USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1912-1913 > Part 5
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Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39
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. Deathis 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.
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 To Chelmsford (No. Wright John Chick Hobbs. 2 FULL NAME {If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE no. Chelmsford
St. :...
Ward)
(City or toan.) Elf death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
20
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
March
30
(Month)
(Day)
1912
(Year)
6 DATE OF BIRTH
March
1
18,37
17
I HEREBY CERTIFY that I attended deceased from
(Month)
(Day)
(Year)
March 20
1912
Mich 31
to
1912
that I last saw h alive on
1912,
and that death occurred, on the date stated above, at.
m .
The CAUSE OF DEATH* was as follows :
organico descaro y hears
tard rechnen
(Duration)
yrs.
Contributory
(SECONDARY)
.(Duration).
.yrs.
mos.
ds.
(Signed)
JE Varney
M.D.
1912
(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
Horsfathers Com.
20 UNDERTAKER
WalterPertan
ADDRESS
Chelmsford
=
7 AGE
75
0
mos.
29
ds.
or ... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Gallery Maker
(b) General nature of industry.
business, or establishment in
which employed (or employer).
Houndry
9 BIRTHPLACE
(State or country)
Eppingham n.H.
10 NAME OF
FATHER
Jacob Hobbe
11 BIRTHPLACE
OF FATHER
(State or country)
Saco The
.
12 MAIDEN NAME
OF MOTHER
Hulda Leighton
13 BIRTHPLACE
OF MOTHER
(State or country)
Eppinghary D. H.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mro J. C.Hobbs
(Address) Ve Cheletord
15 a/r. I. 1912 Edward J. Robbing
REGISTRAR
7
106 Chelmsford
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
PARENTS
3 SEX
Tale
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
yrs.
If LESS than I day ......... hrs.
mos.
10
.ds.
DATE OF BURIAL
April 2
1912
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. Ifthe 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 fevcr (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 4 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.
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate. N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH North Chelies ford (No 4 am Luat
St. :
Ward)
/ (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 4 amhurst Street
Registered No. 21
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mali
4 COLOR OR RACE
· SINGLE
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
Ma
acid
6 DATE OF BIRTH
IF51
(Month)
(Day)
(Year)
7 AGE
61
1
.yrs.
mos.
ds.
or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Second Hand
(b) General nature of industry,
business, or establishment in
which employed (or employer) ...
Cotton Mel
9 BIRTHPLACE
(State or country)
Ireland
PARENTS
12 MAIDEN NAME OF MOTHER Catherine Mulcake
18 BIRTHPLACE OF MOTHER (State or country)
theland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informants
(Address) 4. Unterst tt
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
March
30 th
(Month)
(Day)
199
(Year)
17 1 HEREBY CERTIFY that I attended deceased from June, 1911, to Mar 30th 1912 that I last saw him alive on Man. 24th . 1912 and that death occurred, on the date stated above, at 3 9 m. The CAUSE OF DEATH* was as follows :
Disease of Heart
(Duration).
2 yrs.
mos.
ds.
Contributory ..
(SECONDARY)
(Duration) .
... yrs.
mos.
ds.
(Signed)
M.D.
V cr. 30%
Qx, 1912 (Address)
James
20
Www. 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.
13 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
abril!
i91
20 UNDERTAKER ,
ADDRESS
16 Filed Man 30, 1912 Edward S. Robbing
:
10 NAME OF
FATHER
Pating Noyan
11 BIRTHPLACE OF FATHER (State or country)
Juland
1.07 Chelefond Mass ,
MARGIN RESERVED FOR BINDING
If LESS than
1 day,.
hrs.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oeeupa- tion is vory important, so that the relative healthifulness of various pursuits ean bo known. The quostion applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, o. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, ete. But in many cases, especially in industrial employments, it is noeessary 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," ete., without more precise specifieation, as Day laborer, Farm laborer, Laborer- Coal mine, ete. Women at homo, who are engaged in the duties of the household only (not paid Ilousc- keepers who receive a definite salary), may bo entered as Hlouscwife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should bo taken to report specifically the occupations of persons engaged in domestie service for wages, as Servant, Cook, Ilouscmaid, ete. If the oeeupation has been changed or given up on aeeount of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that faet may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no oeeupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE CAUSING DEATII (the primary affection with respect to time and eausation), using always the same accepted term for the samo disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemie 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, ete., Carcinoma, Sar- coma, ete., of. (name origin: "Cancer " is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart discusc; Chronic interstitial nephritis, ete. The contributory (second- ary or intereurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report more symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatie), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shoek," "Uraemia," " Weakness," etc., when a definite disease ean be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," ete. State cause for whiel surgical operation was undertaken.
Cases for the Medical Examiners. - Under tho provisions of chapter 24 of the Revised Laws deaths under tho following conditions must be referred to the Medical Examiners:
1. Doaths following injury or violence, as Burus, 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, ete.
4. Doaths under circumstances unknown, as A person found dcad, etc.
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
South Chelmsford MasNo.
St. : Ward)
2 FULL NAME
[If married or divoreed woman or widow give maiden name, also name of husband.] @RESIDENCE South
Chelmsford
Mass
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
( Write the word)
I857
(Month)
(Day)
(Year)
7 AGE
If LESS than 1 day, ....... hrs.
55
T
mos.
8
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) ..
º BIRTHPLACE (State or country)
Sudbury Mass
10 NAME OF
FATHER
Thomas
Lyons
11 BIRTHPLACE OF FATHER (State or country)
Ireland
12 MAIDEN NAME OF MOTHER
Ellen
Byron
18 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Jennie A
Lyons
(Address)
South Chelmsford Mass
apr. $1 1912 Edward J. Rolling
®ISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
aker.
2
(Month)
(Day)
1912
(Year)
1 1 HEREBY CERTIFY that I attended deceased from Sekt
-
1903 to
apr. 2
1912.
that I last saw h live on , 191 and that death occurred, on the date stated above, at 3:30a
The CAUSE OF DEATH* was as follows :
Harmoplyser
(Duration).
.yrs.
mos. ds.
Contributory.
/ ...
-
(SECONDARY)
(Duration) 60 yrs.
mos.
ds.
(Signed)
Antony, Scolonia
M.D.
apr. 3, 1912 (Address)
* If death followed injury or violenee 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
FOX
Hill
Cemetery
Billerica
Mass
"O UNDERTAKER
l.m. young
ADDRESS
33 Prescott of
WRITE PLAINLY, WITH UNFADING INK- THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
108
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Charles Lyons
Registered No.
22
Male
White
6 DATE OF BIRTH
Feb
25
yrs.
.
MARGIN RESERVED FOR BINDING
PARENTS
DATE OF BURIAL
april 4
1912
2
:
STANDARD CERTIFICATE OF DEATH.
1
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, Arehitcet, 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 gaill- 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, G 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., Careinoma, Sar- coma, etc., of (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasmns) ; 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- 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.
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.
PARENTS
12 MAIDEN NAME
OF MOTHER
Elizabeth Suffire
13 BIRTHPLACE
OF MOTHER
(State or country) Verano
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Kee ord.
(Informant)
(Address)
16 Filed Luck17 92 6 E Pick
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
ellerch 16h
(Month)
(Day)
......... (Year)
6 DATE OF BIRTH
(Month)
(Day)
1846
(Year)
7 AGE
If LESS than
I day ......... hrs.
66
........ yrs. mos. ds.
or ......... min. ?
$ OCCUPATION
(a) Trade, profession, or
particular kind of work
Carpenter
(b) General nature of industry, business, or establishment in which employed (or employer) ....
9 BIRTHPLACE
(State or country)
Sturbridge
.........
.(Duration).
.. yrs.
mos.
.ds.
Contributory ..
(SECONDARY)
.. (Duration) .
.... yrs.
.mos.
ds.
(Signed) Frederick A Quel
M.D.
10/11912 (Address). Palmer der
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
IS LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
. yrs.
2 mos.
mos. 2 hs
State.
.......... yrs.
.. mos. ............
ds.
Where was disease contracted, if not at place of death ?.
Former or
usual residence ..
.........
19 PLACE OF BURIAL OR REMOVAL Edson
foruste elf,
20 UNDERTAKER
Sul Phecif,
DATE OF BURIAL lech 1992
......
ADDRESS
Palicarlos
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
ellosson ellos,
.... (No .....**** )
Epiléptico Hospitals
. :
Ward)
109 MONSON, MASS,
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Chelmsford lisa
Registered No.
23
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Ellale
4 COLOR OR RACE
White
1 5 SINGLE,
MARRIED
WIDOWED.
OR DIVORCED
(Write the word)
191 2
..
17 I HEREBY CERTIFY that I attended deceased from ellcty, 197 to LLC=416,92 that I last saw halive on ... Week I, 1912 and that death occurred, on the date stated above, at 9-7 .... m. The CAUSE OF DEATH* was as follows :
....
....
..........
......
10 NAME OF
FATHER
Robert Hunt
11 BIRTHPLACE
OF FATHER
(State or country)
Stanbridge
In the
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) 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 Housc- 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, Houscmaid, 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 valrular 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 septicemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
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