Town of Winthrop : Record of Deaths 1919-1921, Part 126

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 126

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(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 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 steam 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 anæsthetic." "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) ..

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

Nov. 2. 1920

V. V. WOVO

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.

166

St ....

Ward

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

& EorgE. HEwith. Stilt

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

(a) Residence.

No ..

35 court Rd

St.,-

Ward.

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

Length of residence in city or towa where death occorred

years

mooths

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Day)

(Year)

17 I/ HEREBY CERTIFY, That-I attended deceased from Fib 1919 ., to.

Nov. 2

that I last saw h.

un alive on

Del-19

, 1920.

and that death occurred, on the date stated above, at 7 a.m. The CAUSE OF DEATH was as follows : Cardiovascular-1aparicio

...

(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 ? Ohavec

(Signed)

2 walk

. , M.D.

Date

223 Elcost One afiliación.

(Address).

vor.

1920

( Montlı)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

(Cemetery)

( City or town)

20 UNDERTAKER

C. R. 1 Samman.

ADDRESS

15 200.6.1920

Filed (Month) (Day) (Year)

REGISTRAR

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

Official position

Date of issue

Permit 11/3/201 195

-'19-XXM )

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, wido wed, os divomed

HUSBAND of

ada Hello (uefa) 26

1853

6 DATE OF BIRTH

( Month)

(Day)

(Year)

7 AGE 67 Years

Months 5 Days

If STILLBORN, enter that fact bere

lf STILLBORN, state period of uterogestation

mns.

If LESS than I day ......... brs. or ........ min.

8 OCCUPATION OF DECEASED (a) Trade. profession, or particular kind of work (h) Georrai nature of indostry, business, or establishment io which employed (or employer)

Retrut

9 BIRTHPLACE (City)

nova Scotia-

John Hillz

11 BIRTHPLACE OF

FATHER (City)

Leavenberg

(State or country) nova Scotia

12 MAIDEN NAME

OF MOTHER

anne Mc Rengi

Luckfurt

13 BIRTHPLACE OF

MOTHER (City) ....

(State or country)

2.1.5'

14 Informant Ceda Mich- Vimehrt (Address) 35 Court Road (de) 1110

State. 35 Cant 12

City or Town

No.

2 FULL NAME

( Usual place of abode)

1920

3 SEX Male (c) Name of employer 10 NAME OF FATHER PARENTS 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. N. D. WRITE PLAINLT, WITTY ONTADINO DLAUR INK THIS IS A PERMANENT NEVOND. Every stem of information ( State or country)

. 150,000.

DATE OF BURIAL

nov.4

19 AJ

Lockhart

nov. 2. 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 applies to cach 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, 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) 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 precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, cto:" Women at home, who are engaged in the duties of tho 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 domestie service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be 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 DEATH (the primary affection with respect to time and causation), using always tho 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; 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 need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (sccondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapsc,""Coma,""Convulsions," "Dehility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Urcmia,""Weakness," etc., when a definito disease can he ascertained as the cause. Always qualify all diseases resulting from childhirth 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, poritonitis, 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 whoni 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 helief tho name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international elassification of causes of death], where contracted, the duration of his last illness, when last seen alivo by the physician, and the date of his deatlı. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. $22.

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 modical examiner only shall make such certificate. . . . The person to whom the per- mit is so given and the physician who certifies to the eause of death shall thereafterfurnish for registration any other necessary information which can ho ohtained 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 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.

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 disahled 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), thermal, or electrical agents, and deaths following ahortion, 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.

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-XXM.)

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County.

Suffolk

Anthrop No 247 Shirley

State Massachusetts.

Registered No.

167

City or Town

BOSTON

St ...

Ward

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

2 FULL NAME

Mary 6. Przera

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

.St.

Ward.

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

Length of residence in city or town where derth occorred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Female White

4 COLOR OR RACE

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

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Felif Rogers

6 DATE OF BIRTH ( Month)

(Day)

(Year)

7 AGE

Years

Months

Days

If STILLBORN, enter that fact here

If STILLBORN, state period of nterogestation

.................. mas.

If LESS than 1 day ......... hrs. or ....... mio.

8 OCCUPATION OF DECEASED (a) Trade, professinn, or particular kind of work (h) General nature ofindustry, business, nr establishment in which employed (or employer).

at home

9 BIRTHPLACE (City)

Boston

(State or country)

Mans

10 NAME OF

FATHER

Michael Cassidy

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

Ireland

12 MAIDEN NAME

OF MOTHER

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

14 Mein n. Cassidy

Informant.

(Address )

247 Shireest& Wetlook

malas

Filed

1100. 6.1920

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

nor.

1920

(Year)

(Month)

(Day)

17 I HEREBY CERTIFY, That I attended deceased from June 10. 19, to nov. 4. , 19

that I last saw h

alive orf

Nor. 4

, 19

and that death occurred, on the date stated above, at 4. m. The CAUSE OF DEATH was as follows : Aubertrophy Height

antonio Schemas

... duration)

.. yrs ....

mos ds.

(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) Launayer alBrech.

., M.de

212 Krukker Will.

Date

nov.

1920

( Month)

( 1):)

fear)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Iboly Cans Malde haas

(City orhown)

(Cemetery)

DATE OF BURIAL Nov 8-1920

20 UNDERTAKER

Af. leansidy

Official position

Health offices per

Date nf

ADDRESS 1 40 spanning Boston Have

Permit nov. 5/20 No. 197

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

CONTRIBUTORY

Chronic nephritis

PARENTS

(a) Residence.

24 y Shirley

( Usual place of abode)

C Nov. 4.1920. 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 applies 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., 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) 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 he 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 "Lahorer," "Foreman," "Manager," "Dealcr," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the 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 he 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 same accepted term for the same diseasc. Examples: Cere- brospinal fever (the only definite synonym is "Epidemie 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 definitc; 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 .; Bronchopneumonia (secondary), 10 ds. . Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""'Coma,""Convulsions,""Dehility" ("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 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, 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 hc 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 deccased, 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 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 dicd; . . . 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 hercinafter 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 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. 88.

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 he, 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 hy violence. - Revised Laws, Chap. 24, Sec. 8.

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for the ohservance 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 disahled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy 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-302

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

(City or town)

1 PLACE OF DEATH

Registered No.

County

Suffolk

State

Massachusetts

Registered No ..

168

BOSTON

No.

B.C.H.MORGUE

(Place of residence)

St.,

Ward

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

2 FULL NAME

HELEN M. PERKINS

MASS.

City or Town.

WINTHROP

No.

56 LOWELL ROAD

St.

(a) Residence. State

(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

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED ((write the word)

WIDOWED

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

HENRY J.

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

JAN.25.1845

Years

Months

Days

If LESS than

I day, ........ hrs. or ....... min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, nr

HOUSEWIFE

CHR. INTERSTITIAL NEPHRITIS

CHR.ARTERIO-SCLEROSIS

.(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)

T. LEARY

M.D.

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

FOREST HILLS CEM.

DATE OF BURIAL

NOV . 1 99 20

Filed. NOV . 1Q

19 20. ENM Hlenew

Filed.

Nov 13, 19 20.

Registrar of city or town where death occurred

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

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

NOV . 7.

1920

I HEREBY CERTIFY, That I attended deceased from

19.20

...... to

19.20

that I last saw b alive on. 19.20

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

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Town of Winthrop : Record of Deaths 1919-1921, Part 126

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

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