USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 26
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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
STANDARD CERTIFICATE OF DEATH 1 PLACE OF DEATH
.(No. ...
St. :
...............
Ward)
Pling M Goddard
Registered No. 28.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Aka 4th 1915,
(Month)
(Day)
.......... (Year)
6 DATE OF BIRTH
1
Tel 13. 1844,.
(Month)
(Day)
(Year)
If LESS than 1 day, ........ hrs.
or ......... min. ?
17
I HEREBY CERTIFY that I attended deceased from
Mar. 27 1915 to apr. 4
, 1915
that I last saw ham alive on.
apr 4
, 1915
and that death occurred, on the date 'stated above, at ..
.... m.
The CAUSE OF DEATH* was as follows :
arteriosclerosis - Myocarditis
8 BIRTHPLACE
(State or country)
Berlin Mars
10 NAME OF
FATHER
James Goddard
(State or country)
ut Berlin Mass
12 MAIDEN NAME
OF MOTHER
Retres Speckford
18 BIRTHPLACE
OF MOTHER
(State or country)
Arthur Mars
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) MM MMand Goddard
Filed. apu7
asat.
REGISTRAR
.. (Duration)
.yrs. .......
.. mos.
.ds.
10
....... yrs.
„ds.
Contributory ..
Epidemia Influenza
....
(SECONDARY)
® (Duration).
... mos.
color
M.D.
(Signed)
apr. 5
Chilingford Mars
8. 191.05 (Address).
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
of death,
.. yrs.
.mos.
.ds.
State ...
............. yrs.
In the
mos.
ds
......
Where was disease contracted, If not at place of death ?. .... Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
1915
-
ADDRESS
UNDERTAKER
RAS AS Webech Market
100
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
....
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.1
@RESIDENCE
3 SEX
Laquale White
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
7 AGE
71
& OCCUPATION
(a) Trade, profession, or
particular kind of work.
.....
(b) General nature of industry,
business, or establishment in
11
which employed (or employer).
11 BIRTHPLACE
OF FATHER
PARENTS
important. See instructions on back of certificate.
(Address)
15
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 mos.
.. mos ..
18 ds.
married
-
191
Scorde
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 (retircd, 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- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or onc supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
1
4
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 Toth Theles ford, (No. Nyugalomra
Vitill
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
Tyngsboro Food. Forth Chelmsford
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
S
3 SEX
may
4 COLOR OR RACE
that
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
16 DATE OF DEATH
april
6 =
195
....
(Month)
(Day)
(Year)
6 DATE OF BIRTH
abul
6
19/07
(Month)
(Day)
(Year)
7 AGE
If LESS than
1 day ...
..... hrs.
that I last saw h ...
......
alive on
191
.........
and that death occurred, on the date stated above, at &a. m.
The CAUSE OF DEATH* was as follows :
shill- ban
9 BIRTHPLACE
(State or country)
Forth Chelmsford
L
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Jersey, Veland
12 MAIDEN NAME
OF MOTHER
ada Langlois
13 BIRTHPLACE
OF MOTHER
(State or country)
Ibland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informan
any Gabriel Quedown father
(Address) Anth Chelui And
16
Filed Win 7, 1955 Jaubert JE Ellio Cast. REGISTRAR
mos.
(Duration)
... yrs.
ds.
Contributory
(SECONDARY)
....
.. (Duration) ...
........... yrs.
mos.
.ds.
M.D.
(Signed)
about 6
.....
191V (Address)
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
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 Status, Center
DATE OF BURIAL
apu 1 195
.......
20 UNDERTAKER
ADDRESS
324 Margit St
Pheles fond mains
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
St. :
Ward)
on audoin
Registered No.
29.
yrs. mos. ds.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work.
-
(b) General nature of industry,
business, or establishment in
which employed (or employer) ...
I HEREBY CERTIFY that I attended deceased from
191
to
1915
10 NAME OF
FATHER
Gabriel audoin
1
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 Ilouse- keepers 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 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 septicemia," " 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.
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 Last Chelmsford (No.
Willeweg Toad St. :
Ward)
(City or town.) {If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
East Chileux ford
PERSONAL AND STATISTICAL PARTICULARS/
3 SEX
Decual that
· DATE OF BIRTH
-
1838
1
(Month)
(Day)
...
(Year)
7 AGE
If LESS than
1 day ........ hrs.
yrs. mos.
ds.
or ......... min. ?
: OCCUPATION
(a) Trade, profession, or
particular kind of work
at Atime
(b) General nature of industry, business, or establishment in which employed (or employer) ....
9 BIRTHPLACE
(State or country)
Unland
PARENTS
12 MAIDEN NAME
OF MOTHER
Margaret Callero
13 BIRTHPLACE
OF MOTHER
(State or country)
Guland
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Jungle
(Informant)
(Address)
East Chelesford
15
File apc. 14, 195 Julet & Elles
aut. REGISTRAR
....
16 DATE OF DEATH
KMonth)
(Day)
1915
(Year)
.............
17
I HEREBY CERTIFY that I attended deceased from
apun 1
.............
1915, to ayer 11
....
1915 ..... that I last saw he alive on Of IO, 1915 and that death occurred, on the date stated above, at 6 /m. The CAUSE OF DEATH* was as follows : Pulmonary Hedera
.......
(Duration)
... yrs. ...
.... mos.
ds.
Contributory ...
Bunchesta
........
..........
(SECONDARY)
(Duration)
yrs.
.. mos. ds.
(Signed)
4/13/ 1915
M.D.
* 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 .............
Where was disease contracted, If not at place of death ?.
Former or usual residence ..
19 PLACE OF BURIAL OR REMOVAL Getinfo Center Toury
DATE OF BURIAL
apul 14 1915
20 UNDERTAKER
1
e
ADDRESS 324 Markt OF 6
1
1
Registered No. 30.
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
rd)
1103 Producidoford ?
10 NAME OF
FATHER
Jau h: Kennedy
11 BIRTHPLACE
OF FATHER
(State or country)
Juland
4
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, 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, 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 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- 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," etc., when a definite disease ean 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:
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 eircumstances 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 Commmwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH ..........
Cheluns ford 103
(City or town.)
Tlf death occurred in a hospital or institution, give its NAME instead of street and number.]
Ellen & O' Connor
2 FULL NAME
Ellen, V. Brennan
Veter O Sono
[If married or divorced woman or widow
give maiden name, also namc of husband.]
@RESIDENCE
Middleas A. Inth Cheles ford'
Registered No. 3 /.
PERSONAL AND STATISTICAL PARTICULARS
$ SEX
Jamal
COLOR OR RACE
6 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write the word)
& DATE OF BIRTH
(Month)
(Day)
1847
(Year)/
7 AGE 68
......... yrs ..
mos.
ds.
....... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
at Home
(b) General nature of industry,
business, or establishment in
which employed (or employer) ...
9 BIRTHPLACE
(State or country)
try) Auth Chelwex ford
PARENTS
12 MAIDEN NAME
OF MOTHER
Shawna Merry
18 BIRTHPLACE
OF MOTHER
(State or country)
Anton maso
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Margaret Ducale Vister
(Address)
Lauren Mass
16 Filed. ahu. 22 1915
asst. REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
4
19
(Month)
(Day)
1915
(Year)
17 I HEREBY CERTIFY that I attended deceased from Cifuil 14, 1915, to abril 14, 1915 that I last saw her alive on. april 19, 1915 and that death occurred, on the date stated above, at 14(m. The CAUSE OF DEATH* was as follows :
Broncho Pneumonia
.....
Contributory ...
Heart Frailes
(SECONDARY)
(Duration)
.... yrs.
......
... mos.
ds.
James faltaba
M.D.
(Signed)
abril 20, 1918
(Address).
Flo. chelmsford
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
of death
... yrs.
.mos. ......
ds.
State.
In the
....... yrs. ............ mos.
. ............. ds ......
Where was disease contracted, If not at place of death ?. ....
Former or usual residence.
..................
DATE OF BURIAL
19 PLACE OF BURIAL OR REMOVALYoury St. Galler, Country
20 UNDERTAKER
ADDRESS
Von 324 Mauret St
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
important. See instructions on back of certificate.
(Duration) ..
.yrs.
.mos.
5
ds.
10 NAME OF
FATHER
George Brennan
11 BIRTHPLACE
OF FATHER
(State or country)
.......
.......
-
St. :
Ward) ...
1 PLACE OF DEATH
Anth Chelen ford (No.
.........
-
If LESS than
I day,
.. hrs.
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 agc. 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 occu- pation whatever, write None.
Statement of cause of death. - Namc, 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 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," "Senilc," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia,", "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
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