USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1919 > Part 29
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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.
Dr. Philliffe
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 tho request of an undertaker or otlier 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 agc, 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, Sccs. 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 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 tho per- mit is so given and the physician who certifies to the causo of death shall thereafter furnish 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, Scc. 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 certificato of death is nceded.
(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 thoso of persons found dead.
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 so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions ou back
of certificate.
15 Filed Och. 30, 1911 Stephen Flik Registrar of city of town where death occorred File Oct 25 99 Edward .....
Registrar of city or towo where deceased resided
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) 006. 20, 19
17 I HEREBY CERTIFY, That I attended deceased from Oct 20. 1919, to Get, 20 19 1
that I last saw het Malive on ...
20 1919
and that death occurred, on the date stated above, at ..... m. The CAUSE OF DEATH* was as follows:
* 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.)
Niveaspol Prostate
Gland.
miocarditis hiddenHeart
Fallers
„(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? yes)
Date of Get, 201919.
Was there an autopsy ?.
no.
What test confirmed diagnosis ?. arthur Loroboria, M.D.
(Sigoed)
10-221917 (Address)
Chelmsford may
19 PLACE (OF BURIAL, CREMATION, OR REMOVAL Chel me 8. mars
Tiveres
e
DATE OF BURIAL Det. 23 2019.
20 UNDERTAKER Walter Terham
ADDRESS Chelmsford
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
male White married
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year)en 2 1839
7 AGE
ro
Ycars
Months
Days
29
If LESS than
I day, ........ brs.
or ....... mio.
8 OCCUPATION OF DECEASED
(a) Trade, professioo, or
particular kind of work ..
Farmer
(b) General nature of industry, business, or establishment in which employed (or employer ) ...
.(c) Name of employer
9 BIRTHPLACE (city or town tafford (State or country)
10 NAME OF FATHER
PARENTS
11 BIRTHPLACE OF FATHER (city of town)
(State or country)
haron
12 MAIDEN NAME OF MOTHERHenrietta dade
Sharon
13 BIRTHPLACE OF MOTHER (city of town) ) (State or country) V.A.
14 wil
Informant
( Address)
Chelmakes
0 24.7 Lowell (City or town)
CERTIFICATE OF DEATH OF NON-RESIDENT
1 PLACE OF DEATH
County
middlesex
State.
mais
Registered No. 83
City or Town.
Lowell
howell Convittoen St,
(Place of residence)
............... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME ..
Francie
(If in the Army for Navy of the United States, give rank, organization, etc.)
St.
(Usual place of abode)
Length of residence in city or town where death occorred
30
years
mooths
days
How long in U. S., H of foreign birth?
years
mooths days
9
If STILLBORN, eoter that fact bere
MARGIN RESERVED FOR BINDING
The Commonwealth of Massachusetts
Registered No ..
(Place of death)
(a) Residence. State
mais City or Town.
Chelmexa No
8
.....
ny
REVNE ; 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 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 of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid 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 _.
(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 terininal 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 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., sepsis, tetanus) may be stated
Her the head of "Contributory." . (Recommendations nf cause of death approved by Committee 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 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.
.
R 303. 6-'18. 50,000.
Form R-302
The Commonwealth of Massachusetts
24.8
CERTIFICATE OF DEATH OF NON-RESIDENT
Tewksbury
(City or town)
Registered No ...
405
County
Middlesex
State
Massachusetts.
Registered No ...
82
(Place of residence)
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Annin Hanley
....
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. State ...
(Usual place of abode)
City or Town.
Length of residence in city or town where death occurred
1
years
months
17
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. 18. 199
17
I HEREBY CERTIFY, That I attended deceased from
Aug. 1
19.
, 19
. Oct. 18
19 19
......
that I last saw h ...
er
alive on
19
and that death occurred, on the date stated above, at 5:55P m. The CAUSE OF DEATH* was as follows :
. 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 spacc.)
Chronic Endocarditis
unknown
(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? HLO Date of ..
Was there an autopsy? No
What test confirmed diagnosis? Clinical Findings,
(Signed) ...
Edna N. Sypher-Kane
... , M.D.
/18, 191 9(Address) State Infirmary, Tewksbury
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
St. Patrick's Cem. Lowell 10 23 10
15 Filed 10/18/ 19 ...
Registrar of city or town where death occurred Filed 2200. 10. 1917 Goboard S. Bobbing
Registrar of city or town where deceased resided
8
-
e
ns
3 SEX Female 7 AGE particular kiod of work. (c) Name of employer PARENTS Informant . .... (Address) of certificate. 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 (State or country)
MARGIN RESERVED FOR BINDING
Years 43 (h) Geoeral nature of industry, business, or establishment in which employed (or employer). carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, If STILLBORN, enter that fact here
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
Not learned
6 DATE OF BIRTH (month, day, and year) L'eb. 23, 1876
Months
7
Days
25
If LESS than I day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or Housework
9 BIRTHPLACE (city or town) ...
Washington.
D. C.
10 NAME OF FATHER Peter
11 BIRTHPLACE OF FATHER (city or town) ... (State or country) Treland
12 MAIDEN NAME OF MOTHER Bridget Scanlon
13 BIRTHPLACE OF MOTHER (city or town) .. (State or country)
Ireland 10
14 Hospital Records.
20 UNDERTAKER Farmor & Son
ADDRESS Tewksbury
1 PLACE OF DEATH
(Place of death)
City or Town ........
Tewksbury.
No.
State Infirmary
No ...
Chelmsford
St.
Oct. 18.
19
..........
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 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, c. g., Farmer or Planter, Physician, Compos- itor, Architcet, 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- catcd 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 (tlie only definite synonym is "Epidemic cercbrospinal 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, ctc., Carcinoma, Sarcoma, etc., of_
(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronie valvular heart disease; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere syinp- tomns or terminal conditions, such as "Asthenia," "Anemia" (merely symptomnatic), "Atrophy," "Col- lapse," "Comna," "Convulsions,"" "Dcbility" ("Con- genital," "Scnilc," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremnia," "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," ctc. 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 Committec on Nomenclature of the American Medical Association.)
Casas 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
PIIYSICIAN.
R 303. 6-18. 50,000.
FORM R-301
1919 1847 72
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
1-6-'19. 150,000.
The Commmuralth of Massachusetts
STANDARD CERTIFICATE OF DEATH
2409 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH Middleage County ...
State
Mass
Registered No.
84
City on Town Gart Chelmsford No Manning Place
St.,.
Ward
(If death occurred in a hospital og institution, give its NAME instead of street and number)
Charlotte f. Bartlett.
2 FULL NAME
(a) Residence. No.
Manning Place
St.,.
. Ward.
( Usual place of abode)
Length of residence in city or town where death occurred
72 years
8
months
5
"days.
How long in U. S., if of foreign hirth ?
years
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female. White.
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Married.
5a If married, widowed, or divorced
HUSBAND of
(or)
Grastua A. Partel.
6 DATE OF BIRTH
Feb.
(Monthi)
19. 1847
(Day)
(Year)
7 AGE 72 Years
Months 5 Days
If STILLBORN, enter that fact here If STILLBORN, state period of uterogestation mns.
If LESS than
1 day, ........ hrs.
or ........ min.
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work. At Home.
(b) Generai nature of industry,
business, er establishment in
which employed ( or employer) ..
At Home.
(c) Name of employer
9 BIRTHPLACE (City)
East Chelmsford
( State or country) Kara.
10 NAME OF
FATHER
William Manning.
11 BIRTHPLACE OF
FATHER (City)
Billerica,
(State or country)
12 MAIDEN NAME
OF MOTHER
Mary A. Baldwin.
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Marc
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH.
(Monthy
24
1919
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
19.
14-
... , to
Oct. 24
1919
that I last saw h & alive on
Cect. 23, 1919.
and that death occurred, on the date stated above, at 2.15Am
The CAUSE OF DEATH was as follows :
Bronchiectores
-
(duration) 10
.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? 20. Date of.
Was there an autopsy ?
no.
What test confirmed diagnosis ?.
(Signed)
Aucun 1, Scolonia
.. . ..... , M.D.
( Address ).
Chelmsford miss
Date ..
Oct.
24
1919.
14 Informant Grastue A Bartlett (Address) East Chelmsford, Maren
15
Oct. 25, 19/1 6 dward , Robbins
(Month) (Day) (Year)
REGISTRAR
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
Joy Hill, Billerica, Mars, Oct, 26 1919,
(Cemetery)
(City or town)
20 UNDERTAKER
großHealey.
ADDRESS
Sowell, Mase.
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the hurial or transit permit was issued Edward & Robban
Offic
position.
Com Click
Date of issne of permit. Oct. 25, 1914 No.
Permit
(Month)
(Day)
(Year)
.....
PARENTS
Billerica
(If in the Army or Navy of the United States, give rank, organization, etc.)
(If non-resident give city or town and State)
months
days
4 COLOR OR RACE
MARGIN RESERVED FOR BINDING
A
00151
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 werd 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, ete. 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 occupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE CAUSING DEATII (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 indefinitc); 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.
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