Town of Winthrop : Record of Deaths 1919-1921, Part 119

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 119

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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)

170 Within Et

Date.

October 13

(Month)

(Day)

, 1920. ( Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL Riverside SaugusMess. Oct 142020

ADDRESS

20 UNDERTAKER

I. E. Henderson Ma Everett Mash

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

MARGIN RESERVED FOR DINDING

so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back

of certificate.

carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,

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

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

16 DATE OF DEATH

Oct

If STILLBORN, eoter that fact bere

Ref. 12.1920 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, Sccts. 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 itsagent, ... or ... from the clerk of the city or town in which the person dicd; . . 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 attend- ing physician, if any, as required by law, or in licu 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 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 appli- cation 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 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 of 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 deccased died, his name and residence, if known, otherwise a deseription 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.

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 discase 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 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.

Notice to Undertakers: s: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have come to his death by violence, until a permit in writing, signed by the Medical Examiner, has first been obtained. - Revised Laws, Chap. 24, Sec. 20.

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 terin tor 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," unqualificd, is indefinite) ; Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neo- plasms); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report incre symptoms or terminal conditions, such as "Asthenia," "Ancmia" (mercly symptomatic), "Atrophy," "Collapse,"

" Coma," " Convulsions,' " Debility" (" Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage.", "Inanition," "Marasmus," "Old age." "Shock," "Uremia," "Weakness," etc., when a definite discase 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 v ich 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 determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of hcod -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 "Contribu- tory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN.

RM R-303

MARGIN RESERVED FOR BINDING

should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information for extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side

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 I'ROVISIONS OF REVISED LAWS, CHAPTER 24)

County

Suffolk

State mass.

No ..

119

Pauline

St., Ward

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

2 FULL NAME Jannie Jaredtera

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

(a) Residence.

No.

(Usual place of abode)

19 bully

Ward.

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

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX female

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED OR

DIVORCED (write the word)

marvel

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

6 DATE OF BIRTH (Month) (Day)

1878 Year)

7 AGE 42 Years

Months

Days

If LESS than

I day, ...... hrs.

If STILLBORN, enter that fact here

If STILLBORN, state period of nterogestation.

months

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)

House wife

9 BIRTHPLACE (City)

Russia

(State or country)

10 NAME OF

alsace Grunt

FATHER

11 BIRTHPLACE OF

FATHER (City ) ....

Russia

(State or country)

12 MAIDEN NAME

OF MOTHER

Bella Grunt

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

Russia

Date

(Month)

(Day)

1920

( Year )

albert Fieldkeng

Informant

(Address)

19 Pauline S

19 PLACE OF BURIAL, CREMATION, or REMOVAL VUMC DATE OF BURIAL

Chevra mishraist Get 131920

(Cemetery)

(City or town)

(Month) (Dayy ( Year)

UNDERTAKER

Jacob Planetiky

ADDRESS

Boston

21 Burial permit

issued by ..

it S. a. Maury

Official Position Lealthe Officet 22 Date of issue .

Oct.13/20 Permit No

179

16 DATE OF DEATH

October 13

(Month)

(Day) 1920 (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 : natural Cameos Heart disease, organic valvular.

(Sudden death )

(See reverse side for description for unknown person)

18 Where was injury sustained

if not at place of death ?...

( Signed)

Lunge Burgen Magneto

., M.D.

Medical Examiner for

Suffolk

Oct. 16. 1920

Filed

(Stonth) (Day) ( Year)

REGISTRAR

Length of residence in city or town wbere death occurred years

Pauline

months

days

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

years

11,326

Registered No.

146

City or Town

PARENTS

MEDICAL CERTIFICATE OF DEATH

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 stand- ard certificate of dcatlı, 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 state- ment containing the facts required by law to be re- turned and recorded, which . . . shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thercof a certificate as herein- after 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 permit is so given and the physician who certifies to the cause of death shall thercafter 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 deceased died, his name and residence, if known, otherwise

a descriptio. 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 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 whose physician is absent from home when the certificate of death is necded.

(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatisni (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 in- jury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

STATEMENT OF CAUSE OF DEATH

Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steain railway accident." "Pistol shot wound of the chest with associated hemorrhage, homi- cidal." "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."

If investigation shows the death to have been due to dis- ease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal gangloid) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"

DESCRIPTION (for unknown person)

Oct. 13. 1920

NOTICE TO UNDERTAKERS : No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have come to his death by violence, until a permit in writing, signed by the Medical Examiner, has first been obtained. - Revised Laws, Chap. 24, Sec. 20.

THIS CERTIFICATE CONSTITUTES SUCH PERMIT

RM R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Winthrop (City or Town)

1 PLACE OF DEATH

County

Suffolk

State

Mass

Registered No.

147

City or Town

Winthrop

No.

40. Taylor St.

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

2 FULL NAME

Thomas Me Donough

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

(a) Residence. No ..

40 Taylor St.

St.,

Ward.

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

( Usual place of abode)

Length of resideoce in city or town where death occurred 25 years

mooths

days.

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

years

mooths

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Margaret Mcdonough

6 DATE OF BIRTH

....

Cannot be learned

( Month)

(Day)

(Year)

if LESS thao

1 day, ........ hıs.

or ........ mio.

If STILLBORN, eoter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, professioo, or

particular kiod of work

Laborer

9 BIRTHPLACE (City)

Tpoland

(State or country)

10 NAME OF

FATHER

Mark

11 BIRTHPLACE OF

FATHER (City)

Ireland

(State or country)

12 MAIDEN NAME

OF MOTHER

Nora Mcdonough

13 BIRTHPLACE OF

MOTHER (City)

Ireland

(State or country)

Informant.

Maregert, McDonough

(Address)

40 Taylor St.

Oct. 23 :0

Filed

(Month) (Day) (Year)

REGISTRAR

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

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

est.

16 1920

(Day)

(Year)

17 I HEREBY CERTIFY, That I attended deceased from Q+16 1920

1920

,to.

that I last saw h

alive on

1920

.....

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

The CAUSE OF DEATH was as follows :

antero- palco

(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 ?

حسبا

What test confirmed diagnosis ?

(Sigoed)

M.D.

(Address).

352 menthal St

1920

Date

( Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Nt. Benedint Boston

(Cemetery)

City or town)

DATE OF BURIAL

10/18/20

20 UNDERTAKER

John F. O Maly.

ADDRESS

Official Health Mifica position

Date of issoe

Permit Oct /8/20 No 1st3

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

19. 50,000.

3 SEX

Male

7 AGE

PARENTS

should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH

(b) Name of employer

Years

Months

Days

....

.....

Oct. 16.1920 C REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

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 be sufficient, e. g., Farmer or Plonter, Physicion, Compositor, Architect, Locomotive engineer, Civil engineer, Stotionory fireman, ctc. Butin many cases, especially in industrial employments, it is necessary to know (0) 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; (0) Solesman, (b) Grocery; (a) Foremon, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Forcman," "Manager," "Dcaler," etc., without more precise specification, as Doy laborer, Form laborer, Loborer - 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 spe- cifically the occupations of persons engaged in domestic service for wagcs, 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 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 (this primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinol fever (tho only definite synonym is "Epidemio 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); Meosles; Whooping cough; Chronic volvular heort 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 .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (mercly symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Dcbility" ("Congenital,""Sanile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old ags," "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- niittec on Nomenclature of tho 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 diseasss, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mlscar- riage, necrosis, peritonitis, phlebitis, pyemla, 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 deccased, 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, this discase of which he died [defined so that it can be classified under the international classification of causes of death], where contractcd, the duration of his last illness, when last secn alive by the physician, and the date of his death. . .. - Revised Laws, Chap. 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 dellvered 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 thercof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, hls 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 sald board or by the selectmen for the purpose, shall upon application make such certificate as Is required of the attending physiclan. If death Is caused by violence, the medical examiner only shall make such certificate. . . . The person to whom the par- mit is so given and the physician who certifies to the causs 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 Lows, Chop. 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 deccased 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. F

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physiclans will certify to such deaths only as thoss 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 Physiclans 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 119

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

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