USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 35
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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.
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 Chelmsford
(No.
Princeton
St. :
Ward)
[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
Princetar h
Registered No.
79
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Finale
4 COLOR OR RACE
Chute
5 SINGLE
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
Teyle
6 DATE OF BIRTH
10
(Month)
(Day)
1911
(Year)
7 AGE
If LESS than
1 day ... Z ... hrs.
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)
No. Chelmsford, hans.
10 NAME OF
FATHER
Grupe C. Thomas Jr.
PARENTS
11 BIRTHPLACE
OF FATHER
No Chelmsford Massa
Middlecy lo.
12 MAIDEN NAME
OF MOTHER
Sophia In. Bicknell
13 BIRTHPLACE
OF MOTHER
(State or country)
Indiana
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Dr V V/ Meias
(Address)
(Lourd Mass.
16 File Dea 11, 1911 Coward & Porting REGISTRAR
16 DATE OF DEATH
17
I HEREBY CERTIFY that I attended deceased from
fre- 10, 1911, to.
ore 10
that I last saw han alive on
Gre.10
191 ] .,
and that death occurred, on the date stated above, at 2.
.m .
The CAUSE OF DEATH* was as follows :
Premature Birth
(Duration)
yrs.
mos.
ds.
Contributory. (SECONDARY)
(Duration) .
yrs.
mos.
ds.
Fv meins
......
M.D.
(Signed)
bre. 10, 191
(Address) ....
160 theswank & Limer
* 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
In the
of death. .yrs.
mos.
ds.
State.
.. yrs.
mos.
ds
Where was dlsease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Jowell Cemetery
DATE OF BURIAL
Weg. 12. 1911
20 UNDERTAKER
ADDRESS
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
MEDICAL CERTIFICATE OF DEATH
10
(Month)
(Day)
1911
(Year)
79 Chelmsford (City or town.)
:
yrs.
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 agc. 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) 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, 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: Cercbro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of " Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, 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 discasc; Chronic interstitial nephritis, etc. The contributory (sccond- ary or intercurrent) affection need not be stated unless im- portant. Example : Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," " Marasmus," " Old agc," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners :
1. Deaths following injury or violence, as Burns, Fulls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Lowell Mann (No. Chalanford It. Host.
Margaret- Obomill
Cast Chelmsford mars.
Registered No.
1799
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dec.
1
(Month)
(Day)
19! (Year)
17 I HEREBY CERTIFY that I attended deceased from
Oct 20, 1911, to.
Leca
....
that I last saw h W alive on
and that death occurred, on the date stated above, at ...
m.
The CAUSE OF DEATH* was as follows :
Carcinoma of 2001
.(Duretion)
.yrs.
mos.
ds.
Contributory ...
(SECONDARY)
4
(Duration)
.yrs.
ds.
most
(Signed)
Varsta Nadsmith
M.D.
... ,
1911 (Address
Lowell mare.
* 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
2
of death
.yrs."
mos.
ds.
State.
yrs.
mos.
ds
Where was disease contracted, If not at place of death ?.
Former or usual residence.
DATE OF BURIAL
19 PLACE OF BURIAL OR REMOVAL no Gaston mare.
20 UNDERTAKER
C. H. Mollay
ADDRESS
Lowell.
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.30
@RESIDENCE
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
While
Female
Jungle
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word).
6 DATE OF BIRTH
-
(Month)
(Day)
(Year)
7 AGE
If LESS than
I day, ....... hrs.
70
yrs.
mos.
ds.
Or ....... min. ?
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or esteblishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Ireland,
10 NAME OF
FATHER
David O'connell,
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland,
12 MAIDEN NAME
OF MOTHER
Unknown
PARENTS
18 BIRTHPLACE
Ireland,
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mr. Hickey
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
... /
8 OCCUPATION
House work
important. See instructions on back of certificate.
(Address)
15
1
Brockton mann
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
.....
Filed 210/2011
REGISTRAR
Lowell 80
(City or town.)
[If deeth occurred in a hospitel or institution, give its NAME instead of street and number.]
Ward)
- In the
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement ; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return " Laborer," "Foreman," "Manager,""Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are 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," "Senilc," 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 Criminul 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.
1911- 22-
1889-
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 -
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH To Cheln hed (No. Princeton It. St ;
81
Vo. Chelmsford.
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME. Sophia May Moore,
[If married or divorced woman or widow give maiden name, alsomname of husband.] @RESIDENCE Nor Chelmsford.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Hemales
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
Married.
OR DIVORCED
(Write the word)
6 DATE OF BIRTH
Jan
(Month)
2%
(Day)
1889
(Year
7 AGE
22 yrs. 10 mos. 16
.ds.
If LESS than I day, .. hrs.
or ....... min. ?
8 OCCUPATION
(a) Trade, 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)
5) So. Bend, Ind.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Ind.
12 MAIDEN NAME
OF MOTHER
. Nemprey
13 BIRTHPLACE
OF MOTHER
(State or country)
Unkmassachusetts
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Gro. C. Moore .
(Address) Nr. Chelmsford, Mass.
Filed Dec. 14, 191) Edward). Bobbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dec.
(Month)
(Day)
191 ,
(Year)
11 I HEREBY CERTIFY that I attended deceased from
Www. 17
1911, to
one 13. 199.
that I last saw h . alive on
One IL, 1911.
and that death occurred, on the date stated above, at 2,30 Am.
The CAUSE OF DEATH* was as follows :
Puerperal Mania
(Duration)
.yrs.
mos.
ds.
Contributory
Exhaustion
(SECONDARY)
(Duration)
.
.yrs.
mos.
ds.
(Signed)
136.13
1911
(Address).
M.D.
* 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
Lowell Cemetery, Dec, 15, 191.
20 UNDERTAKER
ADDRESS
79 Branch St.
Ward)
Sophia May Pickrell Gran to Moore In
Registered No. 181
13
10 NAME OF
FATHER
Arthur Pickrell.
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 inaterial 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., C'arcinoma, Sar- coma, etc., of. (name origin: "Cancer" is less definite ; avoid use of "Tumor " for malignant neoplasins) ; 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 no. Chelmsford (No Edwards Live
St. :
Ward)
arthur Harris Sheldon
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
aRESIDENCE No Chelmatera
Registered No.
82
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
6 DATE OF BIRTH
ยท
- May
(Month)
29 1832
(Day)
(Year)
7 AGE
79
yrs.
6
mos. 23
mos.
.ds.
If LESS than
I day,
hrs.
or .min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Retired
(b) General nature of industry.
business, or establishment in
which employed (or employer).
Iron Foundry
9 BIRTHPLACE
(State or country)
Rupert VE.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Rupert Ht
12 MAIDEN NAME
OF MOTHER
Elizabeth Gordon Harris
13 BIRTHPLACE
OF MOTHER
(State or country)
Canaan n. H.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
To 9 HSheldon
(Address) No Chomatous
16 Filed Dec. 23, 1911 Oderand De Rolling
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
December
22. 191
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from Deer 1915 to Dec 22, 1911. that I last saw hear alive on Dec-22 ...... , 191.2. and that death occurred, on the date stated above, at 2-30m.
The CAUSE OF DEATH* was as follows :
(Duration)
yrs.
mos.
2/ ds.
Contributory. (SECONDARY)
(Duration)
. yrs.
.mos. ds.
7E Jamey
M.D.
(Signed)
Dec 23
.....
(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
Riverside Cena
Chelmsford
DATE OF BURIAL
DEC 24.
191/
20 UNDERTAKER
Walter Perham
ADDRESS
Chelmsford
82 Chelmsford (City or toy n.) [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.
important. See instructions on back of certificate.
10 NAME OF
FATHER
Henry Sheldon
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- keepcrs 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, 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.
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