Town of Winthrop : Record of Deaths 1919-1921, Part 103

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 103

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(Place of death)

(Place of residence)

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

(a) Residence. State

(Usual place of abode)

ADDRESS

nie 21, 1920 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 terin 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," "Forcman," "Manager,' "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - 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 spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Houscmail, 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 fromn 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 .- Namnc, 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 jever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- ficd, 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); 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," "Hcinorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all discases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ctc. State cause for which surgical operation was undertaken. For VIOLENT DEATIIS 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, ctc.

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

3. Sudden deaths of persons not disabled by recognized discase, 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 303. 6-'18. 50,000.

IR-301

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.

102

St. Ward

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

2 FULL NAME

abbie Marie Bonney

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

(a) Residence.

230 Plaisant St.

St.,

Ward.

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

Length of resideoce io city or town where death occurred

years

mooths

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)

Widow.

5a Hurried, widowed, er divorved

HUSBANDOf

() WIFE of

6 DATE OF BIRTH

2 (Month)

1854

( Year)

(Day)

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. (b) Geoerai oature of industry, business, or establishment io which employed ( or employer)

9 BIRTHPLACE (City)

(State or country)

Fall River

Mail:

PARENTS

11 BIRTHPLACE OF

FATHER (City)

(State or country)

Weetport

Mars:

12 MAIDEN NAME

OF MOTHER

ME Cornelia

Bluse

Hall Giver

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

14 "Ary. H. L. Swan)

Informant

(Address)

230 Pleasant S.

Filed June 24,1920 Bessie S, Dodge

(Month) (Day) (Year)

asst. REGISPRAR

21 I HEREBY CERTIFY that a satisfactory stao- dard certificate of death was filed with me BEFORE the borial or transit permit was issued. I. a. Mowry

Official

Meable Officer 4 permit June 23/20 No 15$

Date of

Permit

150,000.

19-XXM.)

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

sionthis

June

1920

( Day )

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

ـجـ

19.20

22, 1920.

that I last saw be alive on

, 19.20 ,

and that death occurred, on the date stated above, at 11:30 A. m. The CAUSE OF DEATH was as follows : Diabetes mellitus

.. (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 ?

200

What test confirmed diagnosis ? Lesine qualyen.

(Signed)

Q. B. Gallen

. M.D.

(Address).

Date.

( Month)

(Day)

(Fear)

DATE OF BURIAL

(Cemetery)

(City or town)

19 PLACHAF BURIAL, CREMATION, AR REMOVAL

Oak Grove Em. Hall Giver 6-24

19.20

20 UNDERTAKER

Char G. Bennison

ADDRESS

instructions and extracts from the laws on back of certificate.

10 NAME OF

FATHER

aww Petter

If STILLBORN, eoter that fact here

If STILLBORN, stale period of oterogestatioo.

mos.

At home

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

City or Town

BOSTON Winthrop

( Usual place of abode)

Winthrop

1920

June 22. 1920 V

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 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 ho sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) tho kind of work and also (b) tho naturo 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," etc., without more preciss specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in tho 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: Furmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death. - Name, first, tho DISEASE CAUSING DEATII (the primary affection with respect to time and causation), using always the samo accepted term for the same discase. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopncumonia ("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, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (diseasc causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (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 definite disease can be ascertained as the cause. Aiways 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 Nomenclatura 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, gangrone, 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 belief the name of the deceased, his supposed age, ths 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. S22.

No undertaker or other person shall bury a human body ... until hs 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 bo returned and recorded, which ... shall be accompanied by a satisfactory certificate of ths 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 solectmen 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 certifies to the cause of death shall 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. - 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 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, Scc. 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 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 unrciated to any form of injury, have 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- 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.

R-301

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.

103

St ..... Ward

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

2 FULL NAME

Harry Wordman Brown

(a) Residence.

No.

119 Terrace Que:

&.St.,. Ward.

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

( Usual place of abode)

Length of residence ia city or town where death occurred

years

months

days .

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

years

June

1920

(Day)

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

1920

to.

, 1920

that I last saw halive on

19.20

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

6.15 P m. The CAUSE OF DEATH was as follows : culosis of Lungs .

(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? no

Date of

Was there an autopsy ?

What test confirmed diagnosis?

Personal observation

12 MAIDEN NAME

OF MOTHER

Eliza Wordman

(Signed)

Q & Gurke

, M.D.

(Address).

Wirthmay,

Date

(Month)

(Day)

1920

(Year)

19 PLACE OF BURIAL, CREMATION, CR REMOVAL

Winthrop

(Cemetery)

(City or town)

DATE OF BURIAL 6-25 1021

ADDRESS

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

Official . position/.

Health Officer

Date of issue 6/25/20

Permit No 154

10-XXM )

4 COLOR OR RACE

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

5a If mmawiody widowed, or divorced/

HUSBAND of

annie M

6 DATE OF BIRTH

( Month)

(Day)

(Year)

7 AGE

74 Years

Months

/ 7 Days

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

If STILLBORN, enter that fact here

If STILLBORN, state period of uterogestation

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 ).

Photographer.

9 BIRTHPLACE (City)

(State or country)

Calais. Maine

PARENTS

11 BIRTHPLACE OF

FATHER (City)

.....

Www. D. Brown Wolfville

(State or country)

nová

13 BIRTHPLACE OF

MOTHER (City) ....

Cannot be learned

(State or country)

14 Mrs. H.W. Kmin.

Informant

(Address )

Anne 28,1920 Bessie & Dodge

(Month) (Day) (Year)

asst REGISTRAR

20 UNDERTAKER

Chas. R. Bennuse

150,000.

instructions and extracts from the laws on back of certificate.

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(ionth)

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

- 5-1846

10 NAME OF

FATHER

City or Town

BOSTON Winthrop.

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

U June 22. 1920 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 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 be sufficient, o. g., Farmer or Planter, Physician, Compositor, Architect, Locomotire 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 necded. As cxamples: (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," etc., without more preciso specification, as Day laborer, Farm laborer, Laborer -- Coal mine, ctc. 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 employcd, 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, tho DISEASE CAUSING DEATII (tho primary affectiou with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- 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, 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 .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital," "Scnile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertained 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- 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 sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, 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 otlicr 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 luis knowledge and belief the name of the deceased, 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 datc 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 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 certifies to the cause of death shall 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. - Revised Laws, Chap. 78, See. 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 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 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.

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Town of Winthrop : Record of Deaths 1919-1921, Part 103

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

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