mos.
ds.
Contributory ... (SECONDARY)
.(Duration)
... yrs.
mos. ds.
(Signed)
7E Jamey
M.D.
Jany 19, 1912 (Adress)
* 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).
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
Of Seph
DATE OF BURIAL
San. 19, 19/20
20 UNDERTAKER breph albert
ADDRESS
171 arkno
91
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Jungle
Registered No.
5
In the
STANDARD CERTIFICATE OF DEATH.
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, 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 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) 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," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are -mos engaged in the duties of the household 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 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 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: Cerebro-spinal fever (the only definite synonyın is "Epidemic 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, etc., of .. (namo 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 (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 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," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions 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, Fulls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
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 strcet, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
N. B. - Every item of information 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 on back of certificate.
PARENTS
12 MAIDEN NAME OF MOTHER Elizabeth m Teaque
13 BIRTHPLACE OF MOTHER State or country) Barr Dead Scotland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Henry O. miner
(Address) mt Pleaseset St, n. Chrmslinh
15 Filed Jan. 27, 1912 Edward J. Robbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
1
27
192
(Year)
1907
17
I HEREBY CERTIFY that I attended deceased from
Jan 1st, 19/2, to
Jan 27th
1912
.....
that I last saw him alive on
on 25 th
. 191.9_
and that death occurred, on the date stated above, at 19 m
The CAUSE OF DEATH* was as follows :
Dighetreria
(Duration)
.. yrs.
mos.
20
ds.
Contributory
Meninquis
(SECONDARY)
(Duration)
.yrs.
mos.
10
ds.
(Signed)
amos & Haben
M.D.
Sam 27
191
Ko Onlineford Maso
* H 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).
At place
of death
yrs.
mos.
In the
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
DATE OF BURIAL
St Joseph's Cemetery Dan 28, 1912
20 UNDERTAKER
1
D. F. O Donnell Son Lowell Muss
92
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME James mi miner [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE mt Pleasant St
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word) single
male
white
6 DATE OF BIRTH
April
(Month)
(Day)
(Year)
7 AGE
If LESS than 1 day, ........ hrs.
5 yrs.
.
mos.
21
ds.
Or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work.
At School
(b) General nature of industry, business, or establishment in which employed (or employer).
At School
9 BIRTHPLACE (State or country) north Chelmal and Mass
10 NAME OF
FATHER
Henry O miner
11 BIRTHPLACE OF FATHER (State or country) Lowell mass
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH north Chelmsford Mas No
mt Pleasant St
St. ;.
Ward)
Registered No.
6
(Month)
(Day)
6
MARGIN RESERVED FOR BINDING
ADDRESS
-
STANDARD CERTIFICATE OF DEATH.
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, 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 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 mil !; (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," 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 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 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 indicated 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 time and causation), using always the same accepted term for the same disease. Examples: Cercbro-spinal fever (the only definite synonym is "Epidemic 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, peritoneum, etc., Carcinoma, Sar- coma, etc., of. (name origin: "Cancer" is less definite ; avoid usc of "Tumor " for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (sccond- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 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," "Hemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions 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, 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.
N. B. - Every item of information 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
I PLACE OF DEATH
Chelmsford Mass (No
St. ;...
Ward)
Fif death occurred in a hospitel or institution, give its NAME instead of street and number.]
2 FULL NAME
Wallace Staveley
{If married or divorced woman or widow
give maiden uame, also name of husband.]
@RESIDENCE
Chelmsford
Mass
Registered No.
7
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Male
White
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
Single
6 DATE OF BIRTH
January
28
I912
(Month)
(Day)
(Year)
7 AGE
If LESS than ! day, .... hrs.
vrs.
mos.
ds.
or ........ min. ?
$ OCCUPATION
(a) Trade, profession, or particular kind of work ...
None
(b) General nature of industry, business, or esteblishment in which employed (or employer) ..
9 BIRTHPLACE (State or country)
Chelmsford 3 Mass
10 NAME OF FATHER
Joseph Staveley
11 BIRTHPLACE OF FATHER (State or country)
England
12 MAIDEN NAME OF MOTHER
Gertrude Whitley
18 BIRTHPLACE OF MOTHER (State or country)
England
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Joseph
Staveley
(Address)
Chelmsford Mass
16 Filed Fish / 1912 Edward Y Robbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
January
3I.
(Month)
(Day)
1912
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Jan 27
1912, to Jan 31
1912,
that I last saw han- alive on.
Jan 31
1912
and that death occurred, on the date stated above, at (o. P.m
The CAUSE OF DEATH* was as follows :
Creatine
(Duration)
yrs.
mos.
ds.
Contributory. (SECONDARY)
(Duration)
yrs.
mos.
ds.
(Signed)
PA with a. Long.
M.D.
Fill
1912 (Address) 226/Kemimack ST
* If death followed injury or violence the certifieate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
.. yrs.
mos.
In the
ds.
State ..
.yrs.
mos.
ds ...
Where was disease contracted, If not at place of death ?.
Former or usual residence
12 PLACE OF BURIAL OR REMOVAL
Edson
Cemetery
DATE OF BURIAL
Feb 2
1912
20 UNDERTAKER
lim. young
ADDRESS
33 Prescott of
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
93
Chelmsford
(City or town.)
·
PARENTS
4
STANDARD CERTIFICATE OF DEATH.
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 eachi 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, Architeet, 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 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) 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," 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 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 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 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: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia") ; Lobar pneumonia, Broneho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
eulosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- eoma, etc., of. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronie interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 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," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," ctc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions 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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