USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 25
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give maiden name, also name of husband.]
@RESIDENCE
Main Roadi Test Chelmsfor:
Registered No.
24
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED Widowed
(Write the word)
" DATE OF BIRTH
March
(Month)
(Day)
(Year)
If LESS than
I day .......
.. hrs.
mos. ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Retaired
Mill Operative
9 BIRTHPLACE
(State or country)
Ireland
11 BIRTHPLACE
OF FATHER
(State or country)
Ir: lund
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Mrs. Bridget Keenan
(Informant)
(Address) Main Rd, W. Chelmsford
Filed Mas 31, 1913. Huber E. Ellis .....
auch REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
17 I HEREBY CERTIFY that I attended deceased from Mich 21, 1915 to. 19100 ......
that I last saw h alive on
Mch 28-
1915
and that death occurred, on the date stated above, at ...
m.
The CAUSE OF DEATH* was as follows :
Broncho. prea execute
.(Duration)
yrs.
....
Contributory ..
Semilly
(SECONDARY)
(Signed)
JEVarney
(Duration)
.. yrs.
....
................
mos.
ds.
MMM.D.
Mch 29, 1915 (Address)
18, Chilean food
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
...... yrs.
.... mos.
In the
ds.
State ............ yrs. .
.... mos. ............ .
._ ds .............
Where was disease contracted, If not at place of death ? ............ Former or usual residence
19 PLACE OF BURIAL OR REMOVAL St. Patrick's
DATE OF BURIAL
7: 37
1915
20 UNDERTAKER
ADDRESS
176 Sicham So
Lowell.
1
.............
29
19/5
(Month)
(Day)
,
(Year)
....
MARGIN RESERVED FOR BINDING
1 PLACE OF DEATH
....
3 SEX
Mole
7 AGE
99
(b) General nature of industry,
business, or establishment in
which employed (or employer).
10 NAME OF
FATHER
12 MAIDEN NAME
OF MOTHER
PARENTS
1ª BIRTHPLACE
OF MOTHER
(State or country)
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
... yrs.
1
96 Cheleur and (City or wown.) ( --
...............
4 COLOR OR RACE
White
1.816
mos.
8
ds.
....
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- 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 discase. 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 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.
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
3 SEX Male 6 DATE OF BIRTH 7 AGE 8 OCCUPATION (a) Trade, profession, or particular kind of work 9 BIRTHPLACE (State or country) 10 NAME OF FATHER 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 --
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Lowell, Mass.
.. (No
Lowell Hospital
St. :
97
Lowell ...
......
(City or town.)
[if death occurred in a hospital or institution, give its NAME Instead of street and number.]
2 FULL NAME
Efthimios Koulos
20
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Chelmsford, Mass.
Registered No. 304
MEDICAL CERTIFICATE OF DEATH
1915
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I attended deceased from March 1,, 1915, to March 4, ........ , 1915 .... that I last saw him alive on ..... March 3. .
1915
and that death occurred, on the date stated above, at 5. 202.
The CAUSE OF DEATH* was as follows : Gastro-Enteritis
(Duration) ... yrs. mos. ds.
Contributory ...
(SECONDARY)
(Duration)
.... yrs.
.......
mos.
ds.
(Signed)
E. J. Clark
M.D.
Mar. 4 , 191 ...
5 (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.
mos.
... ds.
State ....
In the
.yrs.
.. mos.
.ds.
Where was disease contracted, If not at place of death ?.
.... usual residence ... Former or ....
19 PLACE OF BURIAL OR REMOVAL Edspawgfretfrys.
DATE OF BURIAL
March 1. 1915
(Informant)
Manthos Koulos
(Address)
Chelmsford, Mass.
15 Filed_ Mar. 5,191 5
REGISTRAR
16 DATE OF DEATH
March 7.
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)Single
1
(Month)
(Day)
., (Year)
If LESS than
1 day ......... hrs.
-- yrs. .... 5 mos. ds. Or ......... min. ?
(b) General nature of industry, business, or establishment in which employed (or employer) ..
Lowell, Mass.
Manthos Koulos
11 BIRTHPLACE
OF FATHER
(State or country)
Greece
Constantina Stanoulos
13 BIRTHPLACE
OF MOTHER
(State or country)
Greece
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
20 UNDERTAKER
Peter H. Savage
ADDRESS
Lowell
Ward)
PERSONAL AND STATISTICAL PARTICULARS
---
MARGIN RESERVED FOR BINDING
....
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statemcut 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 ou 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 wheu 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 lias 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- BASE 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 ccrebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (uever re- port "Typhoid pneuuiouia"); Lobar pneumonia; Broncho- pneumonia ("Pneumouia,". uuqualified, 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); Mcasles; 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 (discase eausing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia,", "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shoek," "Uraemia," "Weakness," etc .; when a definite disease can be ascertained as the cause. Always qualify all discases 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 circumstances unknown, as A person found 4 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
11 BIRTHPLACE
OF FATHER
(State or country)
Chelmsford, Mass.
12 MAIDEN NAME
OF MOTHER
Mary A. Cordick
13 BIRTHPLACE
OF MOTHER
(State or country)
Boston, Mass.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Father
(Address)
Chelmsford, Mass.
16 Filed
Mar. 16 5 Chin
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
8 SEX
Female
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
16 DATE OF DEATH
March 15.
(Month)
(Day)
(Year)
6 DATE OF BIRTH
March 20
1898 |
(Month)
(Day)
(Year)
7 AGE
If LESS than
[ day, ........ hrs.
.. 1.6
.yrs. .11 mos. 2.2. ds.
or ......... min. ?
3 OCCUPATION
(a) Trade, profession, or
particular kind of work
School Girl
(b) General nature of industry, business, or establishment in which employed (or employer) ..
9 BIRTHPLACE
(State or country) chelmsford, Mass.
.. (Duration).
.............. yrs.
................ mos.
ds.
Contributory ..
(SECONDARY)
.. (Duration)
........
.... yrs.
... mos.
. ...............
ds.
(Signed)
Archibald R. Gardner
M.D.
Mar.
15., 191 5 (Address) Lowell, Mass.
* 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 ?. .... usuai residence .. Former or
19 PLACE OF BURIAL OR REMOVAL Chelmsford, Mass.
DATE OF BURIAL
Mar. 16
191
5
20 UNDERTAKER
J. A. Weinbeck
ADDRESS
Lowell
98
Lowell
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Fannie Blaisdell
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Chelmsford, Mass.
Registered No.374
PERSONAL AND STATISTICAL PARTICULARS
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Lowellm Mass. (No. Lowell Hospital St. : Ward)
26
191
.5.
17 I HEREBY CERTIFY that I attended deceased from March 9, 1918, to. Mar. 15, . 1915. that I last saw or alive on Mar. 15. ............. , 1915 ...... and that death occurred, on the date stated above, at a. m. The CAUSE OF DEATH* was as follows : Epidemic Cerebro Spinal Men- ingitis
....
10 NAME OF
FATHER
Ervin A. Blaisdell
....
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oceu- 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, Architcet, 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) Groccry; (a) Forcman, (b) Automobile factory. The material worked on inay form part of the second statement. Never return "Laborer," "Forcman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborcr, Laborcr - Coal minc, cte. 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, ctc. 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 nis- CASE CAUSING DEATH (the primary affection with respeet 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, peritonacum, etc., Carcinoma, Sar- eoma, 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 (second- ary or intercurrent) affection necd not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-pneumonia (sccondary), 10 ds. Never report mcre symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Scnilc," etc.), "Dropsy," "Exhaustion," "Heart failure,"" "Hacmorrhage," "Inanition," "Marasmus,", "Old age," "Shock," "Uracmia," "Weakness," ete., when a definite discase can be ascertaincd 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 disease, as A death upon the street, or one supposed to be duc 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.
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
...
.........
(City or town.)
{If death occurred in a hospital or institution, give its NAME instead of street and number.]
Harvard Duchene
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
COLOR OR RACE
5 SINGLE.
MARRIED,
WIDOWED
OR DIVORCED
(Write the word)
* DATE OF BIRTH
0 (Month)
(Day)
(Year)
7 AGE
If LESS than 1 day ......... hrs.
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) ..
9 BIRTHPLACE
(State or country)
Lowell Mars
(Duration)
... yrs.
......
Contributory.
(SECONDARY)
Athing, Scobona
M.D.
(Signed)
apr.4
. 1915 (Address).
Chalus fond Man
........
* 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
In the
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
......
1915
16 Filed.
aut. REGISTRAR
16 DATE OF DEATH
3
19152
...
(Month)
(Day)
(Year)
I HEREBY CERTIFY that I attended deceased from
Mar. 29.
.... 1915, to
apr. 3
1915
that I last saw h AM alive on
apr. 3
.1915
............ ,
and that death occurred, on the date stated above, at ................. m.
The CAUSE OF DEATH* was as follows : Certioval Harmonhay:
anterio Pacionalitis?
...........
mos.
7
ds.
10 NAME OF
FATHER
arthur Duchene
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Dr alban 4/f
12 MAIDEN NAME
OF MOTHER
Ida aubry
13 BIRTHPLACE
OF MOTHER
(State or country)
Farrell Meno
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Sunt are
VADDRESS
738
20 UNDERTAKER A Archambault mer
99
1 PLACE OF DEATH
(No. Annetto tore
St. :
Ward)
Registered No.
2
7.
MEDICAL CERTIFICATE OF DEATH
22
-
.......
... yrs.
8 mos. 11
ds.
.........
......... yrş.
.. mos. ..............
ds.
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 applics 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, ctc. Women at homc, 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," unqualificd, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, ctc., 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 (discase 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 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.
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