USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 18
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).
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
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, Ec- 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.
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
1 PLACE OF DEATH
Chelmsford Vass (No. First St. off Warren Avast; Ward)
2 FULL NAME Mary F. McDonough
[If married or divoreed woman or widow give maiden name, also name of husband.] Mary F. Mansfield
Thomas "- Doncuth
aRESIDENCE First St. off Warran Ave. Chelmsford Centre
Registered No. 10
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female
White
5 SINGLE,
MARRIED,
WIDOWED.
OR DIVORCED
(Write the word)
Married
6 DATE OF BIRTH
(Month)
(Day)
1858
(Year)
7 AGE
If LESS then 1 day, ... hrs.
53
yrs. - mos. -
ds.
or. . min. ?
8 OCCUPATION
(a) Trede, profession, or
particular kind of work
At home
(b) General nature of industry, business, or establishment in which employed (or employer).
At home
9 BIRTHPLACE (State or country) Lowell
10 NAME OF
FATHER
Unknown
PARENTS
12 MAIDEN NAME OF MOTHER
rinknown
13 BIRTHPLACE OF MOTHER (State or country)
Unknown
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Thomas Mc Ponoyan
(Address)
Chelmsford rentre
15 Filed .. Feb. 24, 1911 Edward . Retting
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Fab. 22nd
(Month)
(Day)
191.1
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Oct. 10, 1909, to.
Fab. 22nd
1911
that I last saw her alive on
Feb. 2000
191./ ,
and that death occurred, on the date stated above, at /. a.m.
The CAUSE OF DEATH* was as follows :
Paralysis
(Duration)
1 yrs. 6
mos.
ds.
Contributory.
(SECONDARY)
(Duration)
.. yrs.
mos.
ds.
(Signed)
....
Amara toward -
M.D.
406.23. 1911 (Address) Chelmsford
* If death followed injury or violence the certificate of death must be made out by the Medieal Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At plece
In the
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
DATE OF BURIAL
Feb. 24 1931
St. Patrick's
20 UNDERTAKER
ISTAR MEDmonate
ADDRESS
108 Gorham
10
(City or town.)
[If death occurred in a hospitel or institution, give its NAME instead of street and number.]
MARGIN RESERVED FOR BINDING
:
11 BIRTHPLACE OF FATHER (State or country) Unknown
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 engincer, 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, Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., C'arcinoma, Sur- 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 " (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 septicacmia," " 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.
1
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
1 PLACE OF DEATH North Chelmsford (No Tyngsboro Road.
St. :.....
Ward)
No, Chelmsford, (City or town) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
FULL NAME: Anna M. Von Rydingsvard. {If married or divorced woman or widow give maiden name, also name of husband.] Anna OM. S.
Anna M. Davis, Karl Von Rydingevard. aRESIDENCE Timasboro Road, No. Chelmsford. Registered No. / /
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female.
4 COLOR OR RACE
White
6 SINGLE MARRIED, Divorced. WIDOWED, OR DIVORCED ( Write the word)
20.
1855 (Year)
7 AGE
If LESS than I day ......... hrs.
55 Yrs. 11
.yrs.
mos.
80
ds.
or ....... min. ?
8 OCCUPATION
(a)' Trade, profession, or
particular kind of work ..
Artist and Author.
(b) General nature of industry, business, or establishment in which employed (or employer) ...
Artist and Author.
9 BIRTHPLACE
(State or country)
Tyngsboro, Mass.
, 10 NAME OF
FATHER
Joshua H. Davis.
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Boston, Mass.
12 MAIDEN NAME OF MOTHER Ellen M. Cummings.
13 BIRTHPLACE OF MOTHER (State or country)
Chelmsford, Mass.
14 THE ABOVE IS TRUE TO THE BEST ZF MY KNOWLEDGE
(Informan
Are Ellen M. Davis.
(Address) No. Chelmsford, Abase.
16
Filed ... 191
......
.....
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Fieb.
(Month/
(Day)
191.1
(Year)
17
I HEREBY CERTIFY that I attended deceased from
191.
..... , to.
191
that I last saw h -alive on- ....
19|
and that death occurred, on the date stated above, at 400m.
The CAUSE OF DEATH* was as follows :
Velice aberes
.
due enfren to tubal or
Liber culos disease
attendedby christian Sciencedealer
(Duration) 4
4 yrs.
mos.
ds.
Dead when dees os mou
Contributory. (SECONDARY)
(Duration)
.yrs.
most
ds.
(Signed)
M.D.
Mohl, 1911 (Address).
7. cheluitur-
* 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
DATE OF BURIAL
Dunstable Cemetery, March 3, 191.
20 UNDERTAKER
GrowHealey
ADDRESS
79 Branch St
s);
Be;
d-
re
1
less
Sur-
MARGIN RESERVED FOR BINDING
6 DATE OF BIRTH
March (Month)
(Day)
28-
Lalarney
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. Tho 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 Ilouse- 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 ; 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 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, 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
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH South Chelmsford No
Ofarrew Berry.
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husbaud.] @RESIDENCE South Chelmsford
Registered No.
12
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
(Month)
.(Day)
16 DATE OF BIRTH
april
(Month) (Day)
(Year)
7 AGE
If LESS than 1 day, hrs.
60
yrs. 10 mos. 24/ .ds.
or ....... min. ?
8 OCCUPATION
(a) Trede, profession, or particular kind of work
Farmer
(b) Generel nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
Pittsfield me.
10 NAME OF FATHER John Berry.
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Timington me.
12 MAIDEN NAME OF MOTHER
Nancy learn
13 BIRTHPLACE OF MOTHER (State or country)
anson Me.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs. Warrew Berry
(Address)
16 Filed Mar. 6, 1911 Edward Robbins
REGISTRAR
16 DATE OF DEATH
March 13
19!
(Year)
I HEREBY CERTIFY that I attended deceased from nov 191! , to March 3, 1911 ... that I last saw h Mealive on. March 3, 1911. and that death occurred, on the date stated above, at.820/m. The CAUSE OF DEATH* was as follows : Arteriosclerció + Cerebral
Indefinite (Durat
275 3 40 -
yrs. ..
mos. ...
ds.
Contributory. (SECONDARY)
(Duration) yrs.
mos. ds.
Scobaia
M.D.
March 5
1918
(Address).
Chelmsford Mon.
* 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 plece 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
Edson
u.
Lowell. Maso
20 UNDERTAKER
Wallen Pecham
ADDRESS
Chelmsford.
8
od-
B .;
ere
ms); ase ;
less
Sur
important. See instructions on back of certificate.
4 COLOR QR RACE
5 SINGLE.
MARRIED
WIDOWED,Y
( Write the word)
St.
12 Chelmsford. Ward) (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK- THIS IS A PERMANENT RECORD.
3 SEX
m
1850 17
DATE OF BURIAL
Mar 6, 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: (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, Laborcr -- Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- kcepers 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 ; 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 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 childbirthi 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.
MARGIN RESERVED FOR BINDING
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 Commmmwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH North forelmsford
Highland Une.
St. ;
Ward)
(City or town).y [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Cama & Smith
*FULL NAME
[if married or divorced woman or widow give maiden name, also name of husband.]/ @RESIDENCE
Highland aiz North Pralineford
Registered No.
13
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
+ COLOR OR RACE
5 SINGLE MARRIED, WIDOWED, White
OR DIVORCED (Write the word)
& DATE OF BIRTH
29 (Day)
1885 1:
Month)
(Year)
7 AGE
If LESS than 1 day,. hrs.
25
mos.
ds.
or ....... min. ?
$ OCCUPATION Strangrapher (a)' Trade, profession, or particular kind of work ...
(b) General nature of industry, business, or establishment in which employed (or employer) ..
9 BIRTHPLACE (State or country
North Chelmsford Mm
10 NAME OF FATHER
11 BIRTHPLACE OF FATHER (State or country)
towel Mass
12 MAIDEN NAME OF MOTHER
Ilalia Ward
1$ BIRTHPLACE OF MOTHER (State or country)
Wollte Chelmsford
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Lina Farveltil
(Informant)
(Address)
ID
Filed Man. 6. 1911 Edward ). Ning
.....
REGISTRAR
I HEREBY CERTIFY that I attended deceased from July 12, 1911, to. Mek 5, 1911. that I last saw he.Y ... alive on Meh 4
, 191/, and that death occurred, on the date stated above, at 250 /0 m. The CAUSE OF DEATH* was as follows : Pulmonary Interouler ....
(Duration) yrs.
mos. ds.
Contributory .... (SECONDARY)
(Duration)
yrs.
mos. ds.
F & Varney
M.D.
(Signed)
Mich 6
...
191/ (Address).
n. Chile
* If death followed lujury or violence the certificate of death must be made out hy 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 noi al place of death ?
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL March To. 1911
UNDERTAKER
ADDRESS
1 9Worthen
SEX female | white
16 DATE OF DEATH
March
(Month)
191[]
(Year)
(Day)
:
e
d.
North Chelmsford 13
....
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 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 ; 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," " All- 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.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.