Town of Winthrop : Record of Deaths 1910-1912, Part 14

Author: Winthrop (Mass.)
Publication date: 1910
Publisher:
Number of Pages: 956

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 14

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Sopt. 22

191

O to

Oct. 3,

191

51 yrs .-

mos.

.. ds.

or ....... min. ?

& OCCUPATION

(a) Trade, profession, or

particular kind of work

(b) General nature of industry, business, or establishment in which employed (or employer)

9 BIRTHPLACE

(State or country)

Manchester, Eng.

10 NAME OF

FATHER

Edmond Heaton

N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very

(City or town.)

STANDARD CERTIFICATE OF DEATH.

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, Compositor, Architect, Loco- motive 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) Salcs- man, (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 household only (not paid House- keepers who receive a definite salary), may be entered as Ilousewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically 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 the same accepted torm for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia, Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-

culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- comu, 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 (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " All- aemia " (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," " Exhaustion," "Heart failure," " Haemorrhage," " Inanition," " Marasmus," "Old age," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirthi or miscarriage, as " PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.

Cases for the Medical Examiners. - Under the provisions 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 Criminul . Abortion, Poisoning, Starvation, Suffocation, Ex- posure, 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.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

Whichnow (No. Evenrow Road, F:

Ward)

BOSTON ....

(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Malo

4 COLOR OR RACE

White

SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Suiglo

6 DATE OF BIRTH October, 4, 910 (Month) (Day) (Year)

7 AGE

If LESS than ! day, @ hrs.

0 yrs. 0 mos. 0 . ds .

or .. Omin. ?

8 OCCUPATION (Father) Blends. (a)' Trade, profession, or particular kind of work

(b) General nature of industry, business, or establishment in which employed (or employer).

9 BIRTHPLACE

(State or country)

Winthrop, Massi

10 NAME OF

FATHER

Edward D. Par Ler

PARENTS

12 MAIDEN NAME OF MOTHER Wilma G. Dearborn

13 BIRTHPLACE OF MOTHER (State or country)

Saxouville Was

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Edward D. Banter.

(Address)

Everrow Road.

Filed

!91. ...

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

let.

(Month)

(Day)

1910

(Year)

17 I HEREBY CERTIFY that I attended deceased from Cet. of, 1910, to. 191

that I last saw h

alive on

191

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

.m.

The CAUSE OF DEATH* was as follows :

Still- bonn.

(Duration)

yrs.

mos.

ds.

Contributory

(SECONDARY)

...

(Duration) yrs. Swill andCo

mos. . ds.

(Signed)

2.5

1910. (Address) 22 Pin Ja

6. 3.

* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.

18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).

At place

of death.

yrs.

.. mos.

In the

ds.

State

.yrs.

mos.

ds.

Where was disease contracted, Jf not at place of death ? Former or usual residence.

1 PLACE OF BURIAL OR REMOVAL

DATE OF BURIAL Winthrop, Mass Oct. G. 1910.

20 UNDERTAKER

E.g.BrownJr

ADDRESS

low

important. See instructions on back of certificate.

Dearborn Partes

'FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Everrow Road.

11 BIRTHPLACE OF FATHER (State or country) South Boston

M.D.

Cest. 4, 1710

STANDARD CERTIFICATE OF DEATH.

Statement of occupation. - Preciso statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to eachi 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, Loco- motive 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) Sales- man, (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 household only (not paid House- keepers who receive a definite salary), may be entered as Ilousewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically 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 the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup ") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-

culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, 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 (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State canse for which surgical operation was undertaken.

Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, 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.

2 FULL NAME 3 SEX Male 7 AGE 8 OCCUPATION 10 NAME OF FATHER PARENTS 13 BIRTHPLACE OF MOTHER (State or country) important. See instructions on back of certificate. 15 N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very (b) General nature of industry, business, or establishment in which employed ( or employer).

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

I PLACE OF DEATH , Saratoga Springs N. YNo

St. :

Ward)

[If death occurred in a hospital or institution, give its NAME instead of street and number.]

Samuel Stanley Searing

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

Winthrop Mass

Registered No.

24919

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

Oct.

(Month)

(Day)

, 1910

(Year)

1860

I HEREBY CERTIFY that I attended deceased from

191

.. , 191 .. ,

, to ..

If LESS than

1 day, ....

.hrs.

that I last saw h.

alive on

191

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

The CAUSE OF DEATH* was as follows :

(Duration)

yrs.

mos. ...

ds.

Contributory.

(SECONDARY)

.(Duration)

.yrs.

mos. ds.

(Signed)

M.D.

191

( Address).

* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.

18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).

At place

of death

yrs.

mos.

ds.

State. .

yrs.

In the

mos.

ds.

Where was disease contracted,

If not at place of death ?.

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

Mit auburn

DATE OF BURIAL

april 20 %

1911

20 UNDERTAKER

Chai E Chester

ADDRESS

Boston mars

4 COLOR OR RACE

White

5 SINGLE,

MARRIED,

Married

WIDOWED

OR DIVORCED

(Write the word)

16 DATE OF BIRTH

ES60 Oct: 26 -

(Month)

(Day)

(Year)

49 yrs. 9 mos. 10

ds.

or. min. ?

(a) Trade, profession, or

particular kind of work

Clergyman

9 BIRTHPLACE

(State or country)

Saratoga Springs NY,

William Marsh Searing

11 BIRTHPLACE

OF FATHER

(State or country)

Saratoga Springs NY.

12 MAIDEN NAME

OF MOTHER

Caroline Huling

Saratoga Springs N.Y.

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Mrs. S.S. Searing

Widow

(Address)

Wirthunk mass

Filed 191

REGISTRAR

BOSTON

(City or town.)

STANDARD

CERTIFICA.

. is

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, Compositor, Architect, Loco- motive 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) Sales- man, (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 household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically 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 ('AUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of " Croup ") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-

culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Meusles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," " Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.

Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, 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.

1499

Always write with ink.)

TRANSIT PERMIT.

TRANSPORTATION OF CORPSE. NEW YORK STATE DEPARTMENT OF HEALTH.

Transit Permit No.

PERMIT OF LOCAL BOARD OF HEALTH.

This permit must be properly signed and presented, with Undertaker's Certificate, to the Railroad, Express or other Trans- portation Agent, before a body can be shipped.

Saratoga Springs Co. of Savak ya N. Y. april17-19

Permission is hereby given Mineradía

holder of Undertaker's License No. 25

.o remove for burial at Utautumn Cemetery at

State of Mass the body of

(When obtainable) Ther Samuel S. Searing

who died at

Sarafor Spring

1900 , at. UM. 50 years.

N. Y., on Organic Discount Frach Aged. years months .days, the cause of death being

which necessitates shipment under Rule No. 7 of the Rules of the New York State Department of Health for the Transportation of the Dead, as printed on the back of this Permit.

Name of person in charge of transit,

Signed

Melamen & Legget

Registrar

(Official Title)

This Permit and Coupon must be detached and delivered to the Person in charge of the Corpse.

FORM 60

RULES OF THE NEW YORK STATE DEPARTMENT OF HEALTH FOR THE TRANSPORTATION OF THE DEAD.

THESE RULES HAVING BEEN DULY ADOPTED AND PROPERLY PUBLISHED, HAVE THE FORCE OF LAW.

RULE I. The transportation of bodies dead of smallpox or bubonic plague is absolutely forbidden except upon certification, sworn to by the undertaker in charge of the remains, and the certificate of the Health Officer, both to be approved by the State Commissioner of Health, that the bodies have been thoroughly disinfected by (a) arterial and cavity injection with an approved embalming fluid, (6) disinfecting and stopping all orifices with absorbent cotton, and, (c) washing the body with an approved disinfectant, all of which must be done by a licensed embalmer of the State of New York. After being disinfected as above, such body shall be enveloped in a layer of dry cotton not less than one inch thick, completely wrapped in a sheet and bandaged, and encased in an air-tiglit zinc, copper or lead lined coffin, or iron casket, all joints and seams hermetically sealed, and all enclosed in a strong, tight wooden box. Or, the body being prepared for shipment by disinfecting and wrapping as above, may be placed in a strong coffin or casket, and said coffin or casket encased in an air-tight zinc, copper or tin case, all joints and seams hermetically soldered and all enclosed in a strong outside wooden box, or the casket may be enclosed in a hermetically sealed metal case.

RULE 2. The bodies of those who have died of Asiatic cholera, yellow fever, typhus fever, diphtheria (membranus croup), scarlet fever, (scarlatina, scarlet rash), erysipelas, leprosy, glanders or anthrax, shall not be accepted for transportation unless prepared for shipment in the manner prescribed by Rule 1, the same to be approved and certified to by a local health officer.

RULE 3. The bodies of those dead of typhoid fever, puerperal fever, tuberculosis, measles and cerebro-spinal meningitis, or other dangerous communicable diseases other than those specified in Rules 1 and 2 may be received for transportation when prepared for shipment by filling the cavities with an approved embalming fluid, washing the exterior of the body with an approved disinfectant, stopping all orifices of the body with absorbent cotton, and by being arterially embalmed with an approved embalming fluid, all of which must be done by a licensed embalmer of the State of New York, and the same encased in a coffin or casket and outside wooden or metal box. In the event of bodies dying of diseases men- tioned in this rule not reaching their destination within 120 hours after the hour of death, the casket or overbox shall be hermetically sealed.

RULE 4. The bodies of those dead of diseases that are not contagious, infectious or communicable, may be received for transportation why encased in a sound casket or overbox, provided that they reach their destination within thirty hours after death. If the body cannot reach i destination within thirty hours after death, it must be prepared for shipment by filling the cavities with an approved embalming fluid, washing the exterior of the body with an approved disinfectant, stopping all orifices with absorbent cotton and the body must be arterially embalmed with an approved embalming fluid by a licensed embalmer of the State of New York, and the same encased in a coffin or casket and outside wooden or metal box.

RULE 5. In cases of bodies dead of diseases mentioned in Rules I and 2, the body must not be accompanied by persons or articles which have been exposed to the infection of the disease, unless certified by the health officer as having been properly disinfected; and before selling passage tickets, agents shall carefully examine the transit permit and note the name of the passenger in charge, and of any others proposing to accompany the body. The transit permit in such cases shall specifically state who is authorized by the local Board of Health to accompany the remains. In all cases where bodies are forwarded under Rules 1 and 2 notice must be sent by telegraph to health officer at destination, advising the date and train on which the body may be expected. This notice must be sent by or in the name of the health officer at the initial point, and is to enable the health officer at destination to take all necessary precautions at that point.

RULE 6. Every dead body must be accompanied by a person in charge, who must be provided with a passage ticket and also present a full first-class ticket marked "Corpse" for the transportation of the body, and a transit permit-with undertaker's certificate, name of deceased, date of death; age, place of death, cause of death, the point to which the body is to be shipped, and when death is caused by any of the diseases specified in Rules I and 2, the name of the person authorized by the local Board of Health to accompany the body. The undertaker's certificate and paster shall be detached from the transit permit and pasted on the coffin box. The transit permit shall be handed to the passenger in charge of the corpse. When a body is transported by express, the express messenger will be in charge of the body, hold the transit permit and surrender the same to the person to whom the corpse is consigned.

RULE 7. Every disinterred body, dead from any disease or cause, shall be treated as infectious or dangerous to the public health and shall not be accepted for transportation unless said removal has been approved by the local health authorities having jurisdiction where such body is disin- terred, and the consent of the health authorities of the locality to which the corpse is consigned has first been obtained; and if the death was from causes specified in Rule I the approval of the State Commissioner of Health must likewise be obtained. All such disinterred remains shall be enclosed in a hermetically sealed zinc, tin or copper lined coffin or box or hermetically sealed metal case. Bodies deposited in receiving vaults shall not be treated and considered the same as buried bodies when originally prepared by a licensed embalmer of the State of New York as directed in Rules 1, 2 and 3 (according to the nature of the disease causing death), provided shipment takes place within thirty days from time of death. After thirty days all such bodies must be enclosed in a hermetically sealed casket or in a caskct enclosed in a hermetically sealed (soldered) zinc, tin or copper lined box or hermetically sealed metal case, and permission must be obtained from the health authorities of the locality to which the corpse is consigned before the shipment is made. Bodies not so prepared and deposited in receiving vaults will be treated the same as buried bodies.

.RULE 8. The term "approved embalming fluid " as used in these rules means an embalming fluid that has been submitted to a bacteriological test and approved by the Board of Embalming Examiners of the State of New York. A 5 per cent. solution of carbolic acid, a 1-500 solution of corrosive sublimate or 14 per cent. of a 40 per cent. solution of formaldehyde are approved as disinfectants for external washing of bodies when required by these rules. Other prepared disinfectants of equal germicidal action may also be used.

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Town of Winthrop : Record of Deaths 1910-1912, Part 14

Author: Winthrop (Mass.) Publication date: 1910 Publisher: Number of Pages: 956

Author: Winthrop (Mass.)
Publication date: 1910
Publisher:
Number of Pages: 956