USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1920-1921 > Part 34
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sions of chapter 24 01 the neviseu Laws uearns unuer 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.
Occlusion of ressed in regionof the posterin fact of the cultural capsule of the left side of the brain.
R 15. 10-'18. 5,000.
FORM R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
99 No. Chelunsford (City or Town)
1 PLACE OF DEATH
County.
Middlesex
City or Town
no Chelmsford No.
State7.
Sleeper
St .. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Lucy alfred Ineson
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No ....
(Usual place of abode)
Sleeper
Length of residence in city or town where death occurred years
months
days.
How long in U. S., if of foreign hirth ?
years
months days
PERSONAL AND STATISTICAL PARTICULARS
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
Jan ( Month)
1.6 (Day)
1921
(Year)
Years
Months
2
Days
4
If LESS than 1 day, ........ hrs. or ....... min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work. (h) Name of employer
9 BIRTHPLACE (City)
520 Cheluisford
maso.
Percy H. Ineson
11 BIRTHPLACE OF
FATHER (City).
Theowell
(State or country)
mais
12 MAIDEN NAME
OF MOTHER
Ida May Need
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Westford
Masa
14 Percy V. Gnerovi
(Address )
The Chilisford
Filed .. (Month) (Day) (Year)
21 I HIEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued : Justice L. mood
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Mar
(Monthi)
201921
(Day)
(fear)
17
I HEREBY CERTIFY, That I attended deceased from march 3,, 1921 .. , to March 20, 1921.
that I last saw
him alive on
march 20,
1921/
and that death occurred, on the date stated above, at ...
5
... m.
The CAUSE OF DEATH was as follows :
Pylovospasm
.. ( duration) 2
yrs.
mos .. .ds.
( SECONDARY)
(duration) 2 ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?
no
Date of.
What test confirmed diagnosis ?.
Was there an autopsy ?
Physical + lab. Exams.
(Signed).
FrederickD. Lambert, M.D.
(Address)
Tyngsborough, mass
Date
march, 28.
(Month)
. 1921.
(Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL CadRon Lowell
(Lerhetery)
(City or town)
DATE OF BURIAL Mar 22-1921
ADDRESS
Wany wV 1921 Justin L. MaCenes. W. M Tenna Lowell'm
Official Jocon Check position
Date of issue
of permit Man 771921
Permit
6-'20. 20,000.
3 SEX Viale - 7 AGE 10 NAME OF FATHER PARENTS Informant should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH 15 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 (State or country)
MARGIN RESERVED FOR BINDING
7
CONTRIBUTORY
acute nephritis
yrs.
mos ..
20 UNDERTAKER
Mars
Registered No ..
++ 15
St.,
Ward.
(If non-resident give city or town and State)
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, irrespectivo 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 engincer, Civil engineer, Stationary fireman, etc. Butin 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 servico 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.
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 diseasc. Examples: Cere- brospinal fever (tho 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," ctc.), "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- mittec 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.
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 deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and bclicf the name of the deccased, 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 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 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, Scc. 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 mako 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, tho sudden deaths of persons not disabled by recognized diseaso, and those of persons found dead.
100
The Commonwealth of Massachusetts
CERTIFICATE OF DEATH OF NON-RESIDENT
(City or town)
1 PLACE OF DEATH
Registered No.
County,
City of Town Shacut
No ..
(Sanchard Are
.St., Ward
(If death occurred in a hospital or institution, give its NAME instead of strect and number)
2 FULL NAME
Sarah Acrescido
(a) Residence.
State
Mais
City or Town Leonelmotore
St.
(Usual place of abode)
Length of residence in city or town where death occurred
years
3
months
-days
How long in U. S., if of foreign birth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female vite
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Anigle
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
les 17 I HEREBY CERTIFY, That I attended deceased from Lest 1920 ...
6 DATE OF BIRTH (month, day, and year) June 8, 1841
7 AGE
Years
79
Month's
Days
13
If LESS than I day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work
(h) General nature of industry, business, or establishment in which employed (or employer) (e) Name of employer
9 BIRTHPLACE (city or town) (State or country)
10 NAME OF FATHER Samuel Preços
PARENTS
11 BIRTHPLACE OF FATHER (city (State or country)
12 MAIDEN NAME OF MOTHER Sally porre
13 BIRTHPLACE OF MOTHER (city or towordor (State or country)7
14
Informant (Addr
15 Ichq 102: huisman
Registrar of city or town where death occurred
Filed Mar. 29 1924 Justine L. Weare
Registrar of city or town where deceased resided
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
niche 21
19 21
anche 21
192/
that I last saw her
alive on
Im 15-
1921
and that death occurred, on the date stated above, at 11.300 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. (Sce reverse side for addinoral space.) Carcinoma of interna
(duration)
1
. yrs
mos .........
da.
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
Sigoedd
3 2 , 19 / (Address)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL DATE OF BURIAL fondoutentes fondos inch 23 1921
20 UNDERTAKER Dearge It Really
ADDRESS 236 /Vectra
MARGIN RESERVED FOR BINDING
80 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, N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be of certificate.
Braeuch
State maça
(Place of death)
Registered, No.
+516
(Place of residence)
(If in the Army or Navy of the United States, give rank, organization, etc.)
If STILLBORN, enter that fact bere
4 COLOR OR RACE
Filed
REVISED UNITED STATES STANDARD CERTIFICATE OF DE .. [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- ilor, 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) Groecry; (a) Foreman, (b) Automobile factory. The ina- 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 faet 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 tinie 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 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 discase; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Mcasles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symnp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coina," "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 cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Of 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
VI
.. . by Con nittee
: 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 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 303. 6.'18. 50,000.
FORM R-301
The Commonwealth of Massachusetts
101
1 PLACE OF DEATH
County.
State
Mass
Registered No.
1619
City or Town
Chelmsford
No.
St ... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Ida Ellsworth Byany
Locust Rd So Chalcultand St.
Ward.
(If non-resident give city or town and State)
days.
How long in U. S., if of foreign hirth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
March 30
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
Mar. 30, 1921, co
may 30
1921
that I last saw h & alive on
may 30
19.21
and that death occurred, on the date stated above, at
6.150 .... m.
The CAUSE OF DEATH was as follows : Left humpligea - Probably
or ........ min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
at home
(duration)
... yrs ...
... mos ......
.ds.
CONTRIBUTORY.
arterio Sclerose!
(SECONDARY)
(duration)
.. yrs ................
mos .............
ds.
18 Where was disease contracted
if not at place of death?
Did an operation precede death ?
no.
Was there an autopsy ?
200 .
What test confirmed diagnosis ?
Milan , Scoborca
(Signed)
... M.D.
(Address).
Chelmsford, moso.
Date
march 30
(Month)
(Day)
11921-
(Year))
Informant.
Mro Harry S. Sheeva (Sister)
(Address)
Cheematens
(Cemetery)
(City or town)
DATE OF BURIAL
april 1 1921
15
Filed Mar 30 1921 Justice Limone
(Month) (Day) (Year)
REGISTRAR
21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued Justine L. Heonce
ial Snow check .position
Date of of permit Mar 30, 1921 No.
Permit
8-'20. 35,000.
3 SEX Hemale 7 AGE 59 FATHER PARENTS 14 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 (h) Name of employer
MARGIN RESERVED FOR BINDING
Years
Months
Days
26
if LESS than
1 day ......... hrs.
9
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
June
4
1861
(Month)
(Day)
(Year)
9 BIRTHPLACE (City)
Chelmsford
(State or country)
mark.
10 NAME OF
Charles Mr. Byam
11 BIRTHPLACE OF
FATHER (City).
Chelmsford
(State or country)
12 MAIDEN NAME
OF MOTHER
Mary J. Proctor
Chelmsford
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
mark.
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Morefactors
Chelmsford
20 UNDERTAKER
Walter Derham
/ADDRESS
Chelmsford
1921.
4 COLOR OR RACE
white
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
( Usual place of abode)
Length of residence ia city of town where death occurred
years
months
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town)
Date of.
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 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 tho same accepted term for the samc 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 bo 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,""IIemorrhage,""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.
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