USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1919 > Part 12
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200 Chelmsford
(City or town)
1 PLACE OF DEATH
County ...
Medex
Township
Chelmsford
State
mass
Registered No. 35
(If non-resident give city or town and State)
ADDRESS
Chelmsford.
.......
....
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement c.
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 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 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 ot 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 (discase 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,"
"Comna," "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 DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- terminc definitely. ª 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 nrovi- sions of chapter 24 of the Revised Laws death- - 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. 10-'18. 5,000.
Form R-302
The Commomuralth of Massachusetts
MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Chelmsford! OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
(ISSUER UNDER THE PROVISIONS OF REVISED LAWS, CHAPTER 24)
County
Middlesex
State. mare
36
Registered No.
City or Town ...
Chelmsford
No
Hartford Road
St.,.
Ward
Martin Vaylov
2 FULL NAME
(a) Residence.
No.
Chelmsford
St.,.
Ward.
(Usual place of abode)
Length of residence in city or town where death occurred
years
90
months
days
How long in U. S., if of foreign birth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White Married
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of-
Kate S.
6 DATE OF BIRTH
nov.
24 1854
7(Day)
(Month)
(Year)
7 AGE
64
Years
5
Months
24
Days
If LESS than 1 day. ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
SED Retired
(b) General nature of industry, business, or establishment in Gameries-Grovisione which employed (or employer) ...
9 BIRTHPLACE (City)c
Lexington
(State or country)
Imagine
10 NAME OF
albert Taylor
11 BIRTHPLACE OF
FATHER (City)
Bloot Known
(State or country) marine
12 MAIDEN NAME
OF MOTHER
not Known
13 BIRTHPLACE OF not Known MOTHER (City) (State or country) Dame
14 Dus martin a Taylor
Informant
(Address)
Chelmsford
15
May 2/199 Edward J. Robbing
Filed
(Month) (Day) " (Year)
REGISTRAR
21 Burial
ermit Edward & Robbins
issued by
Official Voran Click
position
DATE OF BURIAL May 21, 1919 (Month) (Day) (Year) ADDRESS Lowill make.
22 Date of issue May 21, 1919
8-'18. 13,000.
MARGIN RESERVED FOR BINDING
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 PARENTS
3 SEX
Male
particular kind of work
(c) Name of employer
FATHER
should be carefully supplied. AGE should be stated EXACTLY. MEDICAL EXAMINERS should state CAUSE OF
If STILLBORN, enter that fact here
MEDICAL CERTIFICATE OF DEATH
found Dead
16 DATE OF DEATH
may
18
1919
(Month) (
(Day)
(Year)
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 : Posterior Sclerosis of Spinal Cord and morphinism Found dead in body
(See reverse side for additional space)
18 Where was injury sustained if not at place of death?
(Signed)
Chom
mas B. Smith
M.D.
(Adress) 107 Marsmich St. Lowill
Medical Examiner for
5th, Sist Middleay Co.
may
19
1919
Date
(Mont)
(Day)
( Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL Somall Comiting Low
20 UNDERTAKER
John a Heimlich
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If in the Army or Navy of the United States, give rank, organization, etc.)
(If non-resident give city or town and State)
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 examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deccased dicd, 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. - Revised 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 head -homicide; Poisoned 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
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,
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
202 Chehneford (City or town) Registered No. 37
1 PLACE OF DEATH middlesex
County ..
Township
Chelmsford
.or Village.
........... or
St., .. Ward
Sarah &
(If death occurred in a hospital or institution, give its NAME instead of street and number) Bancraft
2 FULL NAME.
.(ff in the Army"or Navy ofthe United States; giye rank; organization; etc:)"
(a) Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
2
years
Sx4
.Ward.
(If non-resident give eity or town and State)
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Widow
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Jonathan Bancroft
6 DATE OF BIRTH (month, day, and year)
July 3, 1842
7 AGE
Years
76
Months
10
Days
16
If LESS than
1 day ......... hrs.
or ........ min.
Chronic Intestinal Nehfritiz
8 OCCUPATION OF DECEASED
(a) Trade. profession, or
particular kind of work.
at Home
(b) General nature of industry, business, or establishment in which employed (or employer). (c) Name of employer
CONTRIBUTORY
(SECONDARY)
(duration)
... yrs ...
............ mos ................ ds.
Did an operation precede death ?
Date of.
Was there an autopsy ?.
What test confirmed diagnosis ?
5 (Signed).
Tired & Varmer
20,1919 (Address) No. Chelmsford
M.D.
* State the DISEASE CAUSING DEATII, 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 spaee.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Informant
(Address) ne Chelmsford
15
Filed May20, 1919 Edward × Robbins
REGISTRAR
16 DATE OF DEATH (month, day, and year) May 19 1919
17 I HEREBY CERTIFY, That I attended deceased from may 17, 1919, to may 19 1917.
that I last saw her alive on
and that death occurred, on the date stated above, at ...
7 9-
.. m.
The CAUSE OF DEATH* was as follows :
.. (duration)
2
yrs.
.mos.
ds.
9 BIRTHPLACE (city or town) ..
Tyngsboro
(State or eountry)
0
Dass.
10 NAME OF FATHER Thomas Sherburne
PARENTS
11 BIRTHPLACE OF FATHER (city or town).
Pelham
(State or country)
marc
12 MAIDEN NAME OF MOTHER Beten Spalding 13 BIRTHPLACE OF MOTHER (eity or towny Dunstable (State or country)
14 Jus. many Walker
Bhhewill mass.
DATE OF BURIAL Thay 21 1919
ADDRESS
20 UNDERTAKER
David 2. Greig &Son
MARGIN RESERVED FOR BINDING
of certificate.
State
mass.
City
No.
months
days.
How long in U. S., if of foreign birth ?
years
months
1
may 19 1919.
18 Where was disease contracted
if not at place of death?
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH used by U. S. Census and American Public Health Association]
Statement of occupation. - Precio-
tion is very important, so that the rel
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 linc 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 cxamples: (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 laborcr, 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 homc. 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 discase. 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 ncoplasms); 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" " (mercly symptomatic), "Atrophy," "Col- lapsc," "Coma," "Convulsions," "Debility" (“Con-
genital," "Senile," .ctc.), "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 discases 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 dc- 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." (Recomm. " statement of cause of death approved by Commite Nomenclature of the American Medical Association
's for . the Medical Examiners. - Under the pro. f chapter 24 of the Revised Laws deaths (11.7
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. 100,000.
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 mrs. mura flanders
Informant
(Address)
Chelnherford Mars
15 Filed May 21,2019 Edward . Robbing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
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
myra flanders
6 DATE OF BIRTH (month, day, and year) Ung. 20, 1842
7 AGE
76
Years
Months
9
Days
If LESS than
1 day, ........ hrs.
or ........ min.
16 DATE OF DEATH (month, day, and ycar)
May 20, 1919
17
I HEREBY CERTIFY, That I attended deceased from
Mar, 1,, 1919, to
many 19 1919
that I last saw h/M alive on
Mark 19 1919
2
9a
m.
and that death occurred, on the date stated above, at ....
The CAUSE OF DEATH* was as follows :
Otaxie Paraplegia
8 OCCUPATION OF DECEASED-
(a) Trade. profession, nr
Retired
particular kind of work.
(b) General nature of industry, business, nr establishment in which employed (nr employer) .... (c) Name of employer
(duration)
-yrs ...
... mos ..
ds.
CONTRIBUTORY
(SECONDARY)
w(duration)
yrs ..
mcs.
ds.
9 BIRTHPLACE (city or town).
alton
(State or country)
n. 7%.
10 NAME OF FATHER
Enoch Filanders
PARENTS
11 BIRTHPLACE OF FATHER (city or town)
alton
(State or country)
71,7%.
12 MAIDEN NAME OF MOTHER Dorothy tham
13 BIRTHPLACE OF MOTHER (eity or town) Milton (State or country) 21.71
18 Where was disease contracted
if not at place of death?
Did an operation precede death ?
no
Was there an autopsy ?.
20
What test confirmed diagnosis ?..
Signe
5(Signed) Herbert M. Lavaleur
M.D.
20, 1919 (Address) Lowald Thank
* 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
Edson
Cemetery
Lowall mass
DATE OF BURIAL May 23, 1919
.... or
City
No.
.or Village.
Golden tvr
St.,
Ward
(If death oceurred iu a hospital or institution, give its NAME instead of street and number)
2 FULL NAME ..
Charles H. +landers
Why the Army of Navy of the United States give pink, organization, etc.)"
(a) Residence. No.
Chelmsford
St.,
........
.Ward.
(Usual place of abode)
6 years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MARGIN RESERVED FOR BINDING
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
203 Chelmsford (City or toyn)
1 PLACE OF DEATH
County ...
Imiddlese
State
mass.
Registered No. 38
Township
Chelmsford
(If non-resident give city or town and State)
Length of residence in city or town where death nccorred
....
Date of
....
20 UNDERTAKER
ADDRESS
John a. Weinbeck Sonall inars
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]
Statement of cocupation. - 1 ment of oceupa-
is very important, so that ti. Palthfulness of
various pursuits ean be known. The question applies to caeh 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, Architect, 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 speeifieation, 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 homc. Care should be taken to report spe- eifieally the oeeupations of persons engaged in domestie serviee for wages, as Servant, Cook, Housemaid, ete. If the oceupation has been changed or given up on aeeount of the DISEASE CAUSING DEATH, 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 oeeupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affeetion with respect to time and causation), using always the same aeeepted 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, ete., of_
(name origin; "Caneer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection necd 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 symptomatie), "Atrophy," "Col- lapse," "Coma," "Convulsions,"' "Debility" ("Con- genital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease ean be aseertained as the eause. Always qualify all diseases resulting from child- 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 sueh, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoncd by carbolic acid - probably suicide. The nature of the injury, as fraeture of skull, and consequences (e. g., sepsis, tetanus) may be stated
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