Town of Winthrop : Record of Deaths 1916-1918, Part 121

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 121

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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- itor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial einployinents, 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) Forcman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," " Manager," "Dealer," ete., 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 domestie 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. - 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- toncum, etc., Carcinoma, Sarcoma, etc., of_

(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart discase; 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- toms 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- mus," "Old age," "Shock," "Uremia," "Weakness," ete., 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, 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 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 15. 1-'18. 100,000.

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, Tivinu in ITio io A TENMANENVI NEUUND. Every item of information should be

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH (City or town)

1 PLACE OF DEATH

County.

Suffolk

State

Mais

Registered No.

Township

Munching

or Village. 16 Willow avz

St ..

.. Ward

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

2 FULL NAME

Louis Cugine.

Chorley

(a) Residence.

No.

16 20 celoro

arest,

Ward.

(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

3 SEX

male

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Wulver

5a If married, widowed, or divereod

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH (month, day, and year) 200 19-1849

7 AGE

Years

Months

Days

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

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Saleem

(b) General nature of industry,

business, or establishment in

which employed (or employer) .

9 BIRTHPLACE (city or town).

(State or country) mass

10 NAME OF FATHER

Leopole Shortly

PARENTS

11 BIRTHPLACE OF FATHER (city or town)

(State or country)

German

12 MAIDEN NAME OF MOTHER Louisen Johnson

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

Informant

Hanley . G. Wyman

(Address) 16 W ellovo are

15 Filed

, 19

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

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

Sept. 13

19/8

17 I HEREBY CERTIFY, That I attended deceased from June 18 Sept 12 th 195 to.

that I last saw h Am ... alive on

Sept. 12

1918.

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

6 0 m.

The CAUSE OF DEATH* was as follows :

acute reflexitis

(duration)

2 yrs.

mos ..

ds.

CONTRIBUTORY

Diabetes mellitus

(SECONDARY)

Gangrene 7

.(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 confirmed diagnosis ?

M.D.

(Signed)

9/04/191 (Address) 56 Bay State Brand 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 space.)

DATE OF BURIAL

19 PLACE OF BURIAL, CREMATION, OR REMOVAL Wencheok Mais

20 UNDERTAKER

Chas. R. Denman.

ADDRESS

City

No.

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

le Leyes.

of certificate.

KLVISLD UNIILU STĀILS STANDARD CLKILKAIL VI DLAILI [Approved by U. S. Census and American Public Health Association)

"Foreman," "Manager," "Dcaler." 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 .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and eausation), 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 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- toms or terminal conditions, such as " Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Comna," "Convulsions,"" "Debility" ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease ean be ascertained as the cause. Always qualify all diseases resulting from ehild- 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

ANI 5

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, 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 15. 1-'18. 100,000.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City or town)

1 PLACE OF DEATH

County.

Suffolk

State

Registered No ..... .

Township ..

or Village.

City

No. 25%,

St.,

Ward

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

2 FULL NAME

Emma L. Thood.

(a) Residence.

No.

257 Faireth2010 SI

St.,

.. Ward.

(Usual place of abode)

Length of residence in city or town where death occurred 30 years monteur days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Manned

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

John Jeo. H. wood

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

7 AGE

Ycars 68

Months

Days

If LESS than I day, ........ 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

(duration)

.yrs ..

.mos ...

ds.

CONTRIBUTORY

artera-selavoro

-(duration)

yrs ..

............ mos.

ds.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death? no. Date of.

Was there an autopsy ?

What test confirmed diagnosis ?

clausal

(Signed)

MR. Park

LI.D.

7~ 19 /&(Address)

** State the DISEASE CAUSING DEATH, of 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

DATE OF BURIAL 1 - 19/3

20 UNDERTAKER

ADDRESS

Filed 19

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year) . ">

1918.

I HEREBY CERTIFY, That I attended deceased from

July 1.

1918

Ref. 13

.19.45 ..

that I Just saw her

alive on

Ref. 12.

,194.5.

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

11.a.

The CAUSE OF DEATH* was as follows :

Cerebral Vicuarchanges.

9 BIRTHPLACE (city or town)

(State or country)

10 NAME OF FATHER John Hadsent

PARENTS

11 BIRTHPLACE OF FATHER (city or town)

(State or country)

12 MAIDEN NAME OF MOTHER Савнения Авросий Adenbug

13 BIRTHPLACE OF MOTHER (city or town)

(State or country)

Informant

(Address)

257 Victimes

of certificate.

..... VinI nuING inn ITHIS IS A PERMANENT RECORD. Every item of information should be

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

KEVISLD UNIELD SIAILS STANDARD CEKIIFICAIE OF DŁAIII [Approved by U. S. Census 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 .- 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 "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 need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Nevor report mere symnp- toms 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- mus," "Old age," "Shock,"" "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all discases 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 (c. g., sepsis, tetanus) may be stated

under the head of "Contributoly."

(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, Drowning, Gas poisoning, Suicide, Homicide, etc.

2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, ctc.

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 15. 1-'18. 100,000.

Township 3 SEX m 7 AGE Years (a) Trade, profession, or particolar kind of work. (b) General oature of industry, business, or establishment in which employed (or employer) (c) Name of employer 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, STTWITH THATININ IS A IENMANCINI NEUUND. Every Item of Information should be 157 of certificate.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City or town)

1 PLACE OF DEATH

County

Suffolk

State

Man

Registered No ...

City

quehago

No.

24, Lucy aux-

St.,

Ward

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

2 FULL NAME

ME James Quehace Kelly

(a) Residence.

No.

truthop. 24 Liny Co Ward.

(Usual place of abode)

Length of residence in city or town wbere death occurred

IS year

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Sangle

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

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

8-17-03.

Months

Days

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

8 OCCUPATION OF DECEASED

at School

9 BIRTHPLACE (city or town).

Brighton

(State or country) mais

10 NAME OF FATHER Johnftifully

11 BIRTHPLACE OF FATHER (eity or town) ughloro

(State or country) mara

12 MAIDEN NAME OF MOTHER Mary Cheever

13 BIRTHPLACE OF MOTHER (city of town) queforta (State or country) 21.4.

Informant Jahn Hi Kelly

(Address)

Filed , 19

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

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

I HEREBY CERTIFY, That I attended deceased from

1916

that I last saw h.

I m alive on

12+ 3

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

m. The CAUSE OF DEATH* was as follows :

......

(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 ? w Date of

Was there an autopsy ?.

What test confirmed diagnosis ?

(Signed).

- 20

Les , 19 / (Address) 35€

*State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, Usklate (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

St. Paul & Cent.

arlingtony

DATE OF BURIAL 9-16-1918

20 UNDERTAKER muldoon

ADDRESS

Bughton

or Village

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

[.].D.

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [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- 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 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 .- Naine, 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 "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- toncum, etc., Carcinoma, Sarcoma, etc., of_

(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasıns); Measles; Whooping cough; Chronie 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- toms or terminal conditions, such as "Asthenia," "Ancmia" (merely symptomatic), "Atrophy," "Col-

lapsc," "Coma," "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 discases resulting from child- birth or iniscarriage, 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

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Town of Winthrop : Record of Deaths 1916-1918, Part 121

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

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