Town of Winthrop : Record of Deaths 1919-1921, Part 100

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 100

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Medicai examiners shail, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased dicd, 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 como to their death by violence. - Revised Laws, Chap. 24, See. 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 oniy as those of persons to whom they havo given bedside care during a last illness from discase 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 whoso 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), thermal, or electrical agents, and deaths following abortion, but also deaths from diseaso resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

I R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County

Suffolk

Massachusetts

Registered No.

St .....

Ward

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

2 FULL NAME

Baby

Hagman

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

(a) Residence. No.

5-2 Bordón

St.,

.Ward.

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

Length of residence ia city or town where death occurred

years

months

days.

How loog io 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)

5a If married, widowed, or divorced

HUSBAND of

(or) WfFE of

6 DATE OF BIRTH

May

( Month) /

25# 1920

(Day)

(Year)

7 AGE

Years

Months Days

If LESS than

If STILLBORN, enter that fact here

If STILLBORN, state period of nterogestation.

mos.

1 day, ....... hrs. or ........ min.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kiod of work (h) Generai nature ofiodustry, business, or establishmeot in which employed (or employer)

9 BIRTHPLACE (City) 52 (Lasuacon, 81

(Statc or country)

10 NAME OF

FATHER

anche : W.

PARENTS

11 BIRTHPLACE OF

FATHER (City ).

(State or country)

12 MAIDEN NAME

OF MOTHER Z

Marcha - Eleman

Touchund

13 BIRTHPLACE OF

MOTHER (City)

(State or country) Sef Bular

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(tonth)

17 I HEREBY CERTIFY, That I attended deceased from

19 ... 27 ... , to.

0may 29, 1920

that I Jast saw h. f. .. alive on

0,1920.

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

1.53. P.

The CAUSE OF DEATH was as follows : GullCom

(duration)

.yrs .........

.mos ...

.. ds.

CONTRIBUTORY.

6 mos

(duration) yrs.

mos. ds.

18 Where was disease contracted

if not at place of death?

FOR WHAT?

Did an operation precede death ?

Date of

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed).

M.D.

(Address) 114 Cima

Date 0 ans

( Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

(Cemetery)

(City or towy)

20 UNDERTAKER

Clixbenzer

ADDRESS

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the boria! or transit permit was issued. I.a. mours

Official position

Health offres

Date of issue

Permi No 147

150,000. 19-XXM.)

instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH .

Informant

(Address)

June 3 1920 Bessie 1, Dodge

(Month) (Day) (Year)

asak REGISTRAR

No ...

State.

Buscador

City or Town

( Usual place of abode)

1520

(Day)

(Year)

( SECONDARY)

scamange -

6720

May 29. 1920 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

Statement of occupation. - Preciso statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applics to each and every person, irrespective of age. For many occupations a single word or term on the first line will he sufficient, e. g., Former or Planter, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Stationory firemon, ctc. 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) Solesman, (b) Grocery; (a) Foremon, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborcr," "Foreman," "Manager," "Dcaler," etc., without more precise specification, as Doy loborer, Form loborcr, Laborer - Cool 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 spc- cifically the occupations of persons engaged in domestic servico for wages, as Servont, 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 inay he 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 DEATHE (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Ccre- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcomo, etc., of ...... .... (namo origin; "Cancer" is less definite; avoid use of "Tumor" for malignant . neoplasms); Meosles; Whooping cough; Chronic volvular heart diseose; Chronic interstitiol nephritis, etc. The contributory (secondary or inter- current) affection need not bo stated unless important. Example: Meosles (disease causing death), 29 ds .; Bronchopneumonio (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (mcrely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Dchility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can he ascertained as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," ctc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittec 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, gangreno, gastritis, erysipelas, 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 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 death, stating to the best of his knowledge and helief the name of the deccascd, his supposed age, the discase 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 Lows, Chop. 29, Secs. 10 and 1, as amended by Acts of 1910, Chop. 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 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 licu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he 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 thereafter furnish for registration any other necessary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chop. 78, Scc. 38.

Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deccased died, his name and residence, if known, otherwise a description of such person as full as may he, with the cause and manner of his death, and shall make cxamination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Lows, 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 hedside 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 discase unrelated to any form of injury, havo 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), 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.

M R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County.

Suffolk

Massachusetts

Registered No.

St., .Ward

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

2 FULL NAME

Harriet Wyman

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

(a) Residence. No.

( Usual place of abode)

115 Quiaux Rd

St.,

Ward.

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

Length of residence ia city or towo where death occorred

years

months

days.

How loog in U. S., if of foreigo birth ?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

June

2 m

1920

((Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

, 19

., 19

that I last saw h.e ........... alive on

and that death occurred, on the date stated above, at 1.30 M. m. The CAUSE OF DEATH was as follows : natural Causes

(duration)

.yrs.

mos ..

ds.

CONTRIBUTORY.

(SECONDARY)

(duration)

yrs

.. mos. ds.

18 Where was disease contracted if not at place of death ? "FOR" WHAT ?

Did an operation precede death ?

Date of

Was there an autopsy ?

What test confirmed diagnosis ?.

(Signed)

31 met calf

, M.D.

Chamman Boardof Health

Date

June

1920

(Year)

(Month)

(Day)

19 PLACE OF BURIAL, CREMATION OR REMOVAL

Woodlawn

(Cemetery)

(City or town)

20 UNDERTAKER

asar REGISTRAR

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued . S.h. Maury

Official™ Health office Demi Lune 3,12 0 146

DATE OF BURIAL Arina A69 41920 ADDRESS . Withirak

Permit

. 150,000.

'19-XXM.)

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

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

or divorced

6 DATE OF BIRTH

Dec 13 (Month)

1840 ( Year)

7 AGE 79 Years 5. Months

2 / Days

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

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Generai nature of industry,

business, or establishment in

which employed ( or employer ).

th How

Calais

9 BIRTHPLACE (City) (State or country)

Driei

PARENTS

11 BIRTHPLACE OF FATHER (City). (State or country)

12 MAIDEN NAME

OF MOTHER

Harriet Basis

Portland

13 BIRTHPLACE OF MOTHER (City) (State or country)

14 Mr. alle W. Poom

Informant

(Address)

Filed June 3, 1920

Bessie 1. Doder

(Month) (Day) (Year)

....

State

115 Circuit Rd.

No.

City or Town

3 SEX 4 COLOR OR RACE tremal White

(Day)

If STILLBORN, Jeoter that fact hefe

If STILLBORN, state period of uterogestatioo

mcs.

10 NAME OF

FATHER

Varselchu

- ---

June 20 1920 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

Statement of occupation. - Preciso statement of occupation 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, o. g., Farmer or Planter, Physician, Compositar, Architect, Lacomotire engineer, Civilengineer, 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) Gracery; (a) Foreman, (b) Autamobile 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 labarer, Labarer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Ilausekcepers who receive a definite salary), may be entered as Housewife, Housework, or At hame, and children, not gainfully employed, as At school or At hame. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Coak, Hausemaid, ctc. If tho 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 Nane.

Statement of cause of death. - Name, first, tho DISEASE CAUSING DEATH (tho primary affection with respect to time and causation), using always tho samo accepted term for the same discase. Examples: Cere- braspinal fevcr (tho only definite synonym is "Epidemic cerebrospinal ineningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumania; Bronchapneumania ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, eto., of .......... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chranic valvular heart disease; Chranic interstitial nephritis, otc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (discaso causing death), 29 ds .; Branchapneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Ancmia" (merely symptomatic), "Atrophy," "Col- lapse.""Coma,""Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,"" Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definito disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritanitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of causo of death approved by Com- luittce on Nomenclature of the American Medical Association.)

Bronchopneumonia: If primary cause, write the word " pri- mary" ; if secondary, give primary cauce.

Certificates will be roturned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, ceiluiitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipeias, meningitis, miscar- riage, necrosis, peritonitis, phiebitis, 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, furnislı for registration a standard certificate of death, stating to the best of his knowledge and belief the namo 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. 822.

No undertaker or other person shall bury a human body . . . until be has received a permit from the board of health or its agent, . .. · from the clerk of the city or town in which the person died; . .. no such permit shail be issued until there shail 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 certificato of the at- tending physician, if any, as required by law, or in lieu 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 purposo, 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 shali make such certificate. . . . The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can bo 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, Scc. 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 tho view of the dead bodies of only such persons as are supposed to have como 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 tho following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside caro 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, havo died without recent medical attendance or / whose physician is absent from homo when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths sup- / posabiy 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 disabied by recognized disease, and those of persons found dead.

1 R-301

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 and extracts from the laws on back of certificate.

. 150,000.

19-XX

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County.

Suffolk

State

Massachusetts

Registered No.

City or Town

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

anna, Cecelia. Lowery

2 FULL NAME

(a) Residence.

No.

249 Pleasant

St.,

Ward.

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

( Usual place of abode)

Length of resideoce in city or towo where death occurred

years

X months

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

June

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

May 31, 1920, to May 31, 1920.

that I last saw

alive on

may 31, 1920.

and that death occurred, on the date stated above, at 230 A. m.

The CAUSE OF DEATH was as follows :

Pulmonary Tuberculosis

.. (duration)

.yrs.

mos .....

.ds.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs ..

mos ..

.ds.

18 Where was disease contracted

if not at place of death ?

FOR WHAT?

In Zalden-

Did an operation precede death ?

Date of.

Was there an autopsy ?

What test confirmed diagnosis ?

Spreter positive for T.B.

(Sigoed)

Carle Ht. Wackerchack

, M.D.

( Address )

1 mountain Any-walden

Date ..

June

4-1920.

(Month)

(Day)

(Year)

DATE OF BURIAL

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

winchet

(Cemetery) Winchin

(City or town)

1920

20 UNDERTAKER

ADDRESS

rune 6.1920 Bessie L. Dodge

Filed

(Mouth)

(Day) (Year)

Cesar REGISTRAR

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued S. h. Maury

Date of

Permit

Official position

Health officer 5

f permit June 5 No 14.8

PARENTS

11 BIRTHPLACE OF

FATHER (City)

(State or country)

adolph anderson

tweeden

12 MAIDEN NAME

OF MOTHER

Helma. Bergston

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

Days

If STILLBORN, eoter that fact here

If STILLBORN, state period of oterogestation

mos.

If LESS than

1 day ......... hrs.

or ........ min.

8 OCCUPATION OF DECEASED

(a) Trade. profession, or

particolar kind of work ..

(h) Generai nature of industry,

bosioess, or establishment io

which employed ( or employer ).

at Home

9 BIRTHPLACE (City)

Suceder

(State or country)

10 NAME OF

FATHER

Informant.

(Address)

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Town of Winthrop : Record of Deaths 1919-1921, Part 100

Author: Winthrop (Mass.) Publication date: 1919 Publisher: Number of Pages: 1192

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192