USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 2
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The CAUSE OF DEATH* was as follows :
Senile Dementia (10 mos)
Arterio Sclerosis (yes)
Cellulitis R hand.
Duration)
yrs.
mos.
Ods.
Contributory
Septicaemia with Purulent
(SECONDARY)
PerY
carditis (Duration).
... yrs.
.mos.
Cds .
(Signed)
V & Orcutt
M.D.
Jan 24,4 (Address)
Worcester
* 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
All life
At place
of death.
yrs ...
7 mos.
ds.
State.
yrs.
mos.
ds.
Where was disease contracted,
If not at place of death ?.
Unknown
Former or
usual residence.
Chelmsford
19 PLACE OF BURIAL OR REMOVAL Lowell
DATE OF BURIAL
Jan 26
191
4
20 UNDERTAKER
Geo Sessions Co
ADDRESS
Worcester
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
PARENTS
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," unqualificd, 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 nced 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 duc to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dcad, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
& SEX Female 6 DATE OF BIRTH 7 AGE 8 OCCUPATION 9 BIRTHPLACE (State or country) 10 NAME OF FATHER PARENTS 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 8
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Lowell, Mass. (No. Lowell Hospital St. ;.. ..........
Ward)
5
Registered No. 156
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
White
[ 5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED Single
(Write the wordf
June
15,
1905
(Month)
(Day)
1 (Year)
If LESS than I day, ........ hrs.
yrs.
7
mos.
17
ds,
or ......... min. ?
17
I HEREBY CERTIFY that I attended deceased from Jan. 20, 194 , to. Feb. 1, 194 ........ .... that I last saw her alive on Jan. 31. . 191 ... 4, and that death occurred, on the date stated above, at 4 8 mm The CAUSE OF DEATH* was as follows :
Cerebro Spinal Meningitis
(Duration)
yrs.
mos.
ds.
Contributory ..
(SECONDARY)
.(Duration)
.yrs.
mos.
ds.
(Signed)
F. J. Clark
M.D.
Feb. 1 , 19| 4 (Address), Lowell 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
mos.
ds ..
.yrs.
....
Where was disease contracted, If not at place of death ?...
Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL W. Chelmsford, Mass
DATE OF BURIAL
Feb. 1, . 1914
(Informant)
Guster Johnson
(Address)
W. Chelmsford, Mass.
16 Filed HAD. 3 1914/11
REGISTRAR
1
Lowell ......
(City or town.) [if death occurred in a hospital or institution, give its NAME instead of street and number.]
Alice S. Johnson
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE West Chelmsford. Mass.
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH
February 1. 1914
191
(Month)
(Day)
(Year)
....
(a) Trade, profession, or
particular kind of work
School Girl
(b) General nature of industry, business, or establishment in which employed (or employer).
West Cheinsford, Mass.
Gustaf Johnson
11 BIRTHPLACE OF FATHER (State or country) Sweden
12 MAIDEN NAME
OF MOTHER
Alida Petersen
13 BIRTHPLACE OF MOTHER (State or country) West Chelmsford Mass
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
20 UNDERTAKER
Walter Porham
ADDRESS
Chelmsford
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precisc statement of oceu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to caeh and every person, irrespcetive 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," ete., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, ete. 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 domestie 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 faet may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no oceu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- LASE 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, 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, 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 merc 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," "Shock," "Uracmia," "Weakness," ete., when a definite disease ean be ascertaincd as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicacmia," "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 disease, as A death upon the street, or one supposed to be due to Alcoholism, etc
4. Deaths under circumstanecs unknown, as A person found dead, etc.
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
1 PLACE OF DEATH
(No.
Hast Chefomlad st Ward)
2FULL NAME
Georgia_@gemist
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
Hart Chelanstart-
Registered No.
6
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
enala
4 COLOR OR RACE
5 "SINGLE,
MARRIED Married.
WIDOWED,
OR DIVORCED
(Write the word)
1ª DATE OF DEATH
Het. 7" 1914
(Month)
(Day)
(Year)
6 DATE OF BIRTH
Barn aug 23-1881
(Month)
(Day)
1
(Year)
7 AGE
If LESS than
I day, ......... hrs.
or ......... min. ?
-
& OCCUPATION
(a)' Trade, profession, or
particular kind of work.
Black smith
(b) General nature of industry.
business, or establishment in
which employed (or employer) ...................*******
1
9 BIRTHPLACE
(State or country)
Sweden
PARENTS
13 BIRTHPLACE
OF FATHER
(State or country)
Sweden.
.
12 MAIDEN NAME
OF MOTHER
Regina Petterson
18 BIRTHPLACE OF MOTHER (State or country)
Sweden
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mary Margaret Quist
(Address)
16 Filed Set. Y, 1914 Sedmand & Rabbim 1265- 1492
REGISTRAR
...
17 I HEREBY CERTIFY that ! attended deceased from August1, 1912 to Fight. 7 · 4
191 that I last saw hi zualive on Flet. 6" 191- ........... and that death occurred, on the date stated above, at /a.m. The CAUSE OF DEATH* was as follows :
Pulmonary Juber de loses
|(Duration) / yrs. 6
[ .......... yrs. ................. . .................
Contributory ..
(SECONDARY)
.. (Duration).
................ y.
mos.
Hillig F. Lamber
M.D.
201914
(Address) ....
* If death followed injury or violence the certificate of death must be made ont by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
In the
At piace
of death_
........... yrs.
..... mos.
....... ds.
State ............ yTo. ............ mos.
...........
.ds .............
Where was disease contracted, If not at place of death ?..... Former or usual residence.
1 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
1914
2 UNDERTAKER WL Evig & Son.
ADDRESS
6
(City er town.) fif death occurred in a hospital or institution, give its NAME instead of street and number.]
MEDICAL CERTIFICATE OF DEATH
......
32
.yrs.
.............. mos ..
15 de.
5
10 NAME OF
FATHER
andreas Quist
.......
(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, c. 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 (6) the nature of the business or industry, and therefore an additional line is provided for the latter statement ; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman,""Manager,""Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer- Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port"" Typhoid "pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of. .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," " Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," " Marasmus," " Old age," "Shock," " Uraenia," "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.
WRITE PLAINLY, WITH UNFADING INK- THIS IS A PERMANENT RECORD.
3 SEX Female 7 AGE 8 OCCUPATION 9 BIRTHPLACE (State or country) PARENTS (Informant) (Address) 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 38
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Lowell, Mass.
(No. Lowell Hospital
St. ;....
.. Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME Instead of street and number.]
Minnie B. Hanley
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Chelmsford, Mass.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
February 10.
191 4
(Month)
(Day)
(Year)
6 DATE OF BIRTH
February 17, 1875
(Month)
(Day)
1
(Year)
If LESS than
1 day ......... hrs.
.. yrs.
11
mos.
27
.ds.
or ......... min. ?
(a) Trade, profession, or
particular kind of work.
At Home
(b) General nature of industry, business, or establishment in which employed (or employer).
Chelmsford, Mass.
10 NAME OF FATHER George Hanley
11 BIRTHPLACE
OF FATHER
(State or country)
Acton Mass.
12 MAIDEN NAME
OF MOTHER
Justina Wright
18 BIRTHPLACE
OF MOTHER
(State or country)
Chelmsford, Mass.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Milo Wright
Chelmsford, Mass.
16 Feb. 10. 1914. 7
Filed. 191.
........
REGISTRAR
Laryngeal Diphtheria
(Duration) .
.............. yrs.
.. mos ..
........... .. ds.
Contributory ..
(SECONDARY)
.. (Duration) ................ yrs. ........... mos. ds.
(Signed)
E. J. Clark
M.D.
Feb. 11 ,19,19 1Adress).
Lowell 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.
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 Chelmsford, Mass.
20 UNDERTAKER
J. A.
Weinbeck
DATE OF BURIAL
W 1019
121
ADDRESS
Lowell1
6:30 2'
and that death occurred, on the date stated above, at. m. The CAUSE OF DEATH* was as follows :
MARGIN RESERVED FOR BINDING
Lowell
.....
4 COLOR OR RACE
White
1 5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word) Single
Registered No. 205
17
I HEREBY CERTIFY that I attended deceased from
Feb. 8,
191 4 to. Feb. 10,
1914
..........
that I last saw het alive on
Feb. 9,
197
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 enginecr, Civil cngincer, 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- kecpers 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- DASE 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 (nover 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 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," "Uracmia," "Weakness," etc., when a definite disease can be ascertained as the eause. Always qualify all discases 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, a's 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.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
3 SEX Male 7 AGE 8 OCCUPATION 9 BIRTHPLACE (State or country) 12 MAIDEN NAME OF MOTHER PARENTS 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 42
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Lowell, Mass.
.(No.
Lowell General Hospital
00
Lowell
..... (City or town.) {If death occurred in a hospital or institution, give its NAME instead of street and number.]
Gustaf A. Anderson
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
East Chelmsford, Mass.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
10 DATE OF DEATH
February
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