USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1917-1918 > Part 32
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
The Commonwealth of Massachusetts
97
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(City or town.)
Charth Chelmsford wo Short fire
[If death occurred in
a hospital or institution,
give its NAME instead
of street and number.]
St. ;....
............
Ward)
Ceedia- Hastane
'FULL NAME
................
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Registered No.
hurt Pre
39
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED.
WIDOWED
(Month)
OP DIVORCED
(Write the word)
Quale
1ª DATE OF DEATH
May
191.8
(Year)
(Day)
7
$ DATE OF BIRTH
1/2
HEREBY CERTIFY (that I attended deceased from
17
(Month)
(Day)
april 23, 1918 to May 7
1918
Y AGE
that I last saw her alive on ...
mati 7
.....
(Year)
If LESS than
1 day ......... hrs.
,
1918
.mos.
3
ds.
........ min. ?
and that death occurred, on the date stated above, at 23.05 m
The CAUSE OF DEATH* was as follows :
& 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)
ayer mars
.... (Duration) ..
14
........... mos.
............... yrs.
....
Contributory ..
......
........
10 NAME OF
FATHER
............. ds
-
Cesare Saltare
(SECONDARY)
(Duration) .............. yrs.
mos.
(Signed)
Fond & Varney
..........
M.D
May 7, 1918 (Address
ni Chilufford.
............
11 BIRTHPLACE
OF FATHER
(State or country)
Curta
* 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).
Mary mora
PARENTS
At place
In the
of death
.. yrs.
mos. .....
ds.
State ............ yrs.
.... mos.
ds ..
......
............
18 BIRTHPLACE
OF MOTHER
ausma
(State or country)
Where was disease contracted,
, if not at place of death ?.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Former or
usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
(Informant)
(Address) Strutture Hasthe Redlines/ Franca adams Make it/ 04/2 1918
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.
15
Jan St, 1918 Edward , Robbins"
ADDRESS
N. B. ~ Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
............................................................
20 UNDERTAKER Aichambault
REGISTRAR
-
CERTIFICATE OF
Statement of occupation. - Freeise statement of oeeu- 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, ete. 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," ete., without more precise specifieation, as Day laborer, Farm laborer, Laborer - Coal mine, ete. 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 domestie service for wages, as Servant, Cook, Housemaid, ete. If the oeeupation 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 oeeu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- BASE CAUSING DEATH (the primary affeetion 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 "Epidemie eerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber
peritonacum, ete., Carcino? ... (name origin: "Caneer" : malignant
Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (seeond- ary or intereurrent) affection need not be stated unless im- portant. Example: Measles (disease eausing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shoek," "Uraemia," '"Weakness," ete., when a definite disease ean be ascertained as the cause. Always qualify all diseases resulting from ehildbirth or misearriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," ete. 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 Medieal Examiners:
1. Deaths following injury or violenee, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, ete.
2. Deaths supposedly eaused by violenee, 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, ete.
4. Deatlıs under eireumstanees unknown, as A person found dead, ete.
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 Chelmsford (Mars Bridal
Arthur & Halu
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband .!
@RESIDENCE
Pridas It.
...... St. ;..................... Ward)
Chelmsford
......
(City or town.)
fif death occurred in a hospital or instituticn, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
6 SINGLE
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
1
(Year)
If LESS than
1 day. hrs.
or\ min. ?
9 BIRTHPLACE
(State or country}
Chelmsford, mass.
10 NAME OF
FATHER
Patrick A Haley
11 BIRTHPLACE
OF FATHER-
(State or country)
Chelunsford max
1ª BIRTHPLACE
OF MOTHER
(State or country)
Lowell maxt.
"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Patrick H. Halucy.
Filed,
Imay 9 1918 Oderand J. Rolling
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
apr. 27, 1918 to May 8th
...... ,
.. 1918
that I last saw him alive on
.......
May 7 th
/
......... .
1918
and that death occurred, on the date stated above, at 9 a.m.
The CAUSE OF DEATH* was as follows
. .
Bronchio - Pharmonia
....
(Duration)
... yrs.
.mos.
120
Contributory.
(SECONDARY)
(Duration)
... yrs.
.mos.
ds.
(Signed)
Amara Howard
M.D.
Mar 9, 1918 (Address).
Chelmsford
...........
· * If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
In the
At place
of death
... yrs.
mos. .....
ds.
State ...
... yrs.
.mos. .... Where was disease contracted, If not at place of death 7. ...... ..... Former or usual residence ....
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
(Address)
ridge St Bulaustad. Patricks Com May 9. 1918
20 UNDERTAKER
Sur. B. Allenna
ADDRESS
Sowell Pass
3 SEX
4 COLOR OR RACE
male White
· DATE OF BIRTH
(Month)
(Day)
7 AGE
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Nome
(b) General nature of industry,
business, or establishment in
which employed (or employer).
12 MAIDEN NAME
OF MOTHER
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
....
١٠
. 11 mos ..
.......
Mos. 10 ds.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(man
(Month)
(Day)
8
1915
(Year)
..........
2
...... ....
STANDAF
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 linc will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fircman, 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) Grocery; (a) Forcman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ctc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal minc, ete. Women at home, who are engaged in the dutics of the household only (not paid Housc- 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 oceupations 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 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-
sis of lungs, meninges, peritonacum, ctc., Carcinoma, Sar- ,ma, cte., of ....... ...... .(name origin: "Caneer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular hcart discase; 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," "Collapsc," "Coma," "Convulsions," "Dcbility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age,". "Shoek," "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 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.
MARGIN RESERVED FOR BINDING
carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be (b) General nature of industry, business, or establishment in which employed (or employer) .. (c) Name of employer
The Commomuralth of Massachusetts STANDARD CERTIFICATE OF DEATH
Chelmedard (City of town)
County
mådlesek
.. State.
mass
Registered No. 41
Township
North Chelmsford
.... or Village.
.or
.No.
St., .. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Lydia a. Sha
houlding
St.,
Ward.
(If non-resident give city or town and State)
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
May 19, 1918
17 I HEREBY CERTIFY, That I attended deceased from
Dec.
,19 17 May 19, 1918.
that I last saw h Cr
alive on
May 19, 1918
and that death occurred, on the date stated above, at 12:30 Pm.
The CAUSE OF DEATH* was as follows :
Intestinal Obstruction
Duetto
Carcinoma of Uterus and Colon.
(duration)
... yrs ...
.mos ...
ds.
CONTRIBUTORY Intestinal Obstruction
(SECONDARY)
... (duration)
yrs ..
I2
.... ds.
18 Where was disease contracted
if not at place of death?
NO
Did an operation precede death?
Date of.
Was there an autopsy ?
NO
....
What test configmed diagnosis?
(Signed).
M.D.
20g ISS. Chelmsford, Mass.
* State the DISEASE CAUSING DEATHI, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
14 Clarence L. Spaulding
(Address)
Pourle Mask .
15 Filed May 22, 1918 Edward S. Bobbing REGISTRAR
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL May22 198
20 UNDERTAKER
Young& Blake
ADDRESS
Lowell
1 PLACE OF DEATH-
City
(Usual place of abode)
Length of residence in city or town where death occurred
years
3 SEX
4 COLOR OR RACE
Gemale
6 DATE OF BIRTH (month, day, and year)
7 AGE
Years
7/
(a) Trade, profession, or
particolar kind of work ..
PARENTS
(State or country)
mass
Informant
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
(State or country)
mars
0
of certificate.
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Jearyz Spausdin c
Days
Months
7/16
If LESS than
1 day, ........ brs.
or ........ min.
8 OCCUPATION OF DECEASED certiour
9 BIRTHPLACE (city or town) ...
Chelmsford
10 NAME OF FATHER James Hutumore
11 BIRTHPLACE OF FATHER (city or town) Nur drove
(State or country)
12 MAIDEN NAME OF MOTHER видал Гатьлия
May
13 BIRTHPLACE OF MOTHER (city or town) ..
Dream
(a) Residence.
No no. Chelmsford
REVISED UNITED STAIL
[Approved by U. S. Census e
Statement tion is very imt).
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, Compos- itor, Architect, Locomotive 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial 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 Housckcepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifieally 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 indi- cated 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: Cercbrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, ctc., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 Gs .; Broncho- pneumonia (sccondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility " (“Con-
etc.), 'Dropsy,' "Exhaustion," genital," "Senile," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the eause. Always qualify all diseases resulting from ehild- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Of HOMICIDAL, or as probably such, if impossible to de- termine 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
ivnowing conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, ctc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strcet, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstanees unknown, as A person found dead, ete.
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN.
1
·
+
*
R 15. 1-'18. 100,000.
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, N. B. - WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be of certificate.
1 PLACE OF DEATH
County
huddlenel
State
Registered No. 42
Township
City Harth Chela forado.
.or Village.
.or
St ..
.......
.. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(a) Residence.
No
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
days. How long in U. S., if of foreign birth ? years
months days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
6 DATE OF BIRTH (month, day, and year)
7 AGE
Years
Months
Days
1916 If LESS than 1 day ......... hrs. or ........ min.
8 OCCUPATION OF DECEASED
. (a) Trade, profession, or
particular kind of work ...
(b) General nature of industry, business, or establishment in which employed (or employer) .. (c) Name of employer
CONTRIBUTORY
(SECONDARY)
.(duration)
yrs.
mos ..
ds.
18 Where was disease contracted
Lif not at place of death ?
Did an operation precede death? to Date of
Was there an autopsy ?.
200
What test confirmed diagnosis ?
57 (Signed).
/21
, 19/8 (Address) March Cheliangny Man
L., Id.D.
* State the DISEASE CAUSING DEATH, Or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL Ana/2/2018
15 File May 20, 1918 Edward ), Rolling REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) May 20 1918
17 I HEREBY CERTIFY, That I attended deceased from May 18, 1918, to May 20 .. , 1918.
that I last saw hlin
alive on
......
........
May 20 19/8
and that death occurred, on the date stated above, at 1,30 a The CAUSE OF DEATH* was as follows :
namary
(duration)
yrs ..
mos.
ds.
9 BIRTHPLACE (city or town) ...
(State or country)
E OF FATHER Joseph Q. Grande
PARENTS
11 BIRTHPLACE OF FATHER (city or town officiel (State or country)
12 MAIDEN NAME OF MOTHER
Ladel 13 BIRTHPLACE OF MOTHER (city of town) Xa (State or country)
14 Plattur Informant 221504 Il North Blusser LA Pareth (Address) 1
ADDRESS 738
20 UNDERTAKER Archambault Channel
MARGIN RESERVED FOR BINDING
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
100
(City or town)
Lluvia
Guilbert
Rug Claudette
.. St.,
Ward.
(If non-resident give eity or town and State)
5
Dea/3
REVISED UNITEN AT
: CERTIFICATE OF DEATH siealth Association]
Statement of occupation. - 1 statement of occupa-
tion is very important, so +1 ne 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, Compos- itor, Architeet, Locomotive 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial 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 Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically 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 indi- cated 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: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, etc., of.
(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronie valvular heart disease; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 Gs .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col-
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.