USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 24
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OF MOTHER
(State or country)
Rinity Av. JC.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Stephen Laughton
(Address) East Chelmsford
15
Filed. Mar 22 15 Jubel E. Ellis
aust. REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Mar,
11ch-
191 6
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from .
Mar. 11
, 1915, to
Wiar. 11
1915
...
... ,
that I last saw him alive on.
191
....
and that death occurred, on the date stated above, at.
.m.
The CAUSE OF DEATH* was as follows :
-
(Duration)
.yrs.
ds.
mos.
Contributory ...
(SECONDARY)
(Signed)
Arthur 4. Jarbory
Huration)
.mos.
ds.
M.D.
March 20 1915
(Address)
Chelmsford, Vad-
.......
* 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 Jose Futhus
DATE OF BURIAL
Mauzz 1916
ADDRESS
20 UNDERTAKER George W. Eachnian 363 Bridge
.........
92
MARGIN RESERVED FOR BINDING
10 NAME OF
FATHER
Stephan Laughlin
............. yrs.
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 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- kcepers 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- 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, 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: Mcasles (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 septicemia," "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 circumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK- THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts
93 Cheline Lucas (City or town.) [If death occurred in a hospital or institution, give its NAME Instead of street and number.]
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
So Tulanfard
(No
[If married or divorced woman or widow
give maiden name, also name of husband. ] Eliza A Goodwitch
@RESIDENCE
South Chelmsford
Mass
Jerome B.Melvin
....
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
& SINGLE,
16 DATE OF DEATH
March 21
MARRIED
WIDOWED,
Widow
Female
4 COLOR OR RACE
White
(Day)
OR DIVORCED
(Write the word)
(Month)
(Year)
$ DATE OF BIRTH
March
9
1840
(Year)
17
-
(Month)
(Day)
7 AGE
If LESS than
! day ......... hrs.
75
12
or ......... min. ?
& OCCUPATION
(a) Trade, profession, or
.
particular kind of work
At Home
arteriosclerosis -
(b) General nature of industry,
business, or establishment In
Pinky Hemiplegia
-
which employed (or employer).
9 BIRTHPLACE
(State or country)
Lowell Mass
Contributory ...
(SECONDARY)
....
10 NAME OF
FATHER
Charles H. Goodwitch
.(Duration) ....
................ yrs.
.... mos.
.......
....
(Signed)
Auchun L, colonia
.,
M.D.
Mar, 21, 1915 (Address).
Chelmsford, mass.
ds.
Il BIRTHPLACE
OF FATHER
(State or country)
Not Known
.........
* If death followed injury or violence the certificate of death must be made
out by the Medical Examiner.
12 MAIDEN NAME
In the
OF MOTHER
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
Mary M.Dane
PARENTS
At place
of death
yrs.
.....
... mos.
ds.
State.
......
mos.
ds .............
13 BIRTHPLACE
Where was disease contracted,
If not at place of death ?.
OF MOTHER
Andover Mass
(State or country)
Former or
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
usual residence ..
(Informant) Mrs Annie T.Melvin
(Address) So Chelmsford Mass
19 PLACE OF BURIAL OR REMOVAL
Edson Cemetry
DATE OF BURIAL
March 231915
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
...
... yrs.
mos.
ds.
important. See instructions on back of certificate.
St. ;...................
.Ward)
2 FULL NAME
Eliza Ce. Melvina
.(Duration)
........... yrs.
mos.
20 UNDERTAKER
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
.....................................
I HEREBY CERTIFY that I attended deceased from Jan, 26, 1915 to. March 21 195 that I last saw her alive on March 21, 95 and that death occurred, on the date stated above, at 11: 45am. The CAUSE OF DEATH* was as follows :
ds.
....
15 Filed Man. 22, 1915 .......
aut
REGISTRAR
Blake
ADDRESS
33 PrescottSt.
1915
....
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 cach 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 (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 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, 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 eausing 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," ete., when a definite disease can be ascertained as the eause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- - PERAL septicaemia,", "PUERPERAL peritonitis," etc. State eause 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 circumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
7 AGE 8 OCCUPATION 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 particular kind of work
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH no. Chelmsford (No ... - ........ ....
Middlesex
St.
words
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
middlesex h. north Chelefed
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male White
4 COLOR OR RACE
5 SINGLE
MARRIED,
married
WIDOWED, OR DIVORCED (Write the word)
6 DATE OF BIRTH march
(Month)
30
1843
(Day)
(Year)
If LESS than 1 day .......... hrs.
71 yrs. 11
mos.
18
ds.
or ......... min. ?
(a) Trade, profession, or
Secy + / rear
(b) General nature of industry.
business, or establishment in
which employed (or employer) ...
Secy + Treas.
9 BIRTHPLACE
(State or country)
England
10 NAME OF
FATHER
James Woods.
11 BIRTHPLACE
OF FATHER
(State or country)
England
12 MAIDEN NAME
OF MOTHER
ann necoman
13 BIRTHPLACE
OF MOTHER
(State or country)
) England
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
Geo. H. Woods
(Addres) Boston mass
15 Filed.
REGISTRAR
17
I HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows :
arterio - pelemaior
.. (Duration)
........... yrs.
ds.
.mos.
Contributor Lecula Dilatation of Strand
(SECONDARY)
.(Duration)
.yrs.
„mos.
ds.
(Signed)
Mar 2.2. 1915
(Address) ..
.... .
M.D.
MEDICAL EXAMINER
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS 'of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
In the
At place
of death
.yrs.
mos.
ds.
State ..
... yrs.
mos.
ds.
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
north Chelmsford man 23, 1915
20 UNDERTAKER
ger. W. Healey
ADDRESS
79 Branch St.
94
No. Chilisford Ward) (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No. 22
16 DATE OF DEATH
March 20
(Month)
(Day)
191/5
(Year)
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healtlifulness 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 reccive 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Ccrebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never rc- 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," "All- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."
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, ctc.
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 dcad, 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
St. :
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female achète
4 COLOR OR RACE
· SINGLE
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
vola
V
6 DATE OF BIRTH
Juli 2.8 1824
(Month)
(Day)
(Year).
7 AGE
90
.. yrs.
mos.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Actual
(b) General nature of Industry, business, or establishment in which employed (or employer) ..
9 BIRTHPLACE
(State or country)
.(Duration)
.mos ...
..
ds.
Contributory .. (SECONDARY)
(Duration)
... yrs.
mos.
ds.
(Signed)
Arthur J, Scoparia
M.D.
Mar. 26 95
...... (Address).
Chelmsford, Inass
* 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 ...
...
13 BIRTHPLACE
OF MOTHER
14 THE ABOVE ISTTRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
Sarah beichten
(Address) Chehuelva
16
Filed Mar 27, 196 Janbut E. Ellis Cost. REGISTRAR
16 DATE OF DEATH March 25
191 57
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from Mar. 21, 1915, to Mar. 25 1915
that I last saw her alive on
Max. 25
1915
..... about and that death occurred, on the date stated above, at 2:30 1. m. The CAUSE OF DEATH* was as follows :
...
acute Lobar Pneumonia
.........
-
10 NAME OF
FATHER
Salomon button
11 BIRTHPLACE OF FATHER (State or country} -
1
12 MAIDEN NAME
OF MOTHER
Clever
Where was disease contracted, If not at place of death ?. .... Former or usual residence .. ....
19 PLACE OF BURIAL OR REMOVAL lecterbem
DATE OF BURIAL
Mac. 27. 1915
ADDRESS
20 UNDERTAKER
A Memberch
95 Chelus food
(City or town.)
2 FULL NAME
Elizabeth
lighting
[If married or divorced woman or widow
give maiden name, also name of husband.1
@RESIDENCE
So Cheleford
Lincoln senge bergliten
Registered No. 23
..........
... yrs.
5
.........
PARENTS
If LESS than
[ day .......... hrs.
>
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis ") ; Diphtheria (avoid use of " Croup ") ; Typhoid fever (never re- port " Typhoid pneumonia") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc , Carcinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough ; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless 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- posurc, 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 dead, etc.
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
West Chelmsford
(No. Maja 2007
St. :.
................ Ward)
fif death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Huch Holland
[If married or divorced woman or widow
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