USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 35
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2. Deaths supposedly eaused by violenee, 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.
3 SEX Female - 7 AGE 8 OCCUPATION PARENTS important. See instructions on back of certificate. 16 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 Mass .... No. Woods Corner
St. ;...................... Ward)
.....................................
136
No Chelmsford.
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number ..
2 FULL NAME Julia M. Waller [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE No Chelmsford Mass
Julia M, Swett William Waller.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Sept 17 1915
(Month)
(Day)
(Year)
* DATE OF BIRTH
Nov 14
1835
-
(Month)
(Day)
(Year)
If LESS than I day ......... hrs.
79
... yrs ...
mos. ds.
or ......... min. ?
and that death occurred, on the date stated above, at.
uno
two writes
The CAUSE OF DEATH* was, as follows :
anguen
Lecturas
(b) General nature of industry, business, or establishment In which employed (or employer) ...
9 BIRTHPLACE
(State or country)
Potsdam N.Y.
IC NAME OF
FATHER
Acil Swett
11 BIRTHPLACE OF FATHER (State or country) Not Known
12 MAIDEN NAME
OF MOTHER
61
1ª BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) .
Mrs William Bridgeford
(Address)
No Chelmsford Mass
Filed. Sept. 19 1915 Edward & Robbins
REGISTRAR
def calcul
(Duration) . .... yrs.
.mos. ds.
Contributory
antena veleri
(SECONDARY)
(Duration).
.......
yrs.
mos ..
ds.
FELlaney
(Signed)
M.D.
f-18, 1910 (Addre
* 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.
Stato.
......
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 Edson Cemetry
DATE OF BURIAL
Sept 19 1955
20 UNDERTAKER Young 7 (Blake
ADDRESS
' COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widow
191.
..........
17 I HEREBY CERTIFY that I attended deceased froot
about 6 work ago a a Ser -109 death
191.
to ...... ............. .......... ..... ......... ...... . 1918 7 that I last saw h ~ alive on ofml- 6 works an 191 + seen
(a) Trade, profession, or
At Home
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- motivc 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 nceded. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- kcepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At schod 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 ncoplasms) ; Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (sccond- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (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 discase 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
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(City or town.)
no Chelmsford
{If death occurred in
St. :
a hospital or institution,
give its NAME instead
Gerald to Towers
of street and number.]
(No.,
Tay sheet
................
Ward)
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of/husband.]
@RESIDENCE
Registered No.
64
7 May Street north Chelmsford
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
& SEX
1 5 SINGLE,
4 COLOR OR RACE
(Month)
White
MARRIED,
16 DATE OF DEATH
Seft
WIDOWED,
OR DIVORCED
(Write the wordy/9/L
male
(Day)
21
(Year)
· DATE OF BIRTH
19.
19/5
.........
&Month)
(Day)
(Year)
PAGE
If LESS than
1 day ......... hrs.
.yrs.
mos.
2
or ......... min. ?
. ds.
8 OCCUPATION
(a) Trade, profession, or
particular kind of work ....
being undetermined)
(b) General nature of industry,
business, or establishment in
which employed (or employer) ...
9 BIRTHPLACE
(State or country)
north Chelles Ind
a few hours
.(Duration)
ds.
.............. yrs.
mos.
Contributory ..
10 NAME OF
FATHER
.(Duration)
.........
............. yrs.
.......
... mos.
ds.
Frank Tourle
J.D. Halloran
(Signed)
11 BIRTHPLACE
OF FATHER
(State or country)
Jowill pass
.....
M.D.
Self 22 1915 (Address)
(s) 8 Runch Bles
* If death followed injury or violence the certificate of death must be made
out by the Medical Examiner.
12 MAIDEN NAME
OF MOTHER
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
Margaux Carry
PARENTS
At place
In the
of death
.... yrs,
.... mos.
ds.
State.
...... yrs,
.mos.
ds
13 BIRTHPLACE
OF MOTHER
(State or country)
Where was dlsease contracted,
if not at place of death ?...
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Frank Jours lather
Former or
usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
(Address)
ADDRESS
7 May It
important. See instructions on back of certificate.
20 UNDERTAKER
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
.....
(SECONDARY)
15 Filed Sept. 22 1915 Edward for Golfing
REGISTRAR
1915-
17 I HEREBY CERTIFY that I attended deceased from Jeff 14, 1915, to JeA/ 21 . 195 that I last saw hun alive on Sep 21 . 1915. and that death occurred, on the date stated above, at 0 P.m. The CAUSE OF DEATH* was as follows : Combin (the Cause
HIDrwell &Sons You'll
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 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, meningcs, peritoneum, etc., Carcinoma, Sar- coma, etc., of. .........
............ ... (name origin: "Cancer" is less definite; avoid usc 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 discase 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.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
2-1 (No. Marthano
St. :
Ward)
138
(City. or-town.). [If death occurred in a hospital or institution, give its NAME instead of street and number.]
...
Registered No.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
: '; (Month)!
(Day)
191
(Year)
17
I HEREBY CERTIFY that I attended deceased from
191.
, to.
191
that I last saw h.
.........
alive on
191
.....
T
and that death occurred, on the date stated above, at.
.........:........ m ..
OF
The CAUSE OF DEATH* was as follows :
.(Duration)
.. yrs.
-
mos. . ... ...........
ds.
Contributory ..
(SECONDARY)
(Duration)
............... yrs.
.............. mos.
.............. ds.
(Signed)
M.D.
............. , :: 19 !.......... (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
mos.
ds ..
Where was disease contracted, If not at place of death ?..
Former or usual residence
....
19 PLACE OF BURIALFOR REMOVAL,
DATE OF BURIAL
Sept. 27
191 .....
20 UNDERTAKER Cod.
ADDRESS tboro
asit REGISTRAR
1 PLACE OF DEATH
2 FULL NAME
Olivo A. Brooks
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
..
6 DATE OF BIRTH
1
...
(Month)
(Day)
(Year)
7 AGE
:
-
-
.. yrs.
mos.
ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work ...
(b) General nature of industry,
business, or establishment in
which employed (or employer) ..
--
------
9 BIRTHPLACE
(State or country)
nelaton
10 NAME OF
FATHER
John rpor
11 BIRTHPLACE
OF FATHER
(State or country)
.
12 MAIDEN NAME
OF MOTHER
PARENTS
ne Ven Formand
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Hosnitil Rocorda
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.
(Address)
Filed ...
Ga ferry
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
.......
If LESS than
I day, ........ hrs.
....
1
-
....
At place
of death,
........ yrs. ............ mos. ........ ds.
State.
yrs.
-
..........
65
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of varions 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 caborer, 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- posure, etc.
3. Sndden deaths of persons not disabled by recognized disease, as A death upon the strect, or onc supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
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
APLACE OF DEATH Lowell Mass ............
( No. Lowell Hospital
St ....................... Ward)
William Schofield an Schokola
2FULL NAME
{If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Chelmsford Center Mary
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH
October
1915
......
(Month)
(Day)
(Year)
· DATE OF BIRTH
February
9
-..
(Month)
(Day)
(Year)
T AGE
If LESS than
I day .......... hrs.
38 yre. 7
mos ..
29 de.
or ......... min. ?
& OCCUPATION
(a)' Trade, profession, or
particular kind of work.
Machine Printer
(b) General nature of Industry. business, or establishment in which employed (or employer) ........
9 BIRTHPLACE
(State or country)
England
(Duration .............. 08.
Contributory.
Lowered Vital Jong
......
....
(SECONDARY)
... (Duration).
.................
(Signed)
J. C. Mc Cannon
M.D.
Och. 2.
, 1915
(Address).
howell
* 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. ................
State ............ yTS. ............ mos.
.... ds ............
In the
Where was disease contracted, If not at place of death ?.. Former or ... usual residence ...
19 PLACE OF BURIAL OR REMOVAL
Westlawn Cemetery Och. 3
DATE OF BURIAL
... 1915
.....
1& Filed Och 4, 1915
REGISTRAR
139
Lowell
(City or town.)
[if death occurred in a hospital or institution, give its NAME instead of street and number.]
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
PARENTS
10 NAME OF
FATHER
Benjamin Schofield
11 BIRTHPLACE
OF FATHER
(State or country)
England
12 MAIDEN NAME
OF MOTHER
Mary Hawking
when
18 BIRTHPLACE
OF MOTHER
(State or country)
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Will
(Address) Chelmsford- Center mass
20 UNDERTAKER Geo, W. Healey 1
ADDRESS Lowell
A .......... m.
The CAUSE OF DEATH* was as follows :
d'yphoid
Lever
I HEREBY CERTIFY that I attended deceased from September 10, 1915, to September 20 1915 that I last saw h __ alive on. 191 and that death occurred, on the date stated above 19 35
Registered No.
1355
" SEX
4 COLOR OR RACE
Male White
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORCED
(Write t
d) Married
1877
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 engincer, 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) Salcs- man, (b) Groccry; (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 employcd, 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, ete. 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, peritonacum, ctc., Carcinoma, Sar- coma, etc., of .. ...... „(namo origin: "Cancer" is less definite; avoid usc of "Tumor" for malignant neoplasms) ; 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 .; 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 discasc can be ascertained 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.
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