Deaths 1920-1921, Part 1

Author: Chelmsford (Mass.)
Publication date: 1920-1921
Publisher:
Number of Pages: 316


USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1920-1921 > Part 1


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.


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


FORM R-301


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


12 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


1 PLACE OF DEATH


County.


THE Middlesen


State.


Masa


Registered No.


1


City of Town


Chelmsford


No.


South


St .. Ward


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


2 FULL NAME


Nelson H. B. Wardwell.


(a) Residence.


No.


South


St.,


Ward.


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


Leogth of resideoce in city or town where death occurred


12


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


exhite.


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Married


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


Lucy A Hardwell


6 DATE OF BIRTH


March


(Month)


30.


1854


(Year)


7 AGE


65


Years


9


Months


10


Days


If STILLBORN, eoter that fact here


If STILLBORN, state period of uterogestation


. mos.


If LESS than


I day, ........ hrs.


or ........ min.


The CAUSE OF DEATH was as follows : general arterio scleroses -


Right Hacmiplegia-


Myportatie Pneumonia


(duration)


......... ..... yrs.


.mos.


.ds.


CONTRIBUTORY


(SECONDARY)


Pneumonia


(duration)


yrs ...


mos ..


1


18 Where was disease contracted


if not at place of death ?


Did an operation precede death ?


no.


Date of


Was there an autopsy ?


no


What test confirmed diagnosis


(Signed)


M.D.


(Address).


Chileford, Mais.


100


Date


Jan.


://(Month)


(D:Ly)


1920.


(Year)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


String Grove, Andover Mace


7(Cemetery


(City or town)


DATE OF BURIAL


Jan. 11.


1920.


20 UNDERTAKER


gromaHealey.


ADDRESS


79 Branch of


21 I HEREBY CERTIFY that a satisfactory stan- ( dard certificate of death was filed with me BEFORE the burial or transit permit was issued Edward & Robbins


Official Voran Nach


.position


Date of issue Of permit Dam. 10,1920


Permit


1-8-'19. 150,000.


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.


Inf


14 Miss Delia A. Wardwell


(Add Chelmsford benta, Macer


15


Filed Jan. 10, 1920 Gammal. Robban


(Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Jana


9


1920.


(Year)


(Month )


(Day)


17


I HEREBY CERTIFY, That I attended deceased from


19.


19


to


Jan. 9


, 19 20


that I last saw h& ..... M. alive on


Jan 8


. 1920.


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


3.10 A.


m.


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)


Retired.


(c) Name of employer


9 BIRTHPLACE (City)


Andover.


( State or country)


Mars.


10 NAME OF


Benjamin Fr. Hardwell.


FATHER


11 BIRTHPLACE OF


FATHER (City)


Andover


(State or country)


Masa,


12 MAIDEN NAME


OF MOTHER


Hannah & Nella


13 BIRTHPLACE OF


MOTHER (City)


(State or country)


Maso:


Amesbury.


MARGIN RESERVED FOR BINDING


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


should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH


( Usual place of abode)


(If in the Army or Navy of the United States, give rank, organization, ete.)


1919 1854


PARENTS


(Day)


REVISED UNITED : ATES 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 he sufficient, e. g., Former or Plonter, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Stotionory firemon, ctc. 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 husiness or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (0) Spinner, (b) Cotton mill; (o) Solesman, (b) Grocery; (a) Forcman, (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 Doy laborer, Farm laborer, Laborer - Cool mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may he 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 heen 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: Former (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 pneumonio; 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 ncoplasms); Measles; Whooping cough; Chronic valvulor heort disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection necd not be stated unless important. Example: de Messies (disease causing death), 25 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 he 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 hy the physician, and the date of his death. . .. - Revised Laws, Chop. 29, Secs. 10 and 1, as amended by Acts of 1910, Chop. 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 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 ... shall 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 per- 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 Lows, 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 died, his name and residence, if known, otherwise a description of such person as full as may he, with the cause and manner of his death, and shall mako 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, Chop. 24, Sec. 8.


RULES OF PRACTICE


The fulfilment of the purpose of these laws calls for the ohservance 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 hy 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 agents, and deaths following ahortion, 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.


The Commonwealth of Massachusetts


CERTIFICATE OF DEATH OF NON-RESIDENT


owell ( City or town) 107


1 PLACE OF DEATH


Registered No.


(Place of death) 2


City or Town


Lowell


No. St. John's Hospital


(Place of residence)


St .. I Ward


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


2 FULL NAME


mass,


City or Towa helmahora No.


_St.


(a) Residence.


State ..


(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


months days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH (month, day, and y


gan, 26 1920


17 I HEREBY CERTIFY, That I attended deceased from Jan. 16 19.


2 0to


Jan, 26. 1920


that I last saw


blive on


2.6. 1920


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


p. m.


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.)


Broncho- neumonia


Primary Probably beganwith Influenza


(duration).


.y ...


.. mos. .ds.


CONTRIBUTORY


(SECONDARY)


(duration)


.........


.ds.


18 Where was disease contracted


if not at place of death ?


Carlisle mars


Did an operation precede death? no,


Date of


Was there an autopsy?


What test confirmed diagnosis ?.


arthur & Scoloria


M.D.


1.2619 & ( Address)


Chelmsford mars.


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL Cedar Grouplem, Wacheder 1-2/ 1920


20 UNDERTAKER


Higgins Bros.


ADDRESS owell


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 statoment 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 Edward Whidden


Informabt ... (Address) 54 Bailey St, Boston


15


Fil Jan 27120 stephen Flynn F.


Registrar of city or town where death occurred Filb. 5 19 20 Grand t. Co8 /2222 Registrar of city or town where deceased resided


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


32


Years. Months Days


If STILLBORN, enter that fact bere


If LESS than


1 day, ........ hrs.


or ....... min.


8 OCCUPATION OF DECEASED (a) Trade, profession, or


particular kind of work


Farmer


(b) General sature of industry, business, or establishment in which employed (or employer) (c) Name of employer


Boston


9 BIRTHPLACE (city or town).


(State or country)


mars.


10 NAME OF FATHE Benjamin


PARENTS


11 BIRTHPLACE OF FATHER (city or town) Coton (State or country) masa.


12 MAIDEN NAME OF MOTI Emma Presed


13 BIRTHPLACE OF MOTHER (city or town)


(Statc or country)


mars.


Boston


(Şigned).


13


County


middlesex


State


masup


Registered No.


albert S. Whidden


(If in the Army or Navy of the United States, give rank, organization, etc.)


3 SEX


4 COLOR OR RACE


male White Single


.... mos .....


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]


Statement of occupation. - Preeise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits ean be known. The question applics 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, Architcet, 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) Groecry; (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 mine, etc. Women at home, who are engaged in the dutics 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- eifically the occupations of persons engaged in domestie 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- eated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.


Statement of cause of death .- Name, first, the DISEASE CAUSING DEATII (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 "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- ficd, 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; Chronie interstitial nephritis, ete. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (discase causing death), 29 ds .; Broncho- pneumonia (sccondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" ("Con- genital," "Scnile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock,"" "Urcmia," "'Weakness," etc., when a definite disease can be ascertaincd as the eause. 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; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by earbolie 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 Laws deathis 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,


etc.


3. Sudden deathis 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 eircumstances unknown, as A person found dead, etc.


ADDITIONAL SPACE


FOR FURTHER STATEMENTS BY


PHYSICIAN.


!


K 303. 6-'18. 50,000.


FORM R-301


N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information 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 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH


The Commonwealth of Massachusetts


14


STANDARD CERTIFICATE OF DEATH


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


1 PLACE OF DEATH allows


County.


City or Towp


Clickmo find


No.


richards ved Pd.


St.


.Ward


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


2 FULL NAME


(a) Residence.


(Usual place of abode)


Length of residence in city or town wbere death occurred


6.5


years


montbs


days.


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


6.5 years


months


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR ØR RACE


Khito


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Wedrived


Sa If married, widowed, or divorced


HUSBAND of


(or) WIFE of


Frank,


6 DATE OF BIRTH


( Month)


(Day)


(Year)


7 AGE 73 Years


Months - Days


If STILLBORN, enter that fact bere


If STILLBORN, state period of uterogestation.


... mos.


If LESS than


I day, ........ brs.


or ........ min.


8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) General nature ofindustry, business, or establishment in which employed ( or employer).


(c) Name of employer


CONTRIBUTORY


(SECONDARY)


(duration)


yrs ..


.......


mos.


ds.


18 Where was disease contracted


if not at place of death ?


Did an operation precede death?


no.


Was there an autopsy ?


no .


What test confirmed diagnosis ?..


1


Aucun 4, Scorona


M.D.


Date


29


1920.


Month)


(Dar)


(Year)


19 PLACE OF BURIAL, CREMAMON, OR REMOVAL


(Cemetery)


(City or town)


20 UNDERTAKER


ADDRESS


Permit


21 1 HEREBY CERTIFY that a satisfactory stan- dard certificate of death was fled with me BEFORE the burial or transit permit was issued


Edward & Robbins


Official position.


For club


Date of issus Of permit Jan. 34,420 No.


mos.


.ds.


9 BIRTHPLACE (City) (Statc or country) Irland


10 NAME OF


FATHER


Patrick Michale


PARENTS


11 BIRTHPLACE OF FATHER (City) (State or country)


12 MAIDEN NAME


(Signed)


OF MOTHER


Sarah Saly


·


(Address).


13 BIRTHPLACE OF MOTHER (City) (State or country)


14


Informarla


(Address)


15 Jam. 30, 1920 Edward & Robbins


Filed (Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH.,


(Month)


(Day)


28


1920.


(Year)


17 I HEREBY CERTIFY, That gattended deceased from 19/7 to .. Jan. 2/1920


that I last saw hla


alive on


27. 1920.


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


The CAUSE OF DEATH was as follows: Carcinoma


(duration)


3


.. yrs ...


Date of


DATE OF BURIAL Saw 30-20.


1-6-'19. 150,000.


MARGIN RESERVED FOR BINDING


Registered No. 3


State ..


(Ifip the Army or Navy of the United States, give rank, organization, etc. ) St. Ward.


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


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH


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


Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can he 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 he sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial cmployments, it is necessary to know (a) the kind of work and also (b) the nature of the husiness or industry, and therefore an additional line is provided for the latter statement; it should he 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 "Lahorer," "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 house- hold only (not paid Housekeepers who receive a definite salary), may he 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 nisEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may he 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 NEATH (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 necd 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," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Dehility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can he ascertained as the cause. Always qualify all diseases resulting from childhirth 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, childhirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.




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