Town of Winthrop : Record of Deaths 1919-1921, Part 151

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 151

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State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- inittee 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 diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childhirth, convulsions, heinorrhage, gangrene, gastritis, eryslpelas, 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 lias attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and helief the name of the deceased, his supposed age, the disease of which he died [defined so that it can bo classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Lows, Chop. 29, Secs. 10 and 1, as amended by Acts of 1910, Chop. 322.

No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent, . . . . . or ... from the clerk of the city or town in which the person died; . . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in 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 bo obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, 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 as are supposed to have come to their death by violence. - Revised Lows, Chap. 24, Sec. 8.

RULES OF PRACTICE

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

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

(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, 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 hy 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.

R-302

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Foxborough ( City or town)

Registered No ...

(l'lacc of death)

Registered No.

(Place of residence)

St.,

Ward

City or Town

Foxborough

No ... State Hospital

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

2 FULL NAME

Thornton B. Lewis

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

(a) Residence. State ..

Mass.

City or Town.

Winthrop

33 Cottage Ave.

St.

(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

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Div.

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Henrietta Garvin

6 DATE OF BIRTH (month, day, and year) About, 1863

7 AGE

Years

Months

Days

If LESS than

I day, ........ hrs.

or ....... min.

If STILLBORN, enter that fact bere

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work.

Shoe Worker

(b) Name of employer

The Thomas G. Plant Co.

9 BIRTHPLACE (city or town)

Boston

(State or country) Mass.

10 NAME OF FATHER Henry Lewis

PARENTS

11 BIRTHPLACE OF FATHER (city or town)

Boston

(State or country) Mass.

12 MAIDEN NAME OF MOTHER Mary Elizabeth?

13 BIRTHPLACE OF MOTHER (city or town) Boston (State or country) Mass.3/4/2119 (Address) Foxborough State Hospt.

M.D.

Informant

Records Foxborough State

(Address)

Hospital

Filed. 3/4/21, 19

Registrar of city or town where death occurred

1911

Registrar of city or town where deceased resided

16 DATE OF DEATH (month, day, and year) Mar. 3,

19 21

I HEREBY CERTIFY, That I attended deceased from

Oct. 29

2010

Mar. 3, 19

.. 21

that I last saw h

alive on

Mar.

19 ..

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

9:45

.m.

The CAUSE OF DEATH* was as follows :

*State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional spacc.)

Diarrhea and Enteritis

(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?

yes

Laboratory findings

What test confirmed diagnosis ?.

Ransom H. Sartwell

DATE OF BURIAL

3/7/21

20 UNDERTAKER

John williams

ADDRESS

Weymouth

). 25,000

of certificate.

1 PLACE OF DEATH

County

Norfolk

State

Mass.

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 on back

19 PLACE OF BURIAL, CREMATION, OR REMOVAL weymouth

Vilar. 3. 1921 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 term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architeet, Locomotive engincer, 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) Forcman, (b) Automobile factory. The ma- terial 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, etc. Women 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 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Mcasles (discase causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toins or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Cof- lapse," "Coma,"Convulsions," "Debility" ("Con- genital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which 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 dc- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoncd 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 "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)

Cases for the Medical Examinars. - 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, etc.

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-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop ...

1 PLACE OF DEATH

County

Duff

falk

State

Mass

Registered No. 40

City or Town

Winthis

No Miteall Hospital)

St .... ......... .Ward

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

2 FULL NAME

Jours Mary Wolcott

(a) Residence.

No.

20 Deuton Terrace Rvelmistal

Ward.

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

Leogth of residence in city or town where death occurred

years

mooths

days.

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

years

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Temale

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 -

July

6 DATE OF BIRTH

( Month)

(Day)

(Year)

Years

Months

Days

If LESS thao 1 day, ........ hrs. or ....... mio.

If STILLBORN, eoter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, professioo, or

particular kind of work.

For Home

9 BIRTHPLACE (City)

(State or country)

Alexander L. Stubbe

11 BIRTHPLACE OF

FATHER (City)

Duckshah

(State or country)

12 MAIDEN NAME

OF MOTHER

Many Dennett

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

Buckspour

ou ther

14 Gordon Langell

(Address)

5275 Broadway Everett

Fil

Mar. 11 192

(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 She. Mowry

MEDICAL CERTIFICATE OF DEATH

Ich

1921

(Year)

17 I HEREBY CERTIFY, That I attended deceased from . 4

19.19, to!

Dec

. Doch 30

1921

that I last saw her

alive on

mich 30

21.

and that death occurred, on the date stated above, at 2.15pm om. The CAUSE OF DEATH was as follows : Hemiplegia left side complete

Cerebral Hemorrhage apoplex

( 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? no

Date of ..

Was there an autopsy ?

Paralym uft vichy

What test confirmed diagnosis ?.

(Signed)

M.D.

(Address).

Date

mich

174 wishes by whether

3º

6/1921

(Year)

( Month)

(Day)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL Winthrop

DATE OF BURIAL Winther 3/5/21.

(Cemetery) (City or town)

20 UNDERTAKER Frank G. Brown

rown

ADDRESS East Boslm

Official Health Officer „position

Date of issue of permit. 3/3/2/

Permit No 246

7 AGE 10 NAME OF FATHER PARENTS Informant should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (b) Name of employer 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

(City or Town)

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

( Usual place of abode)

mooths days

16 DATE OF DEATH

(Month)

(Day)

William Wileatt

1867

East Gosto

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 be sufficient, e. g., Farmer or Plonter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary firemon, etc. But in many cases, especially in industrial employments, it is necessary to know (o) 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) Salesmon, (b) Grocery; (a) Foremon, (b) Automobile factory. The material worked on may form part of the sccond statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Doy laborer, Farm loborer, Loborer - Cool mine, ete. 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 domestie service for wages, as Servant, Cook, Housemaid, ete. 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: Former (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 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. 's indefinite); Tuberculosis of lungs, men- ings, peritoneum, etc., Carcinoma, Sarcoma, ete., of .. .. (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic volvular heort disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection nced not be stated unless important. Example: Measles (discase 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," ote.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Wcakness," 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- inittee 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 or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertakeror otherauthorized person or of any member of the family of tho 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, the disease of which he died, defined as re- quired by section one, where same was contracted, tho duration of his last illness, when last seen alive by the physician or officer and the date of his death. . ..- Gen. Laws, Chap. 46, Sec. 9.

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 town where the person died; . .. No such permit shall be issued until thereshall 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, in case of an original interment, by a satisfactory certi- ficate 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 bo obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. ... The person to whom the permit is so given and the physi- cian certifying 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. - Gen. Laws, Chap. 114, Sec. 45.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.

.. . He shall in all cases certify to the town clerk or registrar in tho place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. - Gen. Lows, Chap. 38, Sec. 7.

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 these 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. These includo 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

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS PLACE OF DEATH Lubbock County

STANDARD CERTIFICATE OF DEATH

(City or Town)

State.

Registered No.

St.,

.Ward

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

2 FULL NAME

Barbara. Iva.

Mayo

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

(a) Residence.

No.

218 Linien

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

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

20.

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

wido

5a If married, widowed, " ovel

HUDDAND OT

If Horace. Wi Mayo

6 DATE OF BIRTH

Seth 17 -1855 ( Month) (Day)

(Year)

Months

Days 16

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

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

9 BIRTHPLACE (City)

(State or country)

fr. WEare. I.t.

10 NAME OF

FATHER

Elisha B. Perry

11 BIRTHPLACE OF

FATHER (City).

(State or country)

unable to obtain

12 MAIDEN NAME

OF MOTHER

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

14 Eura. C. Mayo

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

HEREBY CERTIFY, That I attended deceased from

Jan

1919

to.

Mar 3

19 21

....

that I last saw h

alive on

mar 2

1921

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

250 P .m. The CAUSE OF DEATH was as follows: Pernicious anaemia

(duration)

1 yrs

mos ..

ds.

CONTRIBUTORY

Endocarditis Mitral

( SECONDARY)

valse

(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)

Horace

Bould

M.D.

(Address).

180 Winthrop St Wutharp

Date

march

1921

(Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL 3/6

1928

(Cemetery) Wunschiop

(City or town)

20 UNDERTAKER

C.R.COM

ADDRESS

Filed Mar. 11.1921

(Month) (Day) (Year)

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

Official position Healthofficer.

Date of issue 3/6/21

Permit

No. 247

3 SEX

7 AGE

PARENTS

Informant.

(Address)

instructions and extracts from the laws on back of certificate.

in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See

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

(h) Name of employer

50,000.

The Commonwealth of Massachusetts

City or Town

mentheo

No ..

215 Linien DE

Mars

march

1921

(Day)

(Year)

Years

Blood count

Mar. 3. 1911 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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Town of Winthrop : Record of Deaths 1919-1921, Part 151

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

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