USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1914-1916 > Part 9
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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 duc to Alcoholism, etc
4. Deaths under eireumstances unknown, as A person found dead, etc.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
'FULL NAME · DATE OF BIRTH TAGE PARENTS important. See instructions on back of certificate. 18 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 DEATHO Maille Chelmsford
... ...........
St. ....................... .Ward)
(City or town. More [If death occurred la a hospital or institution, give its NAME instead of street and number.]
Richard Holch
Margaret Nonalu
... [If married or divorced woman or widow give maiden name, also name of husband @RESIDENCE Matle Chefulford
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
& SEX
Male White
4 COLOR ON RACE
5- SINGLE,
MARRIED,
WIDOWED
OR DIVORCED
(Write the word)
Married
1
(Year)
If LESS than
t day .......... hrs.
& OCCUPATION
Machinist
(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) Vowell
10 NAME OF
FATHER
Richard felel.
11 BIRTHPLACE OF FATHER (State of countryy Ireland
12 MAIDEN NAME Elizabeth Scivilino
18 BIRTHPLACE OF MOTHER (State or country}
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(informant) Mrs. Heledo
(Adres) North Chelmsford & Patricks
Filed May 21, 1914 Edward J. Robbing
-REGISTRAR
17 I HEREBY CERTIFY that Iattended deceased from
.... ,
, 1914 to
191.
4
that I last saw hele
was alive on.
...
may 16
1914
and that death occurred, on the date stated above, at 10:
The CAUSE OF DEATH* was as follows :
....
Tubercular Laryngitis
... (Duration).
3
.................. yrs. ....
......... mos. ds.
Contributory
(SECONDARY)
... (Duration)
Siw. I Welch
.. mos.
................ ds.
(Signed)
......
May 19, 1914 (Address).
2, Runes Bl
......
* 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
of death ... yrs. ............ mos. ... da. ..... State ............ yra. ..... .. ds ............
Where was disease contracted, If not at place of death ?..
Former or usual residence .............
2 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL May 21, 1917
* UNDERTAKER John O'Connell 60 Vorkam
Vormany
...
" DATE OF DEATH
may
(Month)
18
.... ,
191.
4
(Day)
(Year)
(Month)
(Day)
52
... ds.
....... min. ?
32
.... Registered No. 32
.........
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 enginecr, 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 cxamples: (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,", "Dcaler," 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. Carc should be taken to report specifically the occupations of persons engaged in domestie 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 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- DASE CAUSING DEATH (the primary affection with respect to time and eausation), using always the same accepted term for the same discase. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic eerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualificd, is indefinite); Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, ete., 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 merc symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Scnilc," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "Weakness," 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 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:
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, E:c- 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, ete.
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Jo Chemsfred Mans (No.
Highland avea.
Ward)
33
(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 namc of husband ] @RESIDENCE Ho. Chemand Mass.
Registered No.
33
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED
WIDOWED,
OR DIVORGED
(Write the word)
1
anglo
B DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE
22
... .. yrs.
mos.
66.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work ..
Machinest
(b) General nature of industry. business, or establishment in which employed (or employer) ..
720 Chemsford Mice.
9 BIRTHPLACE
(State or country) No Chemstud Makes
PARENTS
12 MAIDEN NAME
OF MOTHER
Margaret Mentally
18 BIRTHPLACE OF MOTHER (State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address) To chemstead Man
16 Filed. May 22, 1914 Edward, Robbing ............ REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from Man 15, 1914, to May 20, 1914. that I last saw have alive on. May 20, 1914. and that death occurred, on the late stated above, at 1280Cm. The CAUSE OF DEATH* was as follows :
Intentar Lampa gitis
(Duration)
/
.... yrs.
.mos.
ds.
Contributory Fabulosa of bowels
.....
(SECONDARY)
.. (Duration) .....
....... yrs.
.. mos. ds.
M.D.
(Signed)
Maya
1914
(Address) Modulaford
* If deathVfollowed 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
Pahicks Way 22191.
ADDRESS
20/UNDERTAKER V. IMDermat 20 Maham
20
(Month)
(Day)
1917
(Year)
If LESS than
1 day, ........ hrs.
10 NAME OF
FATHER
Thos P. Duffy
11 BIRTHPLACE
OF FATHER
(State or country)
Queland
16 DATE OF DEATH
5
Edward Duffy
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 linc 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 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 timc 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 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" (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 dcad, etc.
-
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
1 PLACE OF DEATH 3 SEX Male 6 DATE OF BIRTH 7 AGE yrs. 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) PARENTS 18 BIRTHPLACE OF MOTHER (State or country) CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very 63 important. See instructions on back of certificate. Filed 191 ... - May 21 N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state ....
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Lowell. Mass. (No. Lowell Hospital St. ;.....
... Ward)
34
Lowell ....
.........
(City or town.)
fif death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME
Thomas Brown
....
34
Registered No. 747
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word) Widowed.
16 DATE OF DEATH
May 20
(Month)
(Day)
191 4
(Year)
17
I HEREBY CERTIFY that I attended deceased from
-
(Year)
to
May 13,
191.
.3
May 20,
1914
.........
that I last saw him alive on ..
May 20.
1914
....
and that death occurred, on the date stated above, a. 30
m.
The CAUSE OF DEATH* was as follows :
Lobar Pneumonia
(Duration)
... yrs.
mos.
ds.
Contributory.
(SECONDARY)
(Duration)
yrs.
mos.
ds.
E. J. Clark
M.D.
(Signed)
May 20
4
(Address)
Lowell Hospital
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
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 Edson Cemetery, Lowes-22 4
DATE OF BURIAL
...
191
20 UNDERTAKER
Young & Blake
ADDRESS
Lowell
- - (Month)
--
mos. -wds.
or ......... min. ?
Scotland
10 NAME OF
FATHER
Thomas I.oBrown
11 BIRTHPLACE
OF FATHER
(State or country)
Scotland
12 MAIDEN NAME
OF MOTHER
Agnes Smith
Scotland
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(informant)
Mrs
Jos. Livingston
. Chelmsford, Mass. (Address)
4 ........
REGISTRAR
.. , .........
(Day)
If LESS than
i day ......... hrs.
Laborer
......
191.
......
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE North Chelmsford, Mass.
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oceu- 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 necded. 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 laborcr, 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: Ccrebro-spinal fever (the only definite synonym is "Epidemie 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, ete., Carcinoma, Sar- coma, ete., 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," 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, ete.
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.
:
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,
North Rebelmaturato Mass Holt
St. ;............... Ward)
George Marley Ar
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Halt at
35-
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
....
Registered No.
35
8 SEX
male
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
16 DATE OF DEATH
May
30
[Month)
(Day)
191X
(Year)
· DATE OF BIRTH
3
1912
(Month)
(Day)
(Year)
PAGE One ys Nur mos. 27
If LESS than
1 day, ........ hrs.
.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) ..
(Duration)
............. yrs.
.. mos. .ds.
9 BIRTHPLACE
(State or country)
Chelmsford
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Bradford England
12 MAIDEN NAME
OF MOTHER
Gertrud: Jaques
13 BIRTHPLACE
OF MOTHER
(State or country)
Bradford England
14 THE ABOVE IS TRUE TO THE BEST OF) MY KNOWLEDGE
(Informant)
George marley
(Address)
Halkat AV Chdmsford
15 Filed Jamel, 1914 Edward &, Robbing REGISTRAR
....
17
I HEREBY CERTIFY that I attended deceased from
april 30 1914 to Milay 30
that I last saw ha alive on.
and that death occurred, on the date stated above, at 145 am.
The CAUSE OF DEATH* was as follows :
Deabilis
....
Contributory ..
(SECONDARY)
......
(Duration)
..... yrs.
mos.
ds.
. ......
(Signed)
Y E Jamner
M.D.
May Er, 1914 (Address) Hart Chilundo
* 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 7. .... Former or usual residence ...
DATE OF BURIAL
19 PLACE OF BURIAL OR REMOVAL Riverside Limbo June 1, 1914
20 UNDERTAKER
John a Winback
ADDRESS
16 markedet
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
.......
10 NAME OF FATHER George Marley
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, ctc. 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 arc engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness." If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualificd, is indefinite); Tuber-
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, 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 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.
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