USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 36
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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.
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 Chelletract. (No Boston Road.
Thany & WE Grath
2FULL NAME
[If married or divorced woman or widow
give maiden uame, also name of husband.]
@RESIDENCE
St. : Ward)
Chequeford (City of town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
+ COLOR, OR RACE
YV.
5 SINGLE,
MARRIED,
WIDOWED
OR DIVORCED
(Write the word)
Single
6 DATE OF BIRTH
(Month) (Day)
i
(Year)
7 AGE
40
1
-
.yrs.
mos.
ds.
........ min. ?
8 OCCUPATION
Dress maker
(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 "> Nova Scotia
.(Duration)
.. yrs.
mos.
3
ds.
Contributory
Master
(SECONDARY)
(Duration)
...... yrs.
(Signed)
Amara Howard
M.D.
Dec. 23, 1911 (Address).
Chelmsford Mars.
* 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.
.mos.
ds ...
.........
.......
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL Parzanno nova Scotia
DATE OF BURIAL
DEC 25
1911
15
Filed. Dec. 23, 1911 Edward Robbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dec. 2.3
191.1
(Month)
(Day)
(Year)
17
Dec. 20
I HEREBY CERTIFY that Iattended deceased from
Dee. 23
91/, to
1911.
that I last saw her alive on.
Dec. 22
1911
and that death occurred, on the date stated above, at / a.m.
The CAUSE OF DEATH* was as follows :
Pneumonia
10 NAME Of
FATHER
This. Mcgrath
PARENTS
11 BIRTHPLACE OF FATHER (State or country) B) Ireland
12 MAIDEN NAME OF MOTHER 7 Cizalich Ker
13 BIRTHPLACE OF MOTHER (State or country)
Nova Scotia
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Misauna notte
(Informant)
(Addres ston Road.
20 UNDERTAKER
Camalloy
ADDRESS
PoneMaes
B
d
Registered No.
83
Doston Road Chelmsfordet.
8.3
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
If LESS than
1 day .......
hrs.
mos.
6
ds.
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-
eulosis 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; Chronie valvular heart disease; Chronie 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- acmia " (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
important. See instructions on back of certificate. .
16
Filed .. Dec. 31, 1911 Edward &. Robbing
- REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
white
5 SINGLE
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widow
6 DATE OF BIRTH
1849
17 I HEREBY CERTIFY that | attended deceased from
1911, to ..
De 30
.19|1.
If LESS than
I day ....
hrs.
that I last saw hayalive on
30
1911.
and that death occurred, on the date stated above, at ..
m.
The CAUSE OF DEATH* was as follows :
Paralysie
(Duration) .
.yrs.
mos.
ds.
Contributory ...
(SECONDARY)
(Duration)
mos.
ds.
....
(Signed)
M.D.
Dec. 31, 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
Horefathers Com Chalupy Jan 1, 1912
20 UNDERTAKER
Walter Paskam
ADDRESS Chelmsford.
191/
(Month)
(Day)
(Year)
7 AGE 62
yrs. 4 „ mos. 19 ds.
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).
9 BIRTHPLACE
(State or country)
10 NAME OF
FATHER
Edwards
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Males
12 MAIDEN NAME
OF MOTHER
Fairbank
13 BIRTHPLACE
OF MOTHER
(State or country)
mark
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(informant)
Karl M Perham
(Address)
Chelmsford
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Chelmsford Center (No. Dalton Road St. ;.
Ward)
Hannah Hausbank Serkan
2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Chelmsford
H.F. Edwards, alberth, Paskam
84 Chelmsford (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
84
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH
NEC 30
(Month)
(Day)
(Year)
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK- THIS IS A PERMANENT RECORD.
d.
e
9
10
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, 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 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, peritoneum, etc., Carcinoma, Sur- coma, etc., of. (name origin: "Cancer" is less definite ; avoid usc 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 scpticaemia," " 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OFODEATH
Groton (No.
St. :
Ward)
[if death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Rita Hazel Taylor
[If married or divorced woman or widow give maiden name also name of busland.] @RESIDENCE Mest Chelmsford Mask
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
191/
(Month)
(Day)
(Year)
I HEREBY CERTIFY that I attended deceased from Moramber, 1916, to December, 191.
Die 10 1911 and that death occurred, on the date stated above, a 3 30/in. The CAUSE OF DEATH* was as follows: Pericarditis with Ef
(Duration) acute dilatation I heart . ds. yrs. .mos.
Contributory
(SECONDARY)
(Duration) Arthur &. Kilbourne yrs.
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 .
In the
Stato
... yrs.
mos.
ds ...
Where was disease contracted,
If not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
Test Chelmsford To
20 UNDERTAKER C. M Young
DATE OF BURIAL DEC /3, 1911
ADDRESS 33 Prescott SI-
Lomle Mass
leső
ond-
im-
= .
ite
15
g
PARENTS
11 BIRTHPLACE OF FATHER (State or country) tomel Man
12 MAIDEN NAME OF MOTHER Jamy Serge
13 BIRTHPLACE OF MOTHER (State or country)
Chelmsford May
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
Frederick D. haylon
(Address) Mast Chelmsford Was
16 Filed DEC 11 1911 appleton Worry REGISTRAR
4 COLOR OR RACE
$ SINGLE, MARRIED WIDOWED, P. OR DIVORCED ( Write the word) Jungle
6 DATE OF BIRTH
1995 17
(Month:)
(Day)
(Year)
7 AGE
If LESS than
I day ...... hrs. that I last saw hy alive on.
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) Free mans
10 NAME OF FATHER Frederick 2 Maylor
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 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.
85
(City or town.)
85
Registered No.
3 SEX Finale
...
12 yrs. 2 ... mos. - ds.
mos. ds.
(Signed )
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 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) 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 homc. 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 synonyın 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, Sur- coma, etc., of. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart discase; 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," "Hemorrhage," "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 septicemia," " 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 Chelmsford .. (No. Billerica SK
St. :
Ward)
Elf death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No. 1
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
termale
4 COLOR OR RACE
white
5 SINGLE
MARRIED
Single
WIDOWED,
OR DIVORCED
(Write the word)
6 DATE OF BIRTH Sept 30
(Month)
(Day)
(Year)
7 AGE
68.3
yrs. ..
mos.
5
ds.
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).
9 BIRTHPLACE
(State or country
To action Mass
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
actor
12 MAIDEN NAME
OF MOTHER
Ruth Dole
13 BIRTHPLACE
OF MOTHER
(State or country)
actor
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
-*
(Informant)
(Address)
Chelmsford
15 Filed Jan. tam. 5, 1912. Edward &. Bobbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
2
an.
4
1912
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from Van 2nd 191.2., to
Jan. 4
1912.
that I last saw her alive on
Olan. 3
1912
and that death occurred, on the date stated above, at 90
.... m.
The CAUSE OF DEATH* was as follows :
Central Harmonhace
(Duration) .
yrs.
mos. ...
ds.
Contributory ..
(SECONDARY)
X
(Duration)
2
mos.
ds.
(Signed)
Can 5/ 1912 .Howard.
...
M.D.
(Address).
191
chelmsford 3
.....
* 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
action Ctr Cemetery
DATE OF BURIAL
Sau 6
, 1912
20 UNDERTAKER
Walter Parham
ADDRESS
Chelmsford
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
86
(City or town.)
2 FULL NAME
Hany fletcher
[If married or divorced woman or widow give maiden name, also name of husband.] aRESIDENCE Chelmsford
1843
If LESS than
......
I day .........
hrs.
3
10 NAME OF
FATHER
Daniel Fletcher
MARGIN RESERVED FOR BINDING
:
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 in- 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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