USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 17
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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.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
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. N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state PARENTS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Quigley Giver
2FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
3 SEX
Enale- Strite
5 SINGLE
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
6 DATE OF BIRTH
Summary
(Months)
(Day)
28
(Year)
7 AGE
If LESS than [ day, ....... hrs.
yrs.
mos.
4
ds.
or ....... min. ?
8 OCCUPATION (a) Trade, profession, or particular kind of work
(b) General nature of industry, * business, or establishment in which employed for employer) ..
9 BIRTHPLACE
(State or country)
Do. Thensford mass
JO NAME OF
FATHER
11 BIRTHPLACE OF FATHER, (State or country) Yt rodando / 8.
12 MAIDEN NAME OF MOTHER Sarah Jane Nally.
13 BIRTHPLACE OF MOTHER (State or country)
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
16 Filed fieb. 2 . 19 Edward J. Robbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Jeby
(Month)
1
(Day)
19!7 (Year)
19/1
17
1 HEREBY CERTIFY that I attended deceased from
Sabri 28, 1911, to Jeby 1
, 191/. ,
that I last saw him alive on July 1
, 191] ,
and that death occurred, on the date stated above, at.3 ⑈
m.
The CAUSE OF DEATH* was as follows :
Meningitis simple Congenital
.. (Duration) ...
.. yrs. ....
mos.
...
ds.
Contributory .. (SECONDARY)
(Duration) .
yrs.
mos.
ds.
(Signed)
7 6 Varney
M.D.
Fals I, 1911 (Address).
2. Chaleurfeed
:
* 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.
In the
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
Patrick& Terratog Het 2, 1911
20 UNDERTAKER
ADDRESS
6
(City or town.)
St. :
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
TunisGodward, A" Earthy
Registered No. 6
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, irrespectivo 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 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 ('AUSING 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 ") ; Łobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, 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 (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 " (mcrely 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, 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 strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
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
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH East Chelmsford (No
St. :
Ward)
Chelmsford (City or cown.) fif death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME Margaret Ann O'Hara
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE East Chelmsford
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female chile
6 DATE OF BIRTH
1899
(Month)
(Day)
(Year)
7 AGE
If LESS than
| day, ..... hrs.
that I last saw her alive on
Oct. 28
, 1910
I HEREBY CERTIFY that I attended deceased from Moctober 25, 1910 to Feb, 2nd , 191 / .... and that death occurred, on the date stated above, at / 2-4mm The CAUSE OF DEATH* was as follows : Endocarditis
(Duration)
....
yrs.
6
mos.
ds.
Contributory ... (SECONDARY) Drowsy
(Duration) .
5
mos.
.ds.
(Signed)
Clinasa Itoward
..
M.D.
Feb. 3rd
... , 191f ...... (Address).
Chelmsford mari
* 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.
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 Patricks Day Feb. 4. 191
20 UNDERTAKER
ADDRESS
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK- THIS IS A PERMANENT RECORD.
PARENTS
10 NAME OF
FATHER
John O'Hara
11 BIRTHPLACE OF FATHER (State or country)
Theland
12 MAIDEN NAME OF MOTHER Harriett Agland
13 BIRTHPLACE OF MOTHER (State or country)
Ruland
14 THE ABOVE IS TRUE TO, THE BEST OF MY KNOWLEDGE
(Informant)
Johul O Hara
(Address)
East Chelmsford
15 Filed Fieb. 4 1911 Edward X Postings
REGISTRAR
16 DATE OF DEATH
Feb.
(Month)
2nd
(Day)
19! (Year)
8 OCCUPATION (a) Trade, profession, or particular kind of work
tone
(b) General nature of industry, business, or establishment in which employed (or employer).
Scholar
9 BIRTHPLACE (State or country) Lowell mars.
yrs.
5
mos.
....
ds.
or ....... min .?
.
S
4 COLOR OR RACE
5 SINGLE
MARRIED,
WIDOWED,
OR DIVORCED
( Write the word)
Single
Registered No.
. yrs.
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 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 ('AUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: C'erebro-spinal fever (tho 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, peritonaeum, etc., Carcinoma, Sar- coma, etc., of. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasmns) ; Measles ; Whooping cough; Chronie 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, 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, ctc.
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
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
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH helmsfind. Mars. (No East Chelmsford Rd St. :. .. Ward)
8 -
Chelmsford. (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME. [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Chefrenfand tuces
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
+ COLOR OR RACE
While
5 SINGLE,
MARRIED,
WIDOWED
Married
(Write the word)
6 DATE OF BIRTH april
28
(Month)
(Day)
18.46
(Year)
7 AGE
64 yrs. 9
mos.
If LESS than 1 day, ....... hrs.
8 ds
or ....... min. ?
8 OCCUPATION
(a) Trade, profession, or particular kind of work.
· Machinist
(b) General nature of industry, business, or establishment in which employed (or employer). Kilen Mach Co.
9 BIRTHPLACE
(State or country)
Sweden
10 NAME OF FATHER
11 BIRTHPLACE OF FATHER (State or country)
tweeden
12 MAIDEN NAME OF MOTHER Umie Telesino
13 BIRTHPLACE OF MOTHER (State or country)
Suceder
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Checulfra
15
Filed.
Feb. 8, 1911 Edward Robbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Feb. 6th.
(Month)
(Day)
1911
(Year)
17
I HEREBY CERTIFY that I attended deceased from
May 2", 1910, to.
Feb
191) ,
.....**
that I last saw him alive on.
, 191 / .
and that death occurred, on the date stated above, at 6B. m.
Feb. 1 st
The CAUSE OF DEATH* was as follows :
Endocarditis
...
(Duration) .
yrs.
mos.
ds.
Contributory (SECONDARY)
(Duration}).
.yrs.
mos.
ds.
(Signed)
Umaza Howard.
M.D.
496.6
1911 (Address)
Chelmsford-
.....
* 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
In the
. .. yrs.
....
mos.
ds.
Where was disease contracted, If not at place of death ?.
Former or usual residence
17PLACE OF BURIAL OR REMOVAL
Chelinek
DATE OF BURIAL
Feb. 8, 19/11
20 UNDERTAKER
Waller Pe
Perkamy
ADDRESS
Chelmsford
S
:
OR DIVORCE ALL
Registered No.
8
MARGIN RESERVED FOR BINDING
PARENTS
. ....
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 fircman, 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) Salcs- 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, Houscwork, 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 bo 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," unqualificd, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, 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 (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (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. Suddeu 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
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No. No. Chelmotone
v: ce 20 . St. ; Ward)
Lomce (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No. 30/
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
W
å SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
6 DATE OF BIRTH Sent. 2-2. (Month) (Day)
(Year)
7 AGE
If LESS than I day, .. .. hrs.
yrs.
G
mos.
ds.
or ........ min. ?
8 OCCUPATION (a) Trade, profession, or particular kind of work.
(b) General nature of industry, business, or establishment in which employed (or employer) ..
Several days
(Duration)
.yrs.
mos.
ds.
Contributory .. (SECONDARY)
(Duration)
yrs.
mos.
ds.
(Signed)
JEVarney
M.D.
. 1911
(Address).
.....
* 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
In the
yrs.
mos.
ds
Where was disease contracted,
If not at place of death ?.
Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL
No. Chelmsford, Man.
20 UNDERTAKER
J.G. Weintech
ADDRESS
So Middy RS.
important. See instructions on back of certificate.
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Promo Me
12 MAIDEN NAME OF MOTHER annie While
13 BIRTHPLACE OF MOTHER (State or country)
Scotland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
albert Emery
(Address)
no. Chelmo Pordi Maria
16 Filed Feb. 20 1911 Edward Robbins
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
February
20
(Month)
(Day)
191/
(Year)
1910 17 I HEREBY CERTIFY that I attended deceased from
...
Jeby 19
1917.
to
July 20
191.L.,
that I last saw h
....
alive on
Jeby 19
191/
and that death occurred, on the date stated above, at 6:30 km.
The CAUSE OF DEATH* was as follows :
-
broncho-pneu ma
9 BIRTHPLACE
(Statc or country)
No Chelmsford Thass
10 NAME OF
FATHER
albert Emery
s) ;
e;
d.
te
ess
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
2 FULL NAME
Bessie L. Emery)
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE no. Chelmo Jord Maso.
DATE OF BURIAL
Feb. 22, 1911.
₹
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: (() 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 luborer, 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, Ilousework, 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, Hlousemaid, 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, Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of. .. (name origin : "Cancer" is less definite ; avoid use of "Tumor" for malignant ncoplasms) ; 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.
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