USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1919 > Part 24
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1
FORM R-301
1918 33
1885
( Usual place of abode)
Leogth of resideoce ia city or town wbere death occorred
1
years
3
mooths
days.
How loog io U. S., if of foreigo birth ?
years
mooths
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH.
(Mouth)
Sitet
6
1919
(Year)
17 I HEREBY CERTIFY, That I attended deceased from
....
13.
1885
that I last saw h. M alive on
Sept. 2, 1919.
and that death occurred, on the date stated above, at ..
7a. ... m. The CAUSE OF DEATH was as follows :
Pulmonary and Lawnqual
(duration) 2-
... yrs ..
mos ...
ds.
CONTRIBUTORY (SECONDARY)
(duration)
yrs.
mos.
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?.
no, Date of
Was there an autopsy ?
no.
What test confirmed diagnosis ?....
(Sigoed)
Scobar
1
M.D.
(Address).
Philuneford, more.
Sekt
6
1919.
( Month)
(Day)
(Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
Edson.
Sowell, Mase SeAt. 8. 1919.
(Cemetery)
(City or town)
20 UNDERTAKER
Gromoteater
ADDRESS
Sowell, Nasa
Official Vorm Clerk
position.
22 Date of issue of burial or transit permit.
Soft. 8, 1919
3 SEX Female. (c) Name of employer PARENTS Informant ... (Address) should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See If STILLBORN, eoter that fact here
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
County.
Middlesex
State.
Masa
Registered No.
68
City or Town
Chelmsford
.. No.
Hall Road
St.,.
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Blanche H. Fleming.
(a) Residence. No.
Hall Road, Chelman
Ward.
(If non-resident give city or town and State)
4 COLOR OR RACE
White.
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Singles
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
Sehr.
( Month)
(Day)
( Year)
7 AGE
33
Years
11
Months
24 Days
If STILLBORN, state period of uterogestation ..
OS.
If LESS thao
I day, ........ hrs.
or ........ tin.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
(b) Generai nature of iodustry,
husioess, or establishment in
wbich employed ( or employer) ..
blesk.
9 BIRTHPLACE (City)
Lowell
( State or country)
Mace,
10 NAME OF
FATHER
gareth Fleming.
11 BIRTHPLACE OF
FATHER (City) ...
Clinton.
(State or country)
Mare:
12 MAIDEN NAME
OF MOTHER
Sarah Rutherford.
Lowell,
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
14 Joseth File
157 Agarrain It Sowill
15
Sept 8, 99 Edward S. Bobbing
Filed
(Monthb (Day) (Year)
REGISTRAR
60
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued Edward . Robbing
233
MARGIN RESERVED FOR BINDING
10-'18. 100,000.
blesk
-
1919, to.
Sept to
.,19 .. /
(Day)
(If in the Army or Navy of the United States, give rank, organization, etc.)
Date ..
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, 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 material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Ilousekeepers 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 tho 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 occupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE CAUSING NEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, 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 .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.
State cause for which surgical operation was undertaken.
(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)
Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
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 standard 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 contraeted, 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. 522.
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 con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate 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 violence, the medical examiner " only shall make such certificate. . .. The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafterfurnish for registration any other necessary information 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 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 supposed 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 sup- posably 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.
FORM R-301
The Commmuralth of Massachusetts STANDARD CERTIFICATE OF DEATH
234
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
County
Middlesex
State
Mass
Registered No.
69
City or Town.
No. Chelmsford
No.Princton St.
St.,
.Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Henry Rodie
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No ....
PrinctonSt.
St.,.
Ward.
(If non-resident give city or town and State)
Leogth of residence in city or town where death occurred
10
years
months
days.
How long in U. S., if of foreign birth ? 35
years
mooths
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Acht
10
(Month)
(Day)
1119
bar
17
Į HEREBY CERTIFY, That I attended deceased from
....
that I last saw h .V.ha alive on
Deft 2
, 19 ..
and that death occurred, on the date stated above,
+10.433
.m.
The CAUSE OF DEATH was as follows :
carcinoma Chine
of Basey
(duration)
2
yrs
mos.
ds.
CONTRIBUTORY
( SECONDARY)
cerchal Hamontage
2
(duration)
.. yrs .......
.... mos ....
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death? 100 Date of.
Was there an autopsy ?
clinical
What test confirmed diagnosis ?
R.W. Parker
(Signed)
...
M.D.
(Address).
11
1919
(Month) (Day) ( Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
St. patrick's
Lowell
(Cemetery)
(City or town)
20 UNDERTAKER
John L. Moronoush
ADDRESS
176 Norham St
Lovell
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me/ BEFORE the bu nsit perm Edward & Robbins Torfing
Official Voor Click
position
22 Date of issue of burial Self 13 1919 or transit permit.
3 SEX male 6 DATE OF BIRTH 7 AGE 64 Years particular kind of work ... (c) Name of employer 9 BIRTHPLACE (City) 11 BIRTHPLACE OF FATHER (City) (State or country) 12 MAIDEN NAME OF MOTHER 13 BIRTHPLACE OF MOTHER (City). ~ PARENTS (Statc or country) Informant .. should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH Filed N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See If STILLBORN, eater that fact here
10-'18. 100,000.
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
Annie M.
1855
( Month)
(Day)
( Year)
Months
Days
If LESS than
1 day ......... hrs.
If STILLBORN, state period of uterogestation
. mos.
or ........
8 OCCUPATION OF DECEASED
) Trade, profession, or
=
Machinesthi
(b) Generai nature of iodustry,
business, or establishment in
which employed ( or employer ) ..
Shoe ...... Industry
(Statc or country)
Scotland
10 NAME OF
FATHER
Goerge Rodie
Scotland
Cannot Learned
Scotland
14 Mr s/ Annie M. Rodie
(Address)
Princton St.
15 Sept. 13/9/9 Edward . Rotting
(Month (Day) (Year)
REGISTRAR
DATE OF BURIAL
Sept.13
19
Date ..
MARGIN RESERVED FOR BINDING
( Usual place of abode)
1918, to Jest10, 1919.
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. Butin many cascs, 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 he used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Lahorer," "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 house- hold only (not paid Housekeepers who receive a definite salary), may be entercd 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 CAUSINO DEATH, state occupation at beginning of illness. If retired from husiness, that fact may be indicated 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: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never- report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, 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 he stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Dcbility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""IIcmorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can he ascertained as the cause. Always qualify all diseases resulting from childhirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.
State cause for which surgical operation was undertaken.
(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)
Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
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 otlier authorized person or of any member of the family of the deccased, furnish for registration a standard certificate of death, stating to the best of his knowledge and helief the name of the deceased, his supposed age, the disease of wluch he died [defincd 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 con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in licu thereof a certifi- cate 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 violence, the medical examiner only shall make such certificate. . . . The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafterfurnish for registration any other necessary information which can he 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 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 supposed to have come to their death hy 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 hedside 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 ahsent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably 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 ahortion, hut 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.
FORM R-301
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
235
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
County.
State.
Registered No .=== 70
City or Town No Chelmsford
" 1. Amherst
.St. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Wendell C Honra
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No. # 1 Angarat St
(Usual place of abode)
St.,.
Ward.
(If non-resident give city or town and State)
Length of residence in city or town where death occurred
18
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 !
White
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.
Oct 10 1900
( Month)
(Day)
(Year)
7 AGE
18 Years
13 Months
Days
If LESS than
If STILLBORN, enter that fact bere
If STILLBORN, state period of uterogestation
. mos.
-
I 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) ..
Student
(c) Name of employer
9 BIRTHPLACE (City) No Chelnsfori
(State or country)
10 NAME OF
FATHER
Edward Moore
PARENTS
11 BIRTHPLACE OF
FATHER (City ) ....
Of Fredrickton 1. 3.
(State or country) N.3.
12 MAIDEN NAME
OF MOTHER
Mabel Clark
13 BIRTHPLACE OF
MOTHER (City)
aroton
(State or country)
14
Informant ........
(Address ) in Chatfor Mass
15
Filed .S Sept. 12, 1919 Edward ), Rotting
(Month) (Day) (Year)
REGISTRAR
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Wastlawn
TOvel]
(Cemetery)
(City or town)
DATE OF BURIAL Sent 129 19
20 UNDERTAKER
Young & Plake
ADDRESS
Lowell
21 ! HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
Official position
Town Cluck.
22 Date of issue of burial or transit permit
Sept 12, 1919
MARGIN RESERVED FOR BINDING
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH
10.'18. 100,000.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH.
(Month)
Sert 10 1919
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
may 1
1919, 10
Jest-18, 1919.
that I last saw b.L.m. alive on
Rest 8
. 1914.
and that death occurred, on the date stated above, at G A.
The CAUSE OF DEATH was as follows :
Tuberculosis Pulmonary.
/ duration)
yrs ...
.. mos ...
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs ..
mos ..
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ? no
Date of ..
Was there an autopsy ?
Mr.
What test confirmed diagnosis?)
(Signed).
R. W. Parker
M.D.
Cliveal
(Address)
Lowell
man
Date
( Month)
(Dav)
11
1919.
( Year)
.... m.
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association!
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, 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 material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold 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 faet may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
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