USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1917-1918 > Part 51
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Mestlawn Cemetery, Fec, 18 1918.
20 UNDERTAKER
FromHealey
ADDRESS
79 Branch &t
1918- 84-
1834-
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County.
Middlesex
State
Mare.
Down, Registered No. 10%.
Township
Chelmsford.
City
No ..
...
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Margaret Blackie
(If in the Army or ;wvy of the United States, give rank, organization, etc.)
(a) Residence. No. North Road
St.,
.Ward.
(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
(If non-resident give city or town and State)
St.,
.......
Ward
or
.or Village.
North Road.
162 Chelmsford
M.D.
8
!
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of oceupa- tion 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 terin 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 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 specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at homc, 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 domestie service for wages, as Servant, Cook, Housemaid, etc. It 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- 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 affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (thc 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 eausing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (mercly symptomatie), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" (“Con-
genital,"
"Senile,'
etc.), "Dropsy,"
"Exhaustion,"
"Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Urcmia," "Wcakness," etc., when a definite disease can be ascertaincd 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 suclı, 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., 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, 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 street, or mne 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. 100,000.
Form R-302
The Cometmmwealth of Massachusetts
MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
4
AISSUED UNDER TILE PROVISIONS OF REVISED LAWS, CHAPTER 24)
State.
Registered No.
Chelmsford
City or To
Elizbeth
No.
St.,
Ward
{If death occurred in a hospital or institution, give its NAME instead of street and number)
0 0 cyou
2 FULL NAME
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
46 wochen
St.,
Ward.
(If non-resident give eity or town and State)
months
days
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (grite the word)
16 DATE OF DEATH
found dead
(Month)
(Year)
If LESS than
1 day, ........ hrs.
or ........ min.
Oferratin
(State or country)
21.63
FATHER (City)
Jackville
(State or country) 21.13
12 MAIDEN NAME
OF MOTHER
Marita Andrem.
2
13 BIRTHPLACE OF MOTHER (City) (State or country) 04.13.
Informant
Was Era Handy
(Address)
244 geburt SC.
15
DEC 19,1918, Edward & Robbing
(Month) (Day) (Year)
REGISTRAR
21 Burial permit Edward Jo Robbins issued by
Official position ..
MEDICAL CERTIFICATE OF DEATH
18
1918
(Year)
(Day)
17 I HEREBY CERTIFY, That I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows! Love found Fracture of stue? Thigh
and reg-Fracture Curical Can abrae- Kem over by railroad Iran-
(See reverse side for additional space)
18 Where was injury sustained
if not at place of death?
A hunch
(Signed)
Thousand
...... , M.D.
(Address) 107 Usmialky. Lowed
Medical Examiner for VMh Dist, Midale sex 60
Date
(Month)
(Day)
(Year)
19 PLACE 85 BURIAL, CREMATION, OR REMOVAL Colson. Lowall
20 UNDERTAKER
Down clock
22 Date of issue Dec. 19,19/88
DATE OF BURIAL Dac. 20-1918 (Month) (Day) (Year) ADDRESS 14 Poringer
'18. 13,000.
County
middlesex
(Usual place of abode)
Length of residence in city or town where death occurred
years
3 SEX
4 COLOR OR RACE
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
(Month)
7 AGE
66
Years
4
Months
Days
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work ..
(h) General nature of industry,
husiness, or establishment in
which employed (or employer)
(c) Name of employer
10 NAME OF
FATHER
11 BIRTHPLACE OF
PARENTS
14
should be carefully supplied. AGE should be stated EXACTLY. MEDICAL EXAMINERS should state CAUSE OF
Filed
See reverse side for extracts from the laws relative to the return of certificates of death.
DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information
9 BIRTHPLACE (City)
Sackville
months
days
How long in U. S., if of foreign hirth?
years
163
105
MARGIN RESERVED FOR BINDING
(Day)
EXTRACTS
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a stand- ard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.
No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent, ... or ... from the clerk of the city or town in which the person died; . . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . .. a satisfactory written statement containing the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by vio- lence, the medical examiner only shall make such certificate. . The person to whom the permit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary infor- mation which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.
Medical examniners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are sup- posed to have come to their death by violence. - Reviscd Laws, Chap. 24, Sec. 8.
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of hcad -homicide; Poisoncd by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) should also be stated.
DESCRIPTION (for unknown person).
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have come to his death by violence, until a permit in writing, signed by the Medical Examiner, has first been obtained. - Revised Laws, Chap. 24, Sec. 20.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
3 SEX Gemall 7 AGE PARENTS 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
PLACE OF DEATH Wess Chelmsford (No
Laura E. Hola
2 FULL NAMEX. [If married or divorced womau or widow give maiden name, also name of husband.] @RESIDENCE
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE,
MARRIED,
WIDOWED.
OR DIVORCED
(Write the word)
Widow
· DATE OF BIRTH
Mar 5 -1855
(Month)
(Day) (Year)
If LESS than
I day ......... hrs.
......... min. ?
8 OCCUPATION entrance
(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)
Mier Chelmsford
10 NAME OF FATHER Jonathan &. Hayr
11 BIRTHPLACE OF FATHER (State or country) Siefard N.K.
12 MAIDEN NAME
OF MOTHER
Lucy & Guller
18 BIRTHPLACE
OF MOTHER
(State or country)
ME
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
E.G. Hunston
(Address)
Wenn Chiluard
16 File Dec 22, 1918 Edward S. Rolling
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dic 21
1918
(Month)
(Day)
(Year,
17 I HEREBY CERTIFY that I attended deceased trom Dee /
......
Dec 21
1918
.....
that I last saw her alive on Dec 12
1918
.........
1918
to
...... .... and that death occurred, on the date stated above, at 10. ...... .m. The CAUSE OF DEATH* was as follows :
Carcinoma of the bread-
(Duration) 3
yrs
.mos.
ds.
Contributory. (SECONDARY)
(Duration)
.... yrs.
......
............
.. mos.
ds.
(Signed)
M.D.
Dee 21
. 1918 (Address).
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
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
DATE OF BURIAL Devz3 1918
.........................................
ADDRESS
20 UNDERTAKER Young & Blake.
164
Weer Chelmsford
St. : Ward)
(City or lown.) fif death occurred in a hospital or institution, give its NAME instead of street and number.]
....
Registered No.
106
4 COLOR OR RACE
whoos
-
63
yra. mos. ds.
MARGIN RESERVED FOR BINDING
-
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, Architeet, Loeo- 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 needcd. 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, ctc. 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"); 1 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., Careinoma, Sar- coma, etc., of. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms); 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 (discase 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 septieaemia," "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, ctc.
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. 1-'17. 100,000.
1918- 35-
18837
MARGIN RESERVED FOR BINDING
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,
of certificate.
14 Johan & Douglas.
Informant
(Address)
Chelmsford Mare
15 Filed Dec, 28. 2018 Edward DRalban
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
Hemale.
4 COLOR OR RACE
White
·
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
John S. Douglas.
6 DATE OF BIRTH (month, day, and year) Many 10, 1883
7 AGE
35
Years
Months
7
Days
17
If LESS than
I day, ........ hrs.
or ........ min.
16 DATE OF DEATH (month, day, and year)
Dec., 2)
1918.
17
I HEREBY CERTIFY, That I attended deceased from
Dec. 23
1918 to Drar 27, 1918.
that I last saw her alive on
Deer 27
1918
and that death occurred, on the date stated above, at
10A
.... m.
The CAUSE OF DEATH* was as follows :
Influenza.
with double
Broncho Pneumonia
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
At Home.
particular kind of work.
(b) General nature of industry,
business, or establishment in
which employed (or employer)
(c) Name of employer
At Home.
1
CONTRIBUTORY
(SECONDARY)
(duration)
yrs ..
.mos ..
ds.
9 BIRTHPLACE (city or town) ..
Sowell
(State or country) Mara.
PARENTS
10 NAME OF FATHER
Charles IT, Kidder
11 BIRTHPLACE OF FATHER (city or town) sowell, (State or country) Mark.
12 MAIDEN NAME OF MOTHER Clara Hill
13 BIRTHPLACE OF MOTHER (city or town) ..
) Lowell
(State or country)
Masa.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death? No. Date of X
Was there an autopsy ?.
no.
What test confirmed diagnosis ?
Physical Tests.
12 (Signed)
Amara toward
28. 19/8 (Address)
Chelmsford.
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. (Sce reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION __ OR REMOVAL Hoefather's Cemetery frage helmaford, Mare.
20 UNDERTAKER
Gro Mateales
1655 Chelmsford (City ov toryn)
1 PLACE OF DEATH
County
Middleegy
Township
6 helmeford,
... or Village
.. or
Gasthof
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Alice Kidder Douglas.
(If in the Army or Navy of the United States, give rank, organization, etc?)
(a) Residence. No.
Bartich
St.,
Ward.
(If non-resident give eity or town and State)
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
(Usual place of abode)
Length of residence in city or town wbare death occurred
years
State.
Registered No. 107
City
No.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(duration)
3
.. yrs.
mos .....
ds.
DATE OF BURIAL
Sec. 29, 1918,
ADDRESS
19 Branch It.
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 applics 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, Architect, Locomotive 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 linc is provided for the latter statement; it should be used only when necdcd. 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," "Forcman," "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 houschold 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 homc. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. It 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 .- Namc, 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; Bronchopncumonia ("Pneumonia," unquali- fied, is indefinitc); 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 (sccondary or inter- - current) affection necd not be stated unless important. Example: Measles (discase causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report incre symp- toms or terminal conditions, such as "Asthenia," "Ancmia" (mercly 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 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 DEATIIS 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 carbolie 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, ctc.
3. Sudden deaths of persons not disabled by recognized discase, 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.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY PHYSICIAN.
R 15. 1-'18. 100,000.
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