USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 151
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2 FULL NAME
Mary L. Kempton
(If in the Aryhy or Navy 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
13 years
months
St.,
Ward.
(If non-resident give city or town and State)
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
W
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(01) WIFE of
6 DATE OF BIRTH (month, day, and year)
1871-3-10
7 AGE
Years
Months
HY
9
Days
/3
If LESS than
I day, ........ hrs.
or ....... min.
Double Loban Price
8 OCCUPATION OF DECEASED
(a) Trade, profession, nr
particolar kind of work
School Teacher
(b) General matare of industry, bosiness, or establishment in which employed (or employer) (c) Name of employer
9 BIRTHPLACE (city or town) ..
(Statc or country)
10 NAME OF FATHER Celista Mikempton
PARENTS
11 BIRTHPLACE OF FATHER (city or town)m
(State or eountry)
M.t.
12 MAIDEN NAME OF MOTHER Louise E alder
13 BIRTHPLACE OF MOTHER (city or town)
(State or country) n. A.
....
14 Elisha M. Kempton
Informant
(Address)
newport n.M.
15
Filed .. ACC 26, 19 18
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and ycar) Que 23 2018
17
I HEREBY CERTIFY, That I attended deceased from
Dec 16
1918
to.
Dec 25, 1918
that I last saw haar
alive on
23
18
19.
and that death occurred, on the date stated above, at 3500 m. The CAUSE OF DEATH* was as follows :
(5)
(duration) .
...... yrs ................. mos.nu
ds.
CONTRIBUTORY
(SECONDARY)
.(duration)
............ yrs .........
.mos.
ds.
18 Where was disease contracted
if not at place of death?
Did an operation precede death?
220
Date of.
Was there an autopsy ?.
200
What test confirmed diagnosis ?
(Signed)
13/25/19/8 (Address)
* 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 additional spacc.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Drewpart n. H.
DATE OF BURIAL 17-26-2018
ADDRESS
€
20 UNDERTAKER
9h. C. Skaggs
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.
Celatrao
City
No.
days.
How long in U. S., if of foreign birth ?
years
23.1118
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, c. 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 dutics 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. It 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 &s .; 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- inus," "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, 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 "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.
1
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
County
Suffolk
State
Registered No.
City or Town
No.
St.
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Angelina Matilda Ferguson
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
107 Burdon
St.,
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
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
20.0000
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
weder
6 DATE OF BIRTH
( Month)
(Day)
1848 ( Year)
7 AGE
70 Years
Months
Days
If STILLBORN, enter that fact here
If STILLBORN, state period of uterogestation
mos.
If LESS than
1 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
(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 confirmed diagnosis ?.
(Signed)
(Address)
350
Date ..
( Month)
(Day)
(Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
(Cemetery)
(City or town)
20 UNDERTAKER
ADDRESS
Filed (Month) (Day) (Year)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
(Day)
17 I HEREBY CERTIFY, That I attended deceased from
1
19
to.
, 19
that I last saw h alive on
22
, 19
....
,
and that death occurred, on the date stated above, at 1 m. The CAUSE OF DEATH was as follows :
9 BIRTHPLACE (City)
Italafor n.S.
(State or country)
10 NAME OF
FATHER
PARENTS
11 BIRTHPLACE OF FATHER (City) (State or country) 5
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE OF MOTHER (City) (State or country)
14 Cactus E. F'erqueno
Informant
(Address)
10 ) Burden toffer
15 Picc 26, 1918
[00,000.
21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
Official position.
22 Date of issue of burial or transit permit
N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK -THIS IS A PERMANENT RECORD, Every item of information ...
VINI LILI: - SAL UNUUL VỊ VLAIII
NR-301
instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classifled. Exact statement of OCCUPATION is very important. See
Mars
2 FULL NAME
(If non-resident give city or town and State)
25
(Year)
, M.D.
24 12 F.
DATE OF BURIAL
12/26
19/0
UNIONId JO_ MARGIN RESERVED FO
Dec 23. 1918.
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 healthifulness 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, 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 material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ete., without moro 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 the samo accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid uso 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, ete. 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 symptomatie), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," ete.), "Dropsy,""Exhaustion,""IIeart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., when a definite diseaso can be ascertaincd 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.
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, eryslpelas, meningitis, miscar- rlage, necrosis, porltonitls, 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 illness, 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 deatlı, stating to the best of his knowledge and belief the name of the deceased, 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, tho 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 thero 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 lieu 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 certifics 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, 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 such 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 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), tlcrmal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
R-305
The Commonwealth of Massachusetts
MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
(ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTERS 24 AND 29)
County
State
Mass
Registered No.
Registered No. 2608
Cam br id ge No. Cafe dea Hospital (Place of residence)
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Frederick H. Greenwood
(If in the Army or Navy of the United States, give rank, organization, ete.)
453 Shirley
St.
.Ward .-
Winthrop
(If non-resident give city or town and State)
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
14
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
M
Naomi
18 32
(Month)
(Day)
(Year)
7 AGE
Years
86
8
Months
11
Days
If LESS than
1 day ......... brs.
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)
(c) Name of employer
9 BIRTHPLACE (City)
Brighton, Mass .
State or country)
10 NAME OF
FATHER
James
11 BIRTHPLACE OF
FATHER City)
Brighton , Mass .
(State or country)
12 MAIDEN NAME
OF MOTHER
Rhoda Larrabee
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Brighton , Mass.
14
Informant .
(Address)
Fredk. A. Greenwood
Winthe Mass.
15
Filed . Dec. 31/18
Registrar/of city or town where death occurred
Filed (Month) (Day) (Year)
Registrar of city or town wbere deceased resided
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Dec. 25/18
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows :
Multiple injuries
.....
.. .
Automobile accident
1 hour
(See reverse si We. Auburn. St.
18 Where was injury sustained
if not at place of death?
near Chas .Rv.Rd.
(Signed)
William D. Swan, Med. EX.
M.D.
(Address)
Cambridge
Ist Middlesex
Date
Medical Examiner for.
Dec. 25/18
(Month)
(Day)
(Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
12 /27/18
Mt. Auburn Cem.
(Month) (Day) (Year)
20 UNDERTAKER
Horace D. Litchfield
ADDRESS
Cambridge
21 Burial permit issued by
Official position
22 Date of issue.
DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
VIVIENDOTOLLU CANVIL .. See reverse side for extracts from the laws of the Commonwealth and instructions. N. D. WHITE FLAIRLT, WIEIT UNFADING ULAUR INK THISSALOUSTILL WELL PARENTS
MEDICAL EXAMINERS Should state CAUSE OF
City or Town
(a) Residence.
No.
( Usual place of abode)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
If STILLBORN, enter that fact here
Cabinet maker
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 illness, at the request . of an undertaker or other authorized person or of any member of the family of the deccased, furnish for registration a stand- ard certificate of death, stating to the best of his knowledge and belief the name of the deceased, 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 containing the facts required by law to be returned and recorded, which . . . shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate 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 insuffi- cient, 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 permit is so given and the physician who certifics to the cause of death shall thercafter furnish for registration any other necessary infor- mation 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, 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 such 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 sup- posed 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 nccded.
Dec. 25, 1918
(3) Medical Examiners will investigate and certify to all deaths supposably 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, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
COPIES OF RECORDS OF DEATHS OF NON-RESIDENT DECEDENTS
The clerk of each city and town shall forthwith make certi- fied copies of the records of all . . . deaths recorded during the previous month, if the . . deceased [was a resident ] of any other city or town in this commonwealth or in any other state at the time of said . . . death, and transmit them to the clerk of the city or town of which such . . . deceased . person [was] resident at the time of the said ... death ... and the clerk of a city or town in this commonwealth so receiving such certified copics, or certified copies of . . . deaths, from the clerk of a city or town without the commonwealth, shall record the same. - Revised Laws, Chap. 29, Sec. 13, as amended by Acts of 1910. Chap. 93, Sec. S.
DESCRIPTION (for unknown person)
..
. ..
-
HLVVIIV.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.
The Commonwealth of Massachusetts
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