USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 7
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The Commonwealth of Massachusetts aug 9
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Chelmsford, Mais (No)
Centro
St. :
Ward)
219 Chelmsford. (City or town.) {If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M.
4 COLOR OR RACE
While
5 SINGLE,
MARRIED,
WIDOWED
OR DIVORCED
(Write the word)
Widowed
6 DATE OF BIRTH
Datofor Sept. 25
(Month)
(Day)
1818
(Year)
7 AGE
91
yrs. 10 mos.
15
ds.
or ....... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Farmer
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Wells, maine
.... (Duration)
yrs.
mos.
ds.
Contributory
Sethile
(SECONDARY)
(Signed)
Amara Howard
M.D.
aug. 11, 1910 (Address)
Chelmsford
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR 'RECENT RESIDENTS).
At place
of death
.yrs.
mos.
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 Lowell. Comeles
DATE OF BURIAL
Aug. 12. 1910
20 UNDERTAKER
Walter Venham
ADDRESS
chelmsford
important. See instructions on back of certificate.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Kennebunk Me.
12 MAIDEN NAME OF MOTHER Jemina Stuart
13 BIRTHPLACE OF MOTHER (State or country) Wells, me.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(informant)
This Emma Hubbard
(Address)
checustora
15 Filed Cua 11, 1910 Cdurch de, Voltin.
Tom Clip
REGISTRAR
16 DATE OF DEATH
aug.
(Month)
(Day)
19! 0
(Year)
17 I HEREBY CERTIFY that I attended deceased from august 9th,191.0, to 1910,
If LESS than
I day, .......
hrs.
that I last saw home alive on.
aug.
1900
,
1910,
and that death occurred, on the date stated above, at 2 Pm.
The CAUSE OF DEATH* was as follows :
Cardiac embolism
....
(Duration)
. . yrs.
mos.
ds.
10 NAME OF
FATHER
Jeremiah Hubbard
MARGIN RESERVED FOR BINDING
Charles Hubbard.
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Chelmsford.
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, Arehiteet, 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 cercbro-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; 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 septieaemia," " 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No
no Chelms Man
St. : Ward)
0 22.0 Lowell
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
301
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
J.
4 COLOR OR RACE
20
5 SINGLE
MARRIED,
WIDOWED
OR DIVORCED
(Write the word)
Single
6 DATE OF BIRTH Leb. ... (Month)
13
1909
(Year)
7 AGE
If LESS than
I day,
hrs.
Or ........ min. ?
8 OCCUPATION
(a)' Trade, profession, or
particular kind of work
home
2
(b) General nature of industry, business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country)
no, co helms. hans
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Canada
12 MAIDEN NAME
OF MOTHER
Catherine Tray
13 BIRTHPLACE
OF MOTHER
(State or country)
Canada
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Edward Gray
(Address)
16 Filed. aug 11, 1910 Cdmed Robbing
Coom Che REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
17
I HEREBY CERTIFY that I attended deceased from
aug 3
, 1910 to Ques 10
1916
....... .
that I last saw her alive on
aula 10
191@
.,
and that death occurred, on the date stated above, at 3.50 am.
The CAUSE OF DEATH* was as follows :
Entérite.
cause obscure.
(Duration)
yrs.
mos.
8
ds.
Contributory ...
(SECONDARY)
(Duration)
... . yrs.
mos.
ds.
(Signed)
M.D.
aug 10, 190 (Address).
7. Cholimitent
* 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 disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL no. Chelms. Mas.
DATE OF BURIAL
aug. 11, 1910.
20 UNDERTAKER
PAR , a. Weinbach
ADDRESS
80 Middy St
(Month)
10
(Day)
-
1916
...
(Year)
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
FULL NAME
Margaret Evelyn Gray
[If married or divorced woman of widow
give maiden name, also name of husband.}
@RESIDENCE
no. Chelun mar.
(Day)
3
yrs.
6
mos.
ds.
10 NAME OF
FATHER
Edward Gray
......
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 cach 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 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 fcrer (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid usc of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
4
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 onc supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very 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 Chelmsford (No
St. ;. Ward)
'FULL NAME Genest
{If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
Registered No.
301
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
6 DATE OF BIRTH
July 16
1 Month)
(Day)
(Year)
7 AGE
If LESS than
1 day, ........ hrs.
3 yrs. 2 mos. 280
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) ..
I HEREBY CERTIFY that I attended deceased from
Aug 3
, 1910, to Ang 13, 1910.
1
that I last saw hemmalive on.
Aung 13, 190
and that death occurred, on the date stated above, at & m.
The CAUSE OF DEATH* was as follows :
Scarletthever
(Duration)
yrs.
mos.
10.05
Contributory ..
Arthritis . Jak
(SECONDARY)
.. (Duration)
.yrs.
. mos.
......
ds.
(Signed)
PSmeelu
M.D.
Aug 13, 1910)
(Address) 276 Westland
* 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
head of death
yrs.
mos.
ds.
State.
.yrs.
mos.
ds
Where was disease contracted, if not at place of death ?.
Former or usual residence.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) ....
Nas
az Lett
(Address)
15 Filed ... aug. 13, 1910 Edward S. Robbing
REGISTRAR
221
(City or town.)
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
3 SEX male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
16 DATE OF DEATH
.
And
.
(Month)
13
(Day)
( Year)
9 BIRTHPLACE (State or country) Lawall Mark
10 NAME OF
FATHER
Norman Leith
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Canada
12 MAIDEN NAME OF MOTHER alice M & tak han
13 BIRTHPLACE OF MOTHER (State or country) Leonard
In the
19 PLACE OF BURIAL OR REMOVALO
DATE OF BURIAL
West Lawn Teemily Ung 13 1910
20 UNDERTAKER
John A Wenbeck
ADDRESS
Orum Keith
190h
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, 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. - Namne, 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 ncoplasms) ; Measles ; Whooping cough ; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (sccond- 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," " Alt- 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.
1
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts
222 Chelmsford. (City or town.)
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
St. ;
Chelmsford
Ward)
(No
Boston Road
[If death occurred in
a hospital or institution,
give its NAME instead
Mary Elizabeth Hardy
2 FULL NAME
[If married or divoreed woman or widow
give maiden name, also name of husband.]
@RESIDENCE
of street and number.]
Names m. Hardy.
Registered No.
63
-
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
W.
15 SINGLE,
MARRIED
Widowed
16 DATE OF DEATH
Ung 18
OR DIVORCED
(Write the word)
19! 0
(Year)
(Month)
(Day)
6 DATE OF BIRTH
17
1824
17
I HEREBY CERTIFY that I attended deceased from
(Month)
(Day)
(Year)
Ung. 18
1910, to
Cmq. 18
1910
7 AGE
85
yrs.
that I last saw her alive on.
ang: 18
1910
and that death occurred, on the date stated above,
at 90
· m,
ds.
or ....... min. ?
The CAUSE OF DEATH* was as follows :
Paralysis
8
mos.
If LESS than
1 day, ......
hrs.
8 OCCUPATION
(a) Trede, profession, or
particuler kind of work
Housekeeper
(b) General nature of industry,
business, or establishment in
which employed (or employer) ...
9 BIRTHPLACE
.
(State or country)
Contributory ...
yrs.
mos.
ds.
(Duretion)
10 NAME OF
FATHER)
Sowell Bancroft-
(SECONDARY)
Senile
") Chelmsford. Mais.
.. (Duration)
yrs.
M.D.
mos.
(Signed)
Olmasa Howard
ds.
11 BIRTHPLACE
OF FATHER
(State or country)
Grolow, Mass.
Cia. 20, 1910 (Address).
Chelmsford,
* If death followed injury or violence the certificate of death must be made
out by the Medical Examiner.
12 MAIDEN NAME
OF MOTHER
Mary Haywards
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
PARENTS
At place
In the
of death
yrs.
mos.
ds.
State
yrs.
... .
.
mos.
ds.
....
13 BIRTHPLACE
OF MOTHER
(State or country)
Where was disease contracted,
If not at place of death ?.
Former or
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Klug 21
.. .
important. See instructions on back of certificate.
1910
(Address)
Chelun
Rowell leem.
(Informent).
Mins Minie Hardy
ADDRESS
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
......
15
Filed
aug. 20, 1910 Edward Robbing
REGISTRAR
20 UNDERTAKER
Walter Puchary
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 receivo 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 ; 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, Homieide, 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.
-
" Middlext
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
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