First things and last : the story of birth and death certificates.
- United States. National Office of Vital Statistics
- Date:
- [1960]
Licence: Public Domain Mark
Credit: First things and last : the story of birth and death certificates. Source: Wellcome Collection.
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![But beyond this, the medical information recorded on the certificate is used in medical research for analyzing the causes of death occurring in this country. The key item here is 18c,which lists what, in the opin- ion of the attending physician, was the underlying cause of the death. The underlying cause is defined as the disease or injury which initiated the train of morbid events eading directly to the death or the circumstances of the accident or violence which produced the fatal injury. It is this item to which medical analysts and health authorities give their closest attention, because it is regarded as the most im- portant single statistic relating to the prevention of sick- ness and disease. By classifying and tabulating the information on the death record it is possible to construct a body of mortality CERTIFICATE OF FETAL DEATH! Badeet Bureau No. STATE OF Nevada STATE FILE No. 1, PLACE OF DELIVERY 2. USUAL RESIDENCE OF MOTHER (Where does mother live?) @. COUNTY 13 6. 6. CITY, TOWN, OR LOCATION ¢. CITY, TOWN, OR LOCATION Las Vegas asVegas tn ss Be ee ¢. NAME OF (/f not in hospital, give street address) d. STREET ADDRESS HOSPITAL OR d. IS PLACE OF DELIVERY INSIDE CITY LIMITS? ¢. tS RESIDENCE INSIDE CITY LIMITS? J. \S RESIDENCE ON A FARM? ves KJ yesX) no |) yes |_J wo |] 3. MAME OF FETUS (If given) 4, SEX OF FETUS Paul Simmons mace X) FEMALE J (CO unveTERMineD Sa. THIS DELIVERY 5d. IF TWIN OR TRIPLET, WAS THIS FETUS DELIVERED 6. celle ao (Month) (Dey) (Year) O 16—73178-1 UV. §. COVERREENT PRINTING OFFICE SINGLE [_] Twin §9 Triptet [_) Ist) 20 8 30 (J ary Ad. 7, NAME First Middle Last 8. COLOR OR RACE = eo eT FATHER wa n A Jt 9. AGE (At time of ; 10. BIRTHPLACE (State or foreign country) | 114. USUAL OCCUPATION 116. KIND OF BUSINESS OR INDUSTRY delivery 6 YEARS Nevada awvye 12. oes Firet Middle Last 13. COLOR OR RACE NA MOTHER Irene 14, AGE (At Hime ef ) 15. BIRTHPLACE (State or foreign cowntry) 16. PREVIOUS DELIVERIES TO MOTHER (Do NOT include thle fetus) Gu a. How many | b. How many children | c. How many PREVIOUS fetal NEARS. oo @eBR- children are were born alive but deaths ( fetuses born dead at now lining? are now dead? ANY time after conception)? 18a. LENGTH OF PREGNANCY 185. WEIGHT OF FETUS 19. LEGITIMATE 20. WHEN DID FETUS DIE? 21. WAS AUTOPSY COMPLETED BEFORE DURING LABOR, PERFORMED? WEEKS LB. oz. yesk) nol) Lapor [] OR DELIVERY 4) UNKNOWN [_] yes) wo() 2. PART |. FETAL DEATH WAS CAUSED BY: (Enter only one cause per line for (a), (b), and (¢)) IMMEDIATE Fetal or maternal condition direetl cause (a) __ Premature Separation of Placenta al death (do use suc! causing fet terme ae stillbirth or ea maturdtane eae ene en Aescpi fered Aeneas ef | DUE TO (6) 1935S REVISION OF STANDARD CERTIFICATE (Amended) my, GIVIN' ie TO T oy tating rane Gapestynte ater DUE TO (c) PART I. OTHER SIGNIFICANT CONDITIONS aos fetus or mother, which =< have CONTRIBUTED to fetal death, but, in eo far as ie known, were not related to cause opie in PART | (a). Dia Me 23a. ATTENDANT’S SIGNATURE (Specify if M. D., D. O., mulatfee or arene 2. DATE SIGHED I re ip A beds a z that r > cin Re 2c. ATT ia alas stat a ATTENDANTS ADORESS not Las Vegas | wend fetus was born 1700 S.Charleston, Ne 25a. BURIAL, CREMATION, DATE 25c. NAME OF CEMETERY OR CREMATORY 25d. LOCATION (City, town, or county) (State) rn bbe Bur betes 22,.1957 Woodlawn Cemetary Las Vegas Nevada 26. FUNERAL DIRECTOR ADDRESS egas DATE REC'D BY LOCAL REG, | REGISTRAR'S SIGNATURE F. Carpenter,1,00 S.Main St. Nev. Feb. 22, 19 Faust wht Plates ? Optional heading—CragriFicaTs of FETAL DEATH (STILLBIRTH). PHS-?97 REV. 11-5 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE—PUBLIC HEALTH SERVICE](https://iiif.wellcomecollection.org/image/b32177471_0010.jp2/full/800%2C/0/default.jpg)
