USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 14
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culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of ... ...... (name origin: "Cancer" is less definite; avoid use of " Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), "Atrophy," "Collapse," "" Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners :
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK- THIS IS A PERMANENT RECORD.
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 orach Chelmsford (No
St. :
Ward)
Chelmsford. (City ør town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2FULL NAME
aura
una Jance Byan
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE South Chelwestend.
Registered No.
52
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX 7,
4 COLOR OR RACE
w
5 SINGLE,
MARRIED
WIDOWED
Single
(Write tho word)
16 DATE OF DEATH
september, 18
(Month)
7 (Day)
1914
(Year)
6 DATE OF BIRTH
24
1834 17
(Month)
(Day)
(Year)
7 AGE
80
yrs.
2
mos.
26
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).
(apparently miluany these, as they
was no eukunne to concuiaring
yrs.
clauphere)
(Duration).
6
Contributory.
(SECONDARY)
(Duration)
.yrs.
.mos.
ds.
(Signed)
Marshall L. Alling
..
M.D.
Oct, 3, 1914
(Address) Loreel, Maks.
* 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).
In the
mos.
ds
Where was disease contracted, if not at place of death ?.
Former or usual residonce ..
19 PLACE OF BURIAL OR REMOVAL
Haut and Com
Chelmsford
DATE OF BURIAL
Sept 22
191,
20 UNDERTAKER
Waller
ADDRESS
Chebus font.
1
PARENTS
Il BIRTHPLACE
OF FATHER
(State or country)
Chebusferd.
12 MAIDEN NAME
OF MOTHER
Rebecca hambulain
13 BIRTHPLACE
OF MOTHER
(State or country)
Chelmsford
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Daniel Bryan
(Address)
Lande Chelen ford
15 Filed Sept. 22 1 91 4 Edward ). Rolling
REGISTRAR
I HEREBY CERTIFY that I attended deceased from
april 4, 1914, to death
191
that I last saw he alive on Sekt 19, 1914, and that death occurred, on the date stated above, at 2 a.m. The CAUSE OF DEATH* was as follows : Carcinoma of the hier
mos.
ds.
9 BIRTHPLACE
(State or country)
Chelinefeed
Jeility
10 NAME OF
FATHER
Такие ХО. Вцат
If LESS than I day ......... hrs.
52
At place
of death
.. yrs.
mos.
ds.
State
.. yrs.
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 wlien nceded. 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") ; Diphtheriu (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 ; Chronie 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 .; Broneho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," " Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1PLACE OF DEATH
ast Chelmsford
.. (No.
Gorham
St. :
.. Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Elisabeth & Smith
Elisabeth Kelley: Thomas Smith. ....... [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
Gast Chelmsford
PERSONAL AND STATISTICAL PARTICULARS :
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Sept
(Month)
.
(Dạy)
22.1994
(Year)
I HEREBY CERTIFY that attended deceased from July 5, 1914 to Jak 22 94 .... that I last saw har alive on. Febx 22. 1919 and that death occurred, on the date stated above, at ..... .................... m.
The CAUSE OF DEATH* was as follows :
Pernicious Quemia
...
1
(Duration)
... yrs.
.mos.
ds.
Contributory
(SECONDARY) *
(Duration)
.. ys.
mos.
ds.
(Signed)
Samas Pim COdan
M.D.
6-04-24, 1914 (Address) 29 Cumbens Sp
....
* 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
Edson Someten Sept 24.
1914
(Address)
8. Chelmsford
15 Filed_ Sept. 24, 1914 EdwardJ. Robbins
REGISTRAR
17
(Month)
(Day)
1
(Year)
74
yrs.
mos.
ds.
If LESS than
I day, ......... hrs.
or ........ min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work.
it home
(b) General nature of industry, business, or establishment in which employed (or employer) ..
9 BIRTHPLACE
(State or country)
Ovovidence R.9.
10 NAME OF
FATHER
Daniel Kelley
11 BIRTHPLACE
OF FATHER
(State or country)
Dracut Mass
12 MAIDEN NAME
OF MOTHER
Elizabeth Shepard
18 BIRTHPLACE OF MOTHER (State or country)
Marli Vermont
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
53 Gast Chelmsford (City or towa)
2 FULL NAME
3 SEX
Premale
& DATE OF BIRTH
AGE
PARENTS
(Informant)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
.....
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
manied
Registered No.
53
ADDRESS
20 UNDERTAKER
P.B. Currier El
.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation 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 cxamples: (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," ctc., 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, Houscwork, 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 occu- . pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- EASE 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, ctc., Carcinoma, Sar- coma, etc., of ..... ............ .(name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; Mcasles; 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 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 provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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 diseasc, as A death upon the strcet, or onc supposed to be due to Alcoholism, etc
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
Lowell. Mass.
.(No St. John's Hospital
St. :
...... .Ward)
2 FULL NAME
John McManus
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Gorth Chelmsford, Mass.
Registered No.
1299
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
( Write the word)
Unknown
6 DATE OF BIRTH
-----
1
(Month)
(Day)
(Year)
7 AGE
If LESS than
I day ......... hrs.
67
--
mos. -as.
Or ......... min. ?
$ OCCUPATION
(a) Trade, profession, or
particular kind of work.
Kone
(b) General nature of industry, business, or establishment in which employed (or employer) ...
9 BIRTHPLACE
(State or country)
Lowell, Mass.
10 NAME OF
FATHER
John McManus
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Ireland
12 MAIDEN NAME
OF MOTHER
Unknown
1ª BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
George McManus
(Address)
K. Chelmsford, Mass.
15 Sept. 29 191.
4.
REGISTRAR
54
Lowell .......
....
(City or town.)
[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.
(Duration)
1
yrs. .mos. ...
ds.
Contributory ....
Arterio-Sclerosis
(SECONDARY)
.(Duration).
2
.yrs.
.mos.
...........
ds.
(Signed)
C. M. Brady
M.D.
Sept. 28 4 (Address).
St. John's Hospital
* 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
St. Patrick's
Lowell,
Mass.
DATE OF BURIAL
Cemetery. 29
4
191.
20 UNDERTAKER
McDermott
ADDRESS
Lowell
Filed. -1 .........
16 DATE OF DEATH
September 27.
1914
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
Sept. 24,
191
4.
Sept. 27,
1014
....... ........... that I last saw him alive on Sept. 27. 19| 4
and that death occurred, on the date stated above, at ...... ................... m .
yrs.
The CAUSE OF DEATH* was as follows :
Chronic Bronchitis
.....
11
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits ean 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, c. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engincer, Civil engineer, Stationary fireman, ctc. 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 cxamples: (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," ctc., without more precise spceifieation, 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 occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- CASE 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 "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, peritonacum, 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 im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia,". "An- aemia" (mcrely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., wlien 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 provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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 discase, 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.
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. Warham
St. :
Ward)
Elisa 7
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
5 DATE OF BIRTH
(Month)
(Day)
7 AGE
57
... yrs. mos. ds.
Or ......... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Opercitive
(b) General nature of industry, business, or establishment in which employed (or employer) ...
' BIRTHPLACE
(State or country)
Lowell Mass
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland
12 MAIDEN NAME
OF MOTHER
Comas
18 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
(Address)
16 Filed. Seft- 28, 1914 Edward Y. Rolfing.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
9
27
1914
... ....
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that y attended deceased from
Jan 20, 1913, to
Jeff 27, 1914
that I last saw her alive on
Sept. 20, 1914
and that death occurred, on the date stated above, at ...
m.
The CAUSE OF DEATH* was as follows :
arteno-Sclerosis
.(Duration)
2
.. yrs.
.mos.
ds.
Contributory
Cerebral Softening
(SECONDARY)
(Duration)/ yrs[ ...
... mos.
ds.
1
(Signed)
Sept 28, 1914 (Address
2. Runel Blag
* It 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
St Patricks Cemetery Sept 9,01914
ADDRESS
UNDERTAKER Holm 70lagers 445t
Chelmsford (City or town.) Tif death occurred in a hospital or institution, give its NAME instead of street and number.]
Chelmsford IIIa Registered No.
55
185
(Year)
If LESS than
I day ......... hrs.
10 NAME OF
Patrick Can
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.
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