Town of Winthrop : Record of Deaths 1916-1918, Part 111

Author: Winthrop (Mass.)
Publication date: 1916
Publisher:
Number of Pages: 1316

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 111

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State cause for which surgical operation was undertaken.

(Recommendations on etatement of cause of death approved by Com- mittce 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 soie cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipeias, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH 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 illnese, 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 hie knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined eo that it can be classified under the international classification of causes of death), where contracted, L'ie duration of his last illness, when last seen alive by the physician, and the date of hie death .. - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.

No undertaker or other person ehall 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 pormit shall be issued until there shall have been delivered to such board, agent or cierk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... ehall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in licu thercof 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, shail 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 eo given and the physician who certifice to the cause of death ehall 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. - Reviscd 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 euch 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 lawe calls for the observance of the following rulee of practice:

(1) Attending physicians will certify to euch 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 deathe sup- posably due to injury. These include not only deathe caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or clectrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabied by recognized disease, and those of persons found dead.

RPB 12-10-21-121

U. S. GOVERNMENT WAR DEPARTMENT QUARTERMASTER CORPS GRAVES REGISTRATION SERVICE ARMY BASE. BROOKLYN, N. Y.

3906

DATE 5/17/22 192

TRANSPORTATION OF CORPSE

Permission is hereby granted to convey the body of the following named person who died overseas

in the service of the United States, from New York, N. Y., to_BOSTON, MASSACHUSETTS and soldier escort is hereby authorized to accompany said body in transit.

Full name of deceased GRIFFIN, Henry Q.

Rank and organization 2nd Lt., Co.B. 109th Inf.

Cause of death. KA Date of death 7/18/18

Death occurred on date stated above while serving with the United States Army in France.

Body disinterred by the United States Government in France.

This body has been prepared in accordance with the regulations of the Department of Health of the

City of New York and the issuance of this permit has been approved by the said Department.

R. E. SHANNON, Captain, Q. M. Corps, U. S. A., Officer in Charge.

274 . Sient. Henry 2. Griffin July 18, 1918.

THISIS A PERMANENT RECORD. 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 important. See instructions on back

of certificate.

14 Factur

Informant

(Address) 25 latk are Worthy

Filed ................ , 19

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year)

July 19 1918

17 I HEREBY CERTIFY, That -, 19 ........... , to ...

attended, deceased from

that I last saw h ..

alive on

,19

and that death occurred, on the date stated above, at m. The CAUSE OF DEATH* was as follows : Still Born-never

freattend

(duration)

.yrs ................. mos ....

.ds.

Previonily started places

Freue deliver duration) ........... yrs ............. mos. ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death ?!

Forelle delivery

Date of.

FOR WHAT ?

Was there an autopsy ?

What test confirmed diagnosis ?..

I, Cutting Jours

(Signed)

M.D.

/2/19 (Address)

5298 Winthery Rt Book

* 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. (See reverse side for additional spacc.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL IL Mary Con Jam

DATE OF BURIAL

Imala 1/1918

20 UNDERTAKER

ADDRESS

8 Back

1 PLACE OF DEATH

County Suffolk

State

Massachusetts

Registered No ...........

Township

. or Village

St.,

Ward

('f death occurred in a hospital or institution, give its NAME instead of street and number)

Annatunel

2 FULL NAME

(a) Residence. No .... 25Talk

are St.,. .. Ward.

(Usual place of abode) Length of residence in city or town where death occurred Sears months

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

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

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR ØR RACE

5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word)

5a If married, widowed, or divorced HUSBAND of (or) WIFE of

6 DATE OF BIRTH (month, day, and year)

7 AGE Years

Months

Days

If LESS than 1 day20.hrs. or ........ min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or particular kind of work

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

9 BIRTHPLACE (city or town)

(State or country)

10 NAME OF FATHER

PARENTS

11 BIRTHPLACE OF FATHER (city or town).

(State or country)

12 MAIDEN NAME OF MOTHER :Una Costinar

13 BIRTHPLACE OF MOTHER (city or town). (State or country) Burton Mak

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

BOSTON

(City or town)

City

DOSTON

No ...

( .....

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

"Foreman," " Manager, "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - Coal mine, etc. Wonen 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 spc- eifically 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 oceupation at beginning of illness. If retired from business, that fact 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 time 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, 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, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toins or terminal conditions, . such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col-

"Debility" (“Con- lapse," "Coina," "Convulsions,"

genital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease ean 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, or 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

under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)

Casas 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, Downing, 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. Deatlıs under circumstances unknown, as A person found dead, ete.

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY

PHYSICIAN.

R 15. 2-'18. 100,000.

The Commonwealth of Massachusetts

Winthrop (City or town ) /

1 PLACE OF DEATH

County.

Suffolk

Township

Winthrop

City No.

or Villag Meteal Hospital

St.,

.Ward

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

2 FULL NAME

Baby Simons

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

(a) Residence.

No.

(Usual place of abode)

Length of residence in city or town where death occurred

years

31 Franklin Dust, Geven

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

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

male

4 COLOR OR RACE

5 SINGLE, MANKIND, WIDOWED, OR

Dwongen (noite the word)

5a If married, widowed, or divorced HUSBAND of (or) WIFE of

6 DATE OF BIRTH (month, day, and year) July 201918

7 AGE

Years

Months

Days

If LESS than 1 day, ........ hrs. pr ........ min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or particular kind of work

(b) General nature of industry, business, or establishment in which employed (nr employer) (c) Name nf employer

9 BIRTHPLACE (city or town)

Winthrop Moss

(State or country)

10 NAME OF FATHER

Leopold Simone

11 BIRTHPLACE OF FATHER (city for town (Statc or country)

Reading May

What test confirmed diagnosis? (Signed) Haha 4 machine

219 (Address) chilea M.D.

/ 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. (See reverse side for additional space.)

19 PLACE OF BURIAL, CREMATION, OR RE ROYALO

berty Wolny Knights of Cung July 2/2016 ADDRESS 20 UNDERTAKER Jacob Planetaby Boston

DATE OF BURIALL tt

Informant ...

(Address) 51 Franklin Que

Filed ,19

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year) July 20

1918

17 , 19 I HEREBYCERTIFY, That f attended deceased from tak 20- ,1918 to

that I last saw h .. alive on 19

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

'The CAUSE OF DEATH* was as follows : Still-losa_ Subserations from Card Compression vatra-par- trim

(duration)

...... yrs ................. 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 ?

PARENTS

12 MAIDEN NAME OF MOTHER Hitel Weismart

13 BIRTHPLACE OF MOTHER (city or town (State or country)

Boston Man

14 Louis Simon

of certificate.

N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be so 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,

STANDARD CERTIFICATE OF DEATH

State

Mass

Registered No.

months

days.

How Inng in U. S., if nf foreign birth ?

years

[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 terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, 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) Grocery; (a) Foreman, (b) Automobile factory. The ma- 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 oceupations 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasins); 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: Mcasles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- tous or terminal conditions, such as " Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" ("Con- genital," "Senile," etc.),

" Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "'Weakness," ete., 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," ete. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or 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

under the head of "Contributory".

( Recommendations

on statement of cause of death approved by Committee on Nomenclature 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, ete.

3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strcet, 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 15. 1-'18. 100,000.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City or town )

1 PLACE OF DEATH

County Suffolk

TownshipWinthrop

City

No.

State

Mass.

Registered No.

Village

... or

St ...

.. Ward

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

2 FULL NAME

Frances Carroll

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

(a) Residence. No. 20 Cora St.

(Usual place of abode)

Length of residence in city or town where death occurred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year)

July 22 1918

I HEREBY CERTIFY, That I attended deceased from

04 \ Wy 21

, 1918, to.

that I last saw her alive on

July

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

The CAUSE OF DEATH* was as follows :

Premature birth

(duration)

yrs.

mos.

18 hours

ds.

CONTRIBUTORY

(SECONDARY)

(duration)

... yrs ..

mos.

ds.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death ?

Wo - Date of

Was there an autopsy ?.

les.

What test confirmed diagnosis?

Edward Je Frauiger

(Signed)

7/231918 (Address)

49 Blauthet Road.

M.D.

* State the DISEASE CAUSING DEATHI, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

et. Michaels

DATE OF BURIAL 7/22/18 19

20 UNDERTAKER

Form . O'malley

ADDRESS

Winthrop

3 SEX Female 7 AGE (a) Trade, profession, or particular kind of work. PARENTS 14 so 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, of certificate. 15 N. D. WRITE PLAINLT, WITH UNFADING INK - THIS IS A PERMANENT RECORD. Every item of information should be (h) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer

Informant

Mrs ........ John Kennedy

(Address)

20 Cora St.

Winthrop

Filed ,19

REGISTRAR

St.,

.Ward.

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

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 (month, day, and year)

July 21, 1918

Years

Months

Whys

If LESS than I day, ........ hrs. or ........ min.

8 OCCUPATION OF DECEASED

9 BIRTHPLACE (city or town) Winthrop (State or country)

10 NAME OF FATHER Charles

11 BIRTHPLACE OF FATHER (city or towSwamscott

(State or country)

12 MAIDEN NAME OF MOTHER Mary Kennedy

winthrop

13 BIRTHPLACE OF MOTHER (city or town).

(State or country)

- -

KEFALW WFAGETSIT'S STANDARD CERTIFICATE V [Approved by U. S. Conmss and American Public Health Association)

"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 fact may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death .- Namc, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discasc. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic 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 disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection nced not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broneho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terininal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Dcbility" (“ Con-

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Town of Winthrop : Record of Deaths 1916-1918, Part 111

Author: Winthrop (Mass.) Publication date: 1916 Publisher: Number of Pages: 1316

Author: Winthrop (Mass.)
Publication date: 1916
Publisher:
Number of Pages: 1316