USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1917-1918 > Part 44
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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 "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- toneum, etc., 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 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," ""Debility" ("Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the eause. Always qualify all diseases resulting from child- 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, or 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
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, 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.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS
BY
PHYSICIAN.
R 15. 1-'18. 10,000.
MARGIN RESERVED FOR BINDING
Township City 3 SEX Female 7 AGE Ycars (a) Trade, profession, or particular kind of work ..... PARENTS 14 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, of certificate. 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 io which employed (or employer) ... (c) Name of employer
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
139
WORCESTER!
(City or town)
1 PLACE OF DEATH
County.
.......
State ..
... or Village ...
..... or
Worcester ..... StateHospital
.....
.St., .............
.Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Mary J Dunn
(a) Residence. No.
School.
St., ...........
.Ward.
Chelmsford .... Ma.g.g ..
(If non-resident give city or town and State)
(Usual place of abode)
Length of residence in city or towo wbere death occurred
years
mooths
days.
How loog io U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(01) WIFE of
6 DATE OF BIRTH (month, day, and year) April 30 1858
Months
Days
If LESS than
1 day, ........ hrs.
or ........ min.
8 OCCUPATION OF DECEASED
Mill Hand
9 BIRTHPLACE (eity or town).
Chelmsford
(State or country) Mass
10 NAME OF FATHER John
11 BIRTHPLACE OF FATHER (city or town).
(State or country) Ireland
12 MAIDEN NAME OF MOTHER Maria Dunn
13 BIRTHPLACE OF MOTHER (city or town). (State or country) Ireland
Informant
Records of State Hospital
(Address) Worcester
15 Filed Oct 15, 19 18
REGISTRAR"
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
Oct 10 198
17
I HEREBY CERTIFY, That I attended deceased from
March ---- 5 ........ , 19.1 .. 2 ... , to ....
Oct ..... 1-0 ........ , 19 .... 1.8
that I last saw h ....... er alive on
O.c.t ...... 10 .......... 19 .... 18
and that death occurred, on the date stated above, at
-
-
.m.
The CAUSE OF DEATH* was as follows :
Chronic Endocarditis
(Mitral Valve)
(duration)
... yrs ....
mos.
ds.
CONTRIBUTORY.
Dementia Praecox
....
(SECONDARY)
.(duration)
.............. yrs ................. mos ..
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?.
.. Date of ..
Was there an autopsy ?.
What test confirmed diagnosis ?
(Signed)
Ada F Harris
M.D.
10|11, 19 1 0idress)
Worcester
* 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 Mass.
St Patrick's Cem Lowell
DATE OF BURIAL Oct 14 1918
20 UNDERTAKER
CALLAHAN BROS
ADDRESS WORCESTER
Registered No. 81
No ....
60 5
10
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precisc statement of occupa- tion 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, Compos- itor, Architect, Locomotive cngincer, 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) Forcman, (b) Automobilc 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 Housekccpers 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: Cercbrospinal fcver (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- toneum, etc., Carcinoma, Sarcoma, etc., of_
(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms); Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial ncphritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" ("Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- 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, or HOMICIDAL, or as probably such, if impossible to de- terinine 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., scpsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners :
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PIIYSICIAN.
-
R 15. 1-'18.
10,000.
The Commonwealth of Massachusetts
1 PLACE OF 1 STANDARD CERTIFICATE OF DEATH
Chelmsford (City or town)
State(
Massachusetts stered No. 82
.or Village ..
or
St., .. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number) ... ,
2 FULL NAME
Charles Green
(If ir. the Army or Navy of the United States, give rank, organization, etc.i
St.,
Ward.
(If non-resident give eity or town and Stato)
days.
How long in U. S., if of foreign birth ?
years
months
days
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
Oct. 10.
19/8
17
I HEREBY CERTIFY, That I attended deceased from
Oct 6
19/8, to Cat 10
......
1918
that I last saw him alive on
let 10
19/8.
and that death occurred, on the date stated above, at //3000 m.
The CAUSE OF DEATH* was as follows :
Pro Broncho
... (duration)
-. yrs ..
mos.
2
..... ds.
CONTRIBUTORY
(SECONDARY)
chriphee
..... (duration)
.......
.... yrs ...
.mos ............
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?
Date of.
Was there an autopsy ?.
What test confirmed diagnosis ?..
(Signed) ............
276 Westlandst
* 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 spaec.)
DATE OF BURIAL
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
St Patricks Cene, bet, 11, 1218
20 UNDERTAKER Ser B. Silence 588 Gorham
MARGIN RESERVED FOR BINDING
County ...
Township
No ..
Cheliveford
City ...
6
(a) Residence.
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male White
4 COLOR OFRACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Married
5a If married, widowed, or forced
HUSBAND of
Situace Green
(01) WIFE of
6 DATE OF BIRTH (month, day, and year)
7 AGE
Ycars
Months
Days
If LESS than
1 day, ........ hrs.
ormin.
38
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
Gardener
particular kind of work
(b) General nature of industry,
Ou Fam
business, or establishment in
which employed (or employer)
(c) Name of employer
9 BIRTHPLACE (city or town).
Pachmord
(State or country)
Vermarch
10 NAME OF FATHER
Willian Green
11 BIRTHPLACE OF FATHER (city or town)
(State or country)
Ireland
13 BIRTHPLACE OF MOTHER (city or town).
PARENTS
(State or country)
14
Informant
Am Space gray
(Address)
of certificate.
15
Fil
Oct. 12, 1918 Edward S. Robban
REGISTRAR
N. B. - WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be
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,
-
12 MAIDEN NAME OF MOTHER Not Know Qnt11, 1918(Address)
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATHI [Approved by U. S. Censne and American Public Health /
Statement of occupatien. - Precisc st.
tion 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, 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) Automobilc 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 liome, who are engaged in the duties of the household only (not paid Housekecpers 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 Nonc.
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 discase. Examples: Cerebrospinal fcver (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid usc of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, etc., of_
(namne 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: Mcasles (disease causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (mercly symptomatic), "Atrophy," "Col- lapsc," "Coma," "Convulsions,"""Debility" ("Con- genital," "Senile." etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Urcmia," "Weakness," etc., when a definite disease can be ascertained as the causc. Always qualify all diseases resulting from child- 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, or 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., scpsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Casos for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls Drowning, Gas poisoning, Suicidc, Homicide, etc.
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 street, or onc supposed to be due to Alcoholism., etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY
PHYSICIAN.
1
R 15. 2-'18. 100,000.
The Commomuralth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(Ots or town)
1 PLACE OF DEATH
County ...
Middlesex Co.
State
Mais.
Registered No. 83
Township
Cheliusfin mars
.. or Village.
Centro
...... or
City
No.
St., ...... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
Edwin a Houve
(a) Residence.
No Lowell Road
St.,
Ward.
(If non-resident give city or town and State)
(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
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
oct. 10th
1918
17
I HEREBY CERTIFY, That I attended deceased from
oct. 1 et
1918, to
act. 100 2018.
that I last saw h IM alive on
001.10th
.1918.
and that death occurred, on the date stated above, at ...
57.
... m.
The CAUSE OF DEATH* was as follows :
.
If LESS than 1 day, ........ hrs. or ........ min. Chronic Endocarditis .
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
Leller Carrier
(b) General nature of industry, business, or establishment in which employed (or employer) .... (c) Name of employer
9 BIRTHPLACE (city or towne.
Lowell
man
10 NAME OF FATHER Verebran Howe
11 BIRTHPLACE OFFATHER (city or town)
Souditors.
(State or country)
mars.
12 MAIDEN NAME OF MOTHER abigail Deemed 2, 1918 (Address)
13 BIRTHPLACE OF MOTHER (city of londonderry (State or country) Nitt
14 s. Home
(Address)
15
Filed Oct. 12 1918 Edward Rabbins
REGISTRAR
4
Spanish Influenza"
CONTRIBUTORY
(SECONDARY)
... (duration)
.yrs ...
1 10
.. mos.
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death?
WWW. Date of X
Was there an autopsy ?.
200.
What test confirmed diagnosis ?...
(Signed).
Limasa toward
,
M.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. (Sec reverse side for additional space.)
DATE OF BURIAL
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Redige Cem
Clickins, Fre Cenlia Led. 13
1908
ADDRESS
20 UNDERTAKER*
Walter Fecham Chelisten
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 of certificate.
3 SEX
m.
7 AGE
76
PARENTS
Informant
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
(State or country)
4 COLOR OR RACE
While
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
married
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year) Jan. 31.1842
Years
Month
2
Days
10
(duration)
2 .-
.. yrs.
mos ...
ds.
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupa- tion 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 oeeupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architcet, Locomotive 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) 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," 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 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- eifieally the oceupations of persons engaged in domestie service for wages, as Servant, Cook, Housemaid, ete. It the occupation has been changed or given up on account of tlie DISEASE CAUSING DEATII, state occupation at beginning of illness. If retired from business, that faet may be indi- eated 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 affeetion with respect to time and eausation), 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; Bronehopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, ete., Carcinoma, Sarcoma, ete., of.
(name origin; "Caneer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronie valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- eurrent) affeetion need not be stated unless important. Example: Measles (disease causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia." "Anemia" (merely symptomatie), "Atrophy," "Col-
lapse," "Coma," ""Convulsions,"" "Debility"
(" Con-
genital,"
"Senile,"
ete.), "Dropsy,"
"Exhaustion,"
" Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shoek," "Uremia," "Weakness," ete., when a definite disease ean be aseertained as the eause. Always qualify all diseases resulting from ehild- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ete. State eause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struek- by railway train - accident; Revolver wound of head - homicide; Poisoned by earbolie acid - probably suicide, The nature of the injury, as fraeture of skull, and consequences (e. g., sepsis, tetanus) may be stated
of "Contributory." (Recommendations
on statch ... " cause of death approved by Committee on Nomenelature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly eaused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, ete.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strcct, or one supposed to be due to Alcoholism, ete.
4. Deaths under eireumstanees unknown, as A person found dead, ete.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PHYSICIAN.
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