Town of Winthrop : Record of Deaths 1919-1921, Part 149

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 149

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State cause for which surgical operation was undertaken.

(Recommendations on statement of eause of death approved by Com- Inittce 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 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, the disease of which he died [defined so that it can be classified under the international elassification of eauses of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death .. . - Reviscd Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 522.

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 elerk 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 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 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, Sec. $8.

Medical examiners shall, in all cases, certify to the city or town elerk or to the city registrar in the place where the deecased 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 mako examination upon ths 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 ths observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they havo given bedside eare 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 needsd.

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths eaused directly or indirectly by traumatism (including resulting sspticemia), 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 tliosc 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. XM.)

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

Trong : - Dalli

Thielfs

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

(a) Residence.

No ....

177 Herman IL

( 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 birth ?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Casa . Phillips

6 DATE OF BIRTH

San 9 (Month)

(Day)

(Year)

7 AGE

Years

Months

Days

If LESS than

If STILLBORN, Enter that fact bere

If STILLBORN, state period of uterogestation.

mcs.

1 day ......... brs. or ........ min.

Chronic Valmean Heart Disease

(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 confirme

Personal Colocation

(Signed)

RBP nice

, M.D.

(Address).

14.8 Winthrop man

Date. 726

1921

( Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

(Cemetery) Withul-

wity w town)

DATE OF BURIAL

1/2

1926

20 UNDERTAKER

ADDRESS

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

, 1920

to.

Zub 19

, 19.21

that Plast saw h. W

alive on

Ful 19

19.21

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

6 P

The CAUSE OF DEATH was as follows :

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) (c) Name of employer

9 BIRTHPLACE (City)

(State or country)

maryland

10 NAME OF

FATHER

11 BIRTHPLACE OF

FATHER (City)

(State or country)

PARENTS

12 MAIDEN NAME

OF MOTHER

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

14 wife) Pela Phillips Informant.

(Address)

179 Harmon 5% Wochel.

15 Feb. 28.1921

Filed ..

21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued

S. a. moury

Official Healthofficer position

Date of issue

2/21/21

Permit No 240

No.

174 Human

St., ............... Ward

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

2 FULL NAME

St.,

Ward.

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

Feb19# 1921

5a If married, widowed, divorced

HUSBAND of

(o) WIFE Of

1844

Feb. 19.1921 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 he sufficient, e. g., Farmer or Planter, Physician, Compasitor, Architect, Lacomotive engineer, Civilengineer, Stationary fireman, cic. Butin 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 bo used only when needed. As examples: (a) Spinner, (b) Cottan mill; (a) Salesman, (b) Gracery; (a) Fareman, (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 labarer, Farm labarer, Laborer - Caal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Ilousckeepers who reccive a definite salary), may be entered as Hausewife, Housework, or At hame, and children, not gainfully employed, as At sehoal or At hame. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Caak, Hausemaid, etc. If the occupation has been changed or given up on aceount 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, the DISEASE CAUSING DEATH (tho primary affection with respect to time and causation), using always the same 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 (ncver report "Typhoid pneumonia"); Labar pneumania; Bronchapneumania ("Pneumonia," unqualificd, is indefinite); Tuberculosis of lungs, men- inges, peritaneum, etc., Careinama, Sarcoma, etc., of ...... ... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whaoping caugh; Chronic valvular heart disease; Chranie interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (discase causing death), 29 ds .; Bronchopneumania (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (mcrely 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. 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- 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 soie 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 other authorized person or of any member of the family of the dcccased, 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, the disease 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 seen alive by tho physician, and the date of his death. . . . - Revised Laws, Chap. 29, Sees. 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 tho 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 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 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 tho cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deccased, or as to tho manner or cause of the death, which the clerk or registrar may require. - Revised Laus, Chap. 78, Sec. 38.

Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the vicw 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.

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. Theso 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.

305

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

MEDICAL EXAMINER'S CERTIFICATE OF DEATH (ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTERS 24 AND 29)

Lynn

(Cfty or Town)

1 PLACE OF DEATH

County

Fssex

State.

Mass.

Registered No. 2.14

(Place of death)

(Place of residence)

City or Town.

Lynn

No. 505, Washington

St.,

Ward

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

2 FULL NAME.

George Carter Herrick

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

(a) Residence. No ...

Waldemar Ave.,

. St.,

Ward.

Winthrop

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

Leogth of residence in city or town where death occurred

years

months

days

How long io U. S .. if of foreign birth?

vears

months

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED OR

DIVORCED (write the word)

Married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Hannah Herrick

6 DATE OF BIRTH

About

( Month)

(Day)

1861

(Year)

Years

MonthA

Days

If LESS than 1 day, ...... hrs. Or .. .. min.

If STILLBORN, eoter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particolar kind of work

Shoe worker

9 BIRTHPLACE (city or town)

Beverly ,

(State or country)

Mass.

10 NAME OF FATHER George Herrick

11 BIRTHPLACE OF FATHER (city or town)

Beverly,

(State or country)

Vass.

12 MAIDEN NAME OF MOTHER Mary Q. Prince

13 BIRTHPLACE OF MOTHER (city or town) Beverly, (State or country)

Informant.

Hannah. P. Innis

(Address)

Winthrop, Mass.

15 FiledMar. 8.1931 Filed Mar. 17. 1921.

Registrar of city or town where death occurred

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH.

Feb.

(Month)

(Day)

(Year)

17 1 HEREBY CERTIFY that I have investigated the death of the person above named and that the CAUSE AND MANNER thereof are as follows : Heart disease, presumably arterio

.. sclerosis

Sudden death

(See reverse side for additional space)

18 Where was injury gustained

if not at place of death ?..

(Signed) ...

Nathaniel P. Breed

, M.D.

(Address) ...

Lynn., Mass.

Date

Medical Examiner for.Es.sex ... Co ., 9th ... Diet.

Feb.

1931

(Month)

(Day)

( Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

Feb.23/31

Hale St. Cem., Beverly

(Month) (Day) ( Year)

20 UNDERTAKER

ADDRESS

Geo. W. Full

Calem

21 Burial permit issued by Official position

22 Date of issue .

1931

(Usual piace of abode)

3 SEX 7 AGE 60 PARENTS should be carefully supplied. Age should be stated EXACTLY. MEDICAL EXAMINERS should state GAUSE OF (b) Name of employer See reverse side for extracts from the laws of the Commonwealth and instructions. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.

Registered No.

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 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 he 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, Seca. 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 containing the facts required by law to be returned and recorded, which .. . shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insuffi- cient, the chairman of the board of health, if a physician, or any physician employed by saint hoard 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 thereafter furnish for registration any other necessary infor- mation which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.

Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died. his name and residence, if known. otherwise

a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons se are sup- posed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.

RULES OF PRACTICE

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

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health physicians will certify to such deaths ouly as those of persons who, though disabled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

COPIES OF RECORDS OF DEATHS OF NON-RESIDENT DECEDENTS

The clerk of each city and town shall forthwith make eerti- fied copies of the records of all . . . denths recorded during the previous month, if the . deceased [ was a resident] of any other city or town in this commonwealth or in any other state at the time of said . . . death, and transmit them to the clerk of the city or town of which such . . . deceased person [was] resident at the time of the said ... death ... and the «lerk of a city or town in this commonwealth so receiving such certified copies, or certified copies of . . . deaths, from the clerk of a city or town without the commonwealth, shall record the same. - Remised Laws, Chap. 29, Sec. 13, as amended by Acts of 1910. Chap. 93. Sec. S.

DESCRIPTION (for unknown person).

Jeorge Cart

Feb. 21. 1921 N 1

~ Herrick rice

M R-303

The Commonwealth of Massachusetts

MEDICAL EXAMINER'S CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

(ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTER 24)

State

mass

Registered No ...

City or Town ...

No.

146

Cliff are

St ..

Ward

(If death occurred in a hospital or institut @n tive its NAME instead of street and number)

2 FULL NAME

Calvin

horse Webb

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

(a) Residence.

No.

146 Ceylane

St.,

Ward.

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

(Usual place of abode)

Length of residence in city or town where death occurred years

n'noths

days

How long in U. S., if nf 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)

manuel

16 DATE OF DEATH

(Month)

(Day)

(Year)

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

Gladys Elliott

6 DATE OF BIRTH

Month)

(Day)

(Year)

7 AGE

38 Years

Months

Day 8

If LESS than

1 day, ...... hrs.

If STILLBORN, enter that fact bere

If STILLBORN, state period nf uterngestatinn

months

nr ....... min.

8 OCCUPATION OF DECEASED

(a) Trade, professinn, nr

particolar kind of work

(b) General nature of industry,

business, nr establishment in

which employed ( or employer)

Gran dall Ingernening Co

Richford

PARENTS

11 BIRTHPLACE OF

FATHER (City)

(State or country) -

12 MAIDEN NAME

OF MOTHER

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

Date

(Month)

(Day)

234

1921

(Year)

19 PLACE OF BURIAL, CREMATION, nr REMOVAL

DATE OF BURIAL

2/25-21

(Month) (Day) (Year)

(Cemetery)

(City or town)

20 UNDERTAKER

OR. Bemun

ADDRESS

21 Burial permit

issued by ...

S.a. Mayry

Official position

Health effects Date of

,issue 2/24/21

Permit No ..

243

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: Prisoning les mercura (comosine Suvertuate) - Suicidal

(See reverse side for description for unknown person)

18 Where was injury sustained

if not at place of death ?.

(Signed

M.D.

Medical Examiner for ..

Suffolk

Info

L.G. Elliott

(Address)

1376 Communieet cur 13mm-

Feb. 28.1921

Filed

(Month)} {Day) ( Year)

REGISTRAR

11,536

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 should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,

10 NAME OF

FATHER

9 BIRTHPLACE (City)

(State or country)

1882

MEDICAL CERTIFICATE OF DEATH

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Town of Winthrop : Record of Deaths 1919-1921, Part 149

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

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