USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 22
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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.
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 N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Next Chelmsford (No.
St. :
Ward)
2 FULL NAME Eliza Areer
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
The Chelmsford
Registered No.
26
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Females
4 COLOR OR RACE
white
5 SINGLE,
MARRIED
married
WIDOWED,
OR DIVORCED
(Write the word)
6 DATE OF BIRTH
June
(Month)
(Day)
(Year)
7 AGE
If LESS than
I day,.
. hrs.
66 yrs. 10 mos. 20 ds.
or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
housewife
(b) General nature of industry, business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country)
England
10 NAME OF
FATHER
John Chapman
PARENTS
11 BIRTHPLACE OF FATHER (State or country) England
12 MAIDEN NAME OF MOTHER Hannie Hewett
13 BIRTHPLACE OF MOTHER (State or country)
England
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Thou Ficar
(Address)
W. Chiliintend
16 File Ch. 28, 1911 Edimit Brifing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
17 I HEREBY CERTIFY that I attended deceased from april 20, 1911, to april 26, 91
that I last saw h~ alive on
april 26
. 1911.
and that death occurred, on the date stated above, at 20 m.
The CAUSE OF DEATH* was as follows :
Itemi: legia
6
.(Duration)
.. yrs.
mos.
ds.
Contributory
Cerebral Degeneration
(SECONDARY) Card
(Duration)
yrs.
mos.
ds.
(Signed)
JE Varney
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
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
Mest Com, W. Chelmutand april 28 191
20 UNDERTAKER
M.Pe
a
ADDRESS
(Month)
26
(Day)
191/
(Year)
6
1844
Thomas Fireer
26 Chelmsford (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
r-
;
MARGIN RESERVED FOR BINDING
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, 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, 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.
MARGIN RESERVED FOR BINDING
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 important. See instructions on back of certificate.
.... 7 AGE PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very A
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH forth The lnsanford Tuass
St. :
Ward)
(City or town.) {If death occurred in a hospital or institution, give its NAME instead of street and number.]
FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband } @RESIDENCE north Chelmsford mass
Single
Registered No. 27
PERSONAL AND STATISTICAL PARTICULARS /
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
april
(Month)
(Day)
1917 (Year)
6 DATE OF BIRTH november 4th (Month)
(Day)
(Year)
If LESS than [ day, ........ hrs.
yrs.
„mos.
ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or.
particular kind of work
at Home
Come
(b) General nature of industry, business, or establishment in which employed (or employer) ...
9 BIRTHPLACE (State or country) Houthi tochelmsford
10 NAME OF
FATHER
albert St Cyr
11 BIRTHPLACE
OF FATHER
(State or country)
Canada
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or country)
Canada_
14 THE ABOVE IS TRUE TO THE BEST OF MY/KNOWLEDGE
(Informant)
albertst
10 yr.
(Address)
north, Shelunsford
16
Filed. apr. 30, 19V Edward Rubbing
....
REGISTRAR
I HEREBY CERTIFY that I attended deceased from
191.
..... ,
that I last saw h & alive on
april 28
., 1911.
and that death occurred, on the date stated above, at 4 Pm.
The CAUSE OF DEATH* was as follows :
Inbably due to menugetes
as child hood con vuleine
Jevously , had not been will.
.. (Duretion).
.......
.yrs.
Contributory
(SECONDARY)
(Duration)
.......
.. yrs.
mos.
ds.
JE Varney
M.D.
(Signed)
april 29
...
19% (Addres
* 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 If youph
DATE OF BURIAL
april 30
191
20 UNDERTAKER
Joseph albert
ADDRESS
171 aukendt.
3 SEX
quale While-
4 COLOR OR RACE
5 SINGLE,
MARRIED
WIDOWLD
OR DIVORCED
(Write the word)
Jungle
38
to
april 2,8 1
1917.
-
-
5-21
27
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 overy 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 engincer, 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, 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 timo and causation) , using always the same accepted term for the samo disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never rc- 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; 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 mero symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," " Coma," " Convulsions," "Debility " ("Congonital," "Scnile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all discases 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 duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, ctc.
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 Massariutsetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Lowell 771 622 (No ... 21 fichas / 02/1.
St. :
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No. (2)
PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH
3 SEX Finale
4 COLOR OR RACE
Whiten
& SINGLE
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
1
6 DATE OF BIRTH
(Month) ,
(Daf)
(Year)
7 AGE
If LESS than
1 day ......... hrs.
54 yrs. 1.1
.yrs.
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).
9 BIRTHPLACE
(State or country)
Cambridge Maur
-
PARENTS
12 MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
( Address )
1522 Yorkam It
Filed May 3 191
1 -VISITAn
16 DATE OF DEATH
(Month)
(Day)
1
1911 (Year)
1.853
17
I HEREBY CERTIFY that I attended deceased from
221at 13, 1911, to.
mais /
.. 1911.
.m.
that I last saw hlv alive on
mini 1.
191.
and that death occurred, on the date stated above, at / C/
The CAUSE OF DEATH* was as follows :/
Code cardito
(Duration)
1
.yrs.
mos.
ds.
Contributory .. (SECONDARY)
(Duca tion)
.... yrs.
mos.
.ds.
Robert Lagenes.
M.D.
(Signed)
May 2, 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.
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 Statrich 6.
DATE OF BURIAL
@ UNDERTAKER
ADDRESS
John. I'm Lanough. 108 Youham 21,
28
Lovell
(City or town.)
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of bushand.] @RESIDENCE 1327 Youham
( forchh i Lerine)
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
10 NAME OF FATHER Edmund Hinta
11 BIRTHPLACE OF FATHER (State or country)
11
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) 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 Day laborer, Farm laborer, Laborcr- 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: 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, 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 : Mcasles (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.
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.
1 PLACE OF DEATH
WORCESTER
2FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
(North)
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED,
WIDOWED,
Nale
OR DIVORCED
(Write the word)
16 DATE OF BIRTH
(Month)
(Day)
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) ....
9 BIRTHPLACE
(State or country)
Chelmsford
10 NAME OF
FATHER
Otis
11 BIRTHPLACE
OF FATHER
(State or country)
Westford
PARENTS
13 BIRTHPLACE
OF MOTHER
(State or country)
Bristol RT
(Informant).
Worc. State Asylum
important. See instructions on back of certificate.
(Address)
محيو
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
44
.... yrs. .... 2 ........
.mos.
12.ds.
1 (Year)
If LESS than
A day, ..
.. hrs.
or ........ min. ?
12 MAIDEN NAME
OF MOTHER
Josephine N Fletcher
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Filed May 8, 1911
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
191
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
May ..... 21 ..
.
191.0.9 to
May 3
191 ..... ]
that I last saw him. alive on
May 3.
....... , 191 ...... 1
and that death occurred, on the date stated above, at 9 Pm
The CAUSE OF DEATH* was as follows :
Epilepsy.
(Duration)
yrs.
mos.
ds.
Contributory .. (SECONDARY)
.(Duration)
.... yrs.
mos.
ds.
(Signed)
E V Scribner ,MD Supt
M.D.
May 4 19 1 (Address).
Worcester
* 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. LImos 12
In the
State ..
............ yro.
. ...
.. mos.
ds
Where was disease contracted, If not at place of death ?.
Former or usual residence.
10 PLACE OF BURIAL OR REMOVAL Riverside
(No. Chelmsford
DATE OF BURIAL
May 5. 191]
20 UNDERTAKER
Ceo Sessions Sons Co
ADDRESS
Norcosta
WORCESTER (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Harry I Wright
CHELMSFORD
Registered No.
29
PERSONAL AND STATISTICAL PARTICULARS
Single
29
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(No .... State Asylum St. : Ward)
........
.....
Month)
16 DATE OF DEATH
May 3 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) 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., Carcinoma, Sar- coma, etc., of. .... (name origin: "Cancer" is less definite ; avoid uso of "Tumor " for malignant ncoplasıns) ; 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," "Hacmorrhage," " 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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