USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 37
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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.
(Informant).
) David H. b handler
(Address) No Chelmsford Mane,
N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
.........
The Commonwealth of Massarhusetts
144 No. Chelmsford. (Ohne wertown.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
no Chelmsford
Str.
Ward)
(No.
Westford Rd.
.....
....
2 FULL NAME
Alfred Chandler.
[If married or divorced woman or widow
give maiden name, also name of husband.1
aRESIDENCE 6 helmo ford
Registered No.
7/
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
$ SEX
14 COLOR OR RACE
White.
Male
5 SINGLE,
MARRIED,
Single.
16 DATE OF DEATH
Oct.
15.
(Day)
OR DIVORCED
(Month
(Write the word)
(Year)
· DATE OF BIRTH
July
13.
1915,
4.
(Margin)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
July 13
, to
.......
If LESS than
195
Det 15 95
.....
....
' AGE
/
that I last saw him alive on.
Oct. 15
. 1915
....... .
and that death occurred, on the date stated above, at 10.15 Am.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
Nones
The CAUSE OF DEATH* was as follows :'
Spina Bifida
[ day ......... hrs.
yrs.
3
mos.
1
ds.
(b) General nature of industry,
business, or establishment in
Hydrocephalus
which employed (or employer) ...
None
9 BIRTHPLACE
(State or country)
No. 6 helmeford, Mass
.. (Duration)
.. yrs.
mos.
. ...
Contributory
(SECONDARY)
10 NAME OF
FATHER
David H. Chandler
mos.
.... (Duration)
ds.
.......... ,
M.D.
(Signed)
Arthur T. coboriy
yrs.
11 BIRTHPLACE
OF FATHER
State or country Portland, Me.
Cat. 16. 1915 (Address).
Chelonefor Mans
* 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).
Eleonora J. Mac Donald
ds.
PARENTS
At place
of death
... yrs.
.. mos.
In the
.....
State
......... yrs.
......
.... mos.
ds
13 BIRTHPLACE
Kansas
OF MOTHER
(State or country)
Where was disease contracted,
if not at place of death ?..
Former or
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
usual residence.
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.
.....
...... ....
ds.
19 PLACE OF BURIAL OR REMOVAL Hestlawn Cemetery
DATE OF BURIAL
O2016. 195
16 Filed. Oct. 16, 1915 Edward). Robbing
REGISTRAR
20 UNDERTAKER
GrothHealey.
ADDRESS
79 Branch Pr.
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, etc. 1 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 diseasc. 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 in- 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 agc," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirthli or miscarriage, as "PUER- PERAL scpticaemia," "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.
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)
Woodstock VX
12 MAIDEN NAME
OF MOTHER
adeline?
murillo
13 BIRTHPLACE
OF MOTHER.
(State or country)
Wordstick UX.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Dr. W. 7. Howington
(Address)
Barton
15
Filed Oct. 27, 1915 Edward J. Robbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH Od. 23
(Month)
(Day)
1915
(Year)
6 DATE OF BIRTH
July
26
1844
(Year)
(Month)
(Day)
7 AGE
If LESS than | day, ......... hrs.
71
... yrs.
2
nos
27 ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
ut lumen
(b) General nature of industry, business, or establishment in which employed (or employer).
(Duration)
.. yrs.
mos.
ds.
Contributory ..
(SECONDARY)
(Duration) .... yrs.
... mos.
ds.
M.D.
(Signed)
04.25
(Address) Hallemmat X1
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).
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 ..
PLACE OF BURIAL OR REMOVAL in Ridge Chelmann
DATE OF BURIAL Let. 26, 1910
ADDRESS
20 UNDERTAKER Wallen Perham
145 Chelisted
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Chelmsford
(No ......: )
...
Bridge
St.
2 FULL NAME Frances
[If married or divorced woman or widow give maiden name, also name of husband.1 @RESIDENCE Bridgi XX
Curtis S. Hayuno
Chelming
Registered No.
72
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED ,
OR DIVORCED
(Write the yearlowed
17
1, HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows :
Cadral Humorhage
9 BIRTHPLACE
(State or country)
Woodstock Ut
10 NAME OF
FATHER
Stephen Farnewarto
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
-
Parham
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 specifieation, 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: Cerebro-spinal fevcr (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, ete., 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. 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, 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.
1 PLACE OF DEATH 3 SEX 7 · DATE OF BIRTH YAGE 45 8 OCCUPATION (a) Trade, profession, or particular kind of work (b) General nature of industry, business, or establishment in which employed (or employer) .. PARENTS 18 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(No
Warten
St. ;...........
Ward)
Bertha Hutchinson Dutton
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Chelmsford
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE,
WIDOWED,
Single
OR DIVORCED
(Write the word)
3
1870
(Month)
(Day)
(Year)
If LESS than I day, ......... hrs.
.6
-
.. mos.
21
ds.
........ min. ?
at home
9 BIRTHPLACE
(State or country)
Bastin Mais
10 NAME OF
FATHER
Dr. Samuel L. Dulluita
11 BIRTHPLACE
OF FATHER
(State of Country) active Mans
12 MAIDEN NAME
OF MOTHER
Lumia P. Plenero
Lowell . Mais
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
E. Dublino
(Address)
Schenectady N. Y.
15 Oct. 27, 1915 Edward & Robbins
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
October 24
(Month)
(Day)
1915
(Year)
....
that I last saw h Cc alive on.
Oct 24
195
and that death occurred, on the date stated above, at 3:30pm.
The CAUSE OF DEATH* was as follows :
Chronic panenelignation
....
(Duration) 20?
..... yrs.
mos.
.ds.
Contributory ...........
Участие
(SECONDARY)
.(Duration)
.............. yrs.
.mos.
2/
ds.
(Signed)
Manskal P. Illui
M.D.
Ce/ 26
.....
(Address) Doncel, Fuck
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
yrs.
In the
mos. .
ds.
State ....
......... 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
Det. 27
.....;
191
ADDRESS
20 UNDERTAKER
Waller Punham
14.6
(City/or town.) [lf death occurred in a hospital or institution, give its NAME Instead of street and number.]
73
4 COLOR OR RACE
....
17 I HEREBY CERTIFY that I attended deceased from
....... , to ....
Cet 24 90-
..........
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, 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," "Hacmorrhage," "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.
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) Wilton NY
12 MAIDEN NAME
OF MOTHER
Clara mansur
13 BIRTHPLACE
OF MOTHER
(State or country)
Wilton V+
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Wie Chelundand
16 Filed Oct. 29 1915 Edward y Rubbing
REGISTRAR
147 Maar Chelmsford.
(Citý or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Charles a. Atali
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
.......
@RESIDENCE
Wier Chehard man
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH
Ocr 29
19113
(Month)
(Day)
(Year)
· DATE OF BIRTH
June 11
.........
(Month)
-1846 1
(Day)
(Year)
7 AGE
If LESS than
t day ......... hrs.
69
...... yrs.
... mos.
ds.
Or ......... min. ?
& OCCUPATION
Petered
(a) Trade, profession, or
particular kind of work,
..........................................
artino-sclerosis
of long duration decide car
du caling (Duration)yrs.
mos.
ds.
Contributory ..
(SECONDARY)
..............
(Duration) ................ yrs.
ds.
(Signed)
Qui. 29 90 (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.
„ds ..
In the
..........
Where was disease contracted, If not at place of death ?....
........ Former or usual residence .. .....
.........
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL Nov 24 95
20 UNDERTAKER
ADDRESS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Miss Chelmsford(N
St. ;..............
Ward)
C
74
Registered No.
3 SEX
male
+ COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
manud
17
I HEREBY CERTIFY that I attended deceased from
Od- 23
1915 to
Qel. 29
... 1915
that I last saw h
alive on.
04.28
. 1915
and that death occurred, on the date stated above, at 831 am
The CAUSE OF DEATH* was as follows :
...
(b) General nature of industry, business, or establishment In which employed (or employer).
9 BIRTHPLACE
(State or country)
Mermada IVA
10 NAME OF
FATHER
Joseph 3. Hall
................
. ....
MARGIN RESERVED FOR BINDING
STANDARD CERTIFICATE OF DEATH.
1
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, 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 fevcr (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-
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