USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 52
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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- posurc, 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.
1. Deaths under circumstances unknown, as A person found dead, etc.
R 16. 3-'16. 5,000.
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)
Hartford Ut.
12 MAIDEN NAME
OF MOTHER
Sarah Wood
1ª BIRTHPLACE
OF MOTHER
(State or country)
West Lebanon N. tt
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
7. a Hagen
Sister)
(Address)
Chelisting. mars
15
Filed.
191.
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH Sept. 18
(Month)
(Day)
1916
(Year)
* DATE OF BIRTH
Feb.
22
1849
....
(Month)
(Day)
.... (Year)
' AGE
67
.......... yrs ..
6
.... mos.
27
ds.
or ......... min. ?
· 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)
" West Lebanon N. H.
(Duration)
..... yrs.
...
mos.
... ......
ds.
(Sigped)
Archi.
Contributory ...
(SECONDARY)
(Duration)2
........... yrs.
. ............... mos.
... ds.
Acciona.
M.D.
Liptina, 19110 (Address).
Clubes ford man's
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
5
-
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
DATE OF BURIAL
Sept 20
6
191
..................... ....
ADDRESS
20 UNDERTAKER
Walter Cerkan cheluufunda
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH
Chelmsford, Mais ..
Boslos Rd.
203 Chelunsford.
...
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
uma L. Salmon
..-
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Chelmsford
Edward a Salmone
....
Registered No.
47
PERSONAL AND STATISTICAL PARTICULARS
3 SEX 7.
· COLOR OR RACE
w.
5 SINGLE,
MARRIED
WIDOWED,
WhyOB Eroived
....
17
I HEREBY CERTIFY that I attended deceased from
191.
Sept. 18, 1916
........ to
that | last saw h ........ alive on ....
.......
Sept: 5, 1916
and that death occurred, on the date stated above, at ...
..................... m.
The CAUSE OF DEATH* was as follows :
General arteriosclerosis -
........
......
....
10 NAME OF
FATHER
Sanford. Hagen
......
....
if LESS than
( day ........ hrs.
MARGIN RESERVED FOR BINDING
..............
St. ;....
Ward)
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g .. Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- kcepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employcd, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestie 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 Nonc.
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, Suicidc, 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.
1
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH streeten route.t
ID ' PLACE OF DEATH howell mass (No .. St. John's Hospital st, Ward)
arthur Boucher
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
0
@RESIDENCE
no. Chelmsford mass
PERSONAL AND STATISTICAL PARTICULAR$
3 SEX
4 COLOR QR RACE
male white
6 SINGLE,
MARRIED,
WIDOWED.
OR DIVORCED
(Write the word)
finale
it
(Month)
(Day)
Wear)
If LESS than
1 day ......... hrs.
22
werr ........ mos .........
ds.
Or ......... min. ?
Laborer
(b) General nature of industry, business, or establishment In which employed (or employer) ...
te Con
o
9 BIRTHPLACE
(State or country)
Quebra Canada
10 NAME OF
FATHER
Edmond Boucher.
11 BIRTHPLACE
OF FATHER
(State or country)
Quebra
12 MAIDEN NAME
OF MOTHER
Edvige Dube
13 BIRTHPLACE
OF MOTHER
(State or country)
Queles
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Eugene Boucher
Graniteville
16 001.2 1916Deploy Flymo ......
REGISTRAFI
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
September 30 19/6
(Month) (Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
191.
.. ,
........
, to.
191
.......
that i last saw h .............
alive on.
19!
....
and that death occurred, on the date stated above, at.
m.
The CAUSE
OF DEATH* was as follows :
decident
(Fall uponig pick)
1. most
..... (Duration) ...
... yrs. ........
ds.
Contributory Punctured Wound of
ancillary artery (Right)
.mos ..
.ds.
.. ,
M.D.
(Signed)
Leer, 30, 1916 (Address) 60 Merch St, Lowell
* 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.
mo8.
ds .....
.....
Where was disease contracted,
If not at place of death ?.
Former or
usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
A. Catherine Com Granitebili Card.
1 191 6 ........
20 UNDERTAKER
John G. Healey
ADDRESS,
Graniteville
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
· DATE OF BIRTH 7 AGE & OCCUPATION PARENTS important. See instructions on back of certificate. (Address) N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should stato CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very ......
2011
Lowell .........
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
4.8 14576
(a) Trade, profession, or
particular kind of work
4. OV. maria
:
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, 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 linc is provided for the latter statement; it should be used only when necded. 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, Laborcr - 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 homc. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Houscmaid, 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 affcetion with respect to tiine and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fcver (the only definite synonym is "Epidemic cercbro-spinal meningitis") ; Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- mmeumonia ("Pneumonia," unqualified, is indefinite); Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. .........
...... .(name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Mcasles (disease causing death), 29 ds .; Broncho-pneumonia (secondary.), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (mercly 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 opcration 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- posurc, 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, ctc.
R 18. 3-'16. 10,000.
4
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Aret Cheles ford (No Aast Chelive In
Ward)
[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
That Chelunsford Mas
Registered No.
49
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
DATE OF BIRTH
aug
(Month)
(Day)
(Year)
7 AGE
If LESS than
I day ......... hrs.
25
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)
Chelwexford Maso
PARENTS
12 MAIDEN NAME
OF MOTHER
aley a. Magnant
1ª BIRTHPLACE OF MOTHER (State or country) Willimantic Com
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
anthony , mener another
(Address) Hat Chelive And Mass
16
Filed. Oct. 4. 1916 Edward Robbins
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Oct-
4
(Month)
(Day)
1916 (Year)
17 I HEREBY CERTIFY that I attended deceased from
........
191.
Odf- 3
1916
that I last saw her alive on
to
....
Del- 3
1916
.....
and that death occurred, on the date stated above, at 6 am
The CAUSE OF DEATH* was as follows :
Congenital Debilly.
:
(Duration) Patrick
........ yrs.
....
.... mos.
ds.
Contributory
(SECONDARY)
... (Duration)
............. yrs.
.mos.
.... dr.
7 E Varney
M.D.
(Signed)
Det. 4. 1914 (Addres
..........
* 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.
OS ...
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
ast chelesford
DATE OF BURIAL
oct 4
6
191
...
-.......
20 UNDERTAKER
-
ADDRESS 324 mart 4
MARGIN RESERVED FOR BINDING
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.
10 NAME OF
FATHER
11 BIRTHPLACE
OF FATHER
(State or country)
7 meses
1 ... mos. ... ds.
11 19.85
205-11 Thelives ford / ass
(City or town.) -
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," "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.
R. 15-8-'15. 100,000.
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 Commonwealin of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
... ( (No. Middlesex . ......... 1
St. :
Town, 206 No. 6 chelmsford "(City "tommy) Ward) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
George Dearles 2 FULL NAME
[If married or divorced woman or widow give maiden name, also name of husoand.] @RESIDENCE Middlesex
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
8 SEX
Male
4 COLOR OR RACE
White.
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married.
· DATE OF BIRTH
(Month)
(Day)
(Year)
7 AGE
If LESS than ( day ........ hrs.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Labores.
(b) General nature of Industry,
business, or establishment In
which employed (or employer) ..
Labores.
res
9 BIRTHPLACE
State or country) Tunstable, Mason
10 NAME OF
FATHER
Searlee.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Unknown.
12 MAIDEN NAME
OF MOTHER
Unknown
18 BIRTHPLACE
OF MOTHER
(State or country)
Unknown
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Edgar f. Barter
(Address)
No. Chelmsford,
15 Filed
Oct. 9, 1916 Edward J. Bobbing
REGISTRAR
-
Teremestão Celarica
sevn il years
... (Duration)
... yrs.
....
mos.
ds.
Contributory ...
(SECONDARY)
......... ......... ........
... (Duration)
yrs.
mos.
ds.
JEJamey
M.D.
(Signed)
Del-8
1914 (Address).
Mert Chelungul
* 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.
Where was disease contracted, If not at place of death ?.
Former or
usual residence ..
......
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Dunstable Mace Oct. 10. 196.
20 UNDERTAKER Grom Healey.
ADDRESS
79 BranchSx
8
............ .
(Month)
(Day)
1916 (Year)
1916
17
I HEREBY CERTIFY that I attended deceased from
May 19.
1916 t
to
.......
that I last saw h alive on.
Cel. 7
1916
.....
and that death occurred, on the date stated above, at 4A
.... m. The CAUSE OF DEATH* was as follows : .
48
..... yrs.
. .....
.... mos.
15
ds.
23. 11
10 DATE OF DEATH
Oct.
50
MARGIN RESERVED FOR BINDING
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oeeu- 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 employcd, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in- domestic serviee 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 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 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 rc- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
1
culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of ... ......... .(name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intereurrent) 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," ete., 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," ete. State cause for which surgical operation was undertaken.
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