Deaths 1920-1921, Part 34

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


USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1920-1921 > Part 34


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


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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