Deaths 1920-1921, Part 19

Author: Chelmsford (Mass.)
Publication date: 1920-1921
Publisher:
Number of Pages: 316


USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1920-1921 > Part 19


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60


4 COLOR OR RACE


vhite


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


June 27


( Month)


(Day)


( Year)


Years


Months


1


Days


16


Ii STILLBORN, enter that fact here


If LESS than


1 day, ........ hrs.


er ....... min.


Cholera Infantum


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particolar kind of work.


none


9 BIRTHPLACE (City)


Lowell


(State or country)


10 NAME OF


FATHER


Jhhn E. Wrigley


11 BIRTHPLACE OF


FATHER (City).


(State or country) New Brunswick


12 MAIDEN NAME


OF MOTHER


Mary A. Dollard


13 BIRTHPLACE OF MOTHER (City) (State or country)


Lowell


Date


aug.


13


1920.


( Month)


(Day)


(Year)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


St. Patrick's


Lovell


DATE OF BURIAL Aug 14,20


(Cemetcry)


(City or town)


20 UNDERTAKER


John L. McDonovan


174


ADDRESS Gorham


21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued a: Edward J. Robbins


Offic position


Town Click


Date of issue of permit aug 14, 1929 No


Permit


3.'20. 20,000.


15 aus 14, 1920. Edward & Robbing


(Month (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


aug. 13


1920


(Day)


(Year)


17


I HEREBY CERTIFY, That I attended deceased from


aug. 6


19.26, to.


aug, 13


1920


1920


that I last saw him


alive on


aug. 12


1920


and that death occurred, on the date stated above, at


2


a


.m.


The CAUSE OF DEATH was as follows :


(duration)


.yrs ..


mos.


7


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.


X


Was there an autopsy ?


no


What test confirmed diagnosis ?


(Signed)


amasa Howard


M.D.


(Address).


Chelmsford Mass.


1


14 John E. Wrigley


(Address)


Chelmsford Ct. Ness.


60


Second St.


St.,


Ward.


(If non-resident give city or town and State)


16 DATE OF DEATH.


(Month)


A


L


STATES STANDARD CERTIFICATE OF DEATH


[Approved by U. S. Census and American Public Health Assori-


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 necded. 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 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 doraestic 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 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 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.


COMMONWE,


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 discase 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 tho 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 Commonwealth of Massachusetts


61


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


1 PLACE OF Bruddluce


County


Chy of Town.


East


Chelmsford


St ... .. Ward


(If death occurred in a hospital or justitution, give its NAME instead of street and number)


2 FULL NAME


(a) Residence.


No.


East Chelmsfords.


(Usual place of abode)


Length of residence in city or town where death occorred


25


years


months


days.


How long in U. S., if of foreign birth ?


25


years


mooths


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Female White


4 COLOR OR RACE


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


(Month)


(Day)


(Year)


7 AGE 56 Years


Months


Days


If LESS than


If STILLBORN, enter that fact here


I day, ........ hrs.


If STILLBORN, state period of uterogestatioo. -mos.


or ........ min.


8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) Geoeral oature ofindustry, business, or establishment in which employed ( or employer).


at Home


(c) Name of employer


9 BIRTHPLACE (City) (State or country)


duland


PARENTS


10 NAME OF


FATHER


Timothy bryan


11 BIRTHPLACE OF FATHER (City ) ... (State or country)


12 MAIDEN NAME


OF MOTHER


Bridget Lauden


13 BIRTHPLACE OF


MOTHER (City)


(State or country)


freland


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


(Month


1L


(Day)


(Year)


17


I HEREBY CERTIFY, That I attended deceased from


June 29


120.


to ..


20


Aug 16


19


19


that I last saw h


alive on


Aug 15


20


and that death occurred, on the date stated above, at.


1210 %


m.


The CAUSE OF DEATH was as follows :


Chemie nechali


.(duration)


yrs ......


3


mos.


ds.


CONTRIBUTORY.


(SECONDARY)


(duration)


.yrs ..


.mos.


ds.


18 Where was disease contracted


if not at place of death ?


Did an operation precede death ?


Date of


Was there an autopsy ?


What test confirmed diagnosis ?,


(Signed)


9. 1. Mechan M.D.


(Address).


228 Ir author


Date


(Month)


(Day)


1920


(Year)


19 PLACE OF BUNDL, CREMATION, OR REMOVAL It Patrick Lowell


(Cemetery)


(City or town)


DATE OF BURIAL


aug 18/20


ADDRESS


15 Quy. 17, 1920 Edward J. Rolfune


REGISTRAR


21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued an Edward J. Rochung


Official Town Click. position.


Date of issue of permit Que, 17,1920 No


Permit


1-6-'19. 150,000.


MARGIN RESERVED FOR BINDING


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


14 many Informant .. (Address) East Fla


you


Filed (Month)(Day) (Year)


20 UNDERTAKER


Higgins Bros 415 Lawrenif


STANDARD CERTIFICATE OF DEATH


Registered No.


00


Hannah Ceryan


()in the Army or Nay of the United States, give rank, organization, etc.) Ward.


(If non-resident give city or town and State)


20


....


duland


REVISED UNITED STATES STANDARD CEKTirithis v.


[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 he 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 he sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engincer, Civil engincer, 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 he 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 servico 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 occupation whatever, write None.


1


:


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: 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,""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 -NNWEALTH 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 helicf the name of the deceased, his supposed age, the disease of which he died [defined so that it can bo classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive hy the physician, and the date of his death. . . . - Reviscd 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 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 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 he, 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 disahled 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 Commomuralth of Massachusetts STANDARD CERTIFICATE OF DEATH


62


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


1 PLACE OF DEATH


County.


Masx,


State


Ma.s.s.


Registered No.


51


St. .Ward


(If death oceurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


Robert Franklin Smith


(If in the Army or Navy of the United States, give rank, organization, etc.)


(a) Residence.


No. Chelmsford


St.


Ward.


( If non-resident give eity or town and State)


Length of residence in city or town where death occurred


10


years


months


days.


How long in U. S., if of foreign birth ?


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


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


for) WIFE of


Cora B. Smith


6 DATE OF BIRTH


Aug. 15 1864


( Month)


(Day)


(Year)


7 AGE 56


Years


C


Months


5


Days


If STILLBORN, enter that fact here


If STILLBORN, state period of nterogestation


.... mos.


If LESS than


1 day, ........ hrs.


or ........ min.


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work.


stone cutter


(b) General nature ofindustry,


business, or establishment in


which employed ( or employer)


(retired)


(c) Name of employer


CONTRIBUTORY


( SECONDARY)


(duration)


.. yrs ยป


mos ...........


.ds.


18 Where was disease centracted


if not at place of death ?


Did an operation precede death ?


no.


Date of.


X


Was there an autopsy ?


200


What test confirmed diagnosis ?


(Signed)


amara Stoward


M.D.


(Address)


Chelmsford Mars


Date ....


august


20


1920


( Month )


( Day)


(Year)


TO PLACE OF BURIAL, CREMATION, OR REMOVAL


Pine Ridge


Chelmsford


(Cemetery)


(City or town)


DATE OF BURIAL Aug. 21/120.


20 UNDERTAKER Walter Perham


ADDRESS Chelmsford


Permit


21 I HEREBY CERTIFY that a satisfactory stan-


BEFORE the burial or transit permit was issued Edward & Rolling


Official


position


Jon Click


Date of issue of permit aug. 20, 1920 .No


.......


-


(duration)


1 yrs.


.. mos.


ds.


9 BIRTHPLACE (City)


Leeds


(State or country)


N. Y.


10 NAME OF


FATHER


George, Smith


PARENTS


11 BIRTHPLACE OF


FATHER (City)


Leeds


(State or country)


N. Y.


12 MAIDEN NAME


OF MOTHER


not known


13 BIRTHPLACE OF


MOTHER (City)


N. Y. State


(State or country)


14


Informant


Mrs. R. F. Smith


(Address)


Chelmsford Wass.


15


any 20, 1920


Edward & Rolling


(Month(Day) ( Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


(Month)


august


20


1920


Year)


(Day)


17


I HEREBY CERTIFY, That I attended deceased from


to


now.


1919


aug-20


1920.


that I last saw h Lm alive on


aug: 19


19 .. 24 0,


and that death occurred, on the date stated above, at


1 a.m.


The CAUSE OF DEATH was as follows :


byrrhosis of Swan.


MARGIN RESERVED FOR BINDING


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


1-6-'19. 150,000.


--


( Usual place of abode)


City or Town


Chelmsford


No.


REVISED UNITED STATES STANDARD ICATE OF DEATH


[Approved by U. S. Census and American Public Heanu Association]


Statement of occupation. - Precise statement of oceupation 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, 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 material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dcaler," 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 Ilousckeepers who reeeive 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 oceupations 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 eause of death. - Name, first, the DISEASE CAUSING DEATII (the primary affection with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemie eercbrospinal 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, ete., 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, ete. 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 terminai conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions," "Debility" ("Congenital,""Senile," ete.), "Dropsy,""Exhaustion,""Heart failure," "Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., when a definite disease can be ascertained as the eause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.




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