Town of Winthrop : Record of Deaths 1919-1921, Part 189

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 189

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Statement of cause of death. - Name, first, the DISEASE CAUSINO DEATH (the primary affection with respeet to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ... ... . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. 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 symptomatie), "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 ean bo ascertained as the cause. Aiways qualify all diseases resulting from childbirth or misearriage, 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, erysipeias, 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 shali forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contraeted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Sccs. 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 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 cierk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which . .. shali be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cato as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . .. The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the elerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.

Medical examiners shall, in all eases, eertify to the eity or town elerk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chap. 24, 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 havo given bedside care during a last illness from disease unrelated to any form of injury.

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

(3) Medical examiners will investigate and certify to all deaths sup- posabiy due to injury. These include not only deaths eaused 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 deathis 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

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County

Suffolk

State.

Massachusetts

Registered No.

City or Town

No. 100 Park Ave.

St.,

.. Ward

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

2 FULL NAME

Edna Ruth Blunt

(a) Residence.

No. 100 Park ave.

St.

Ward. Printhran Highland

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

Length of residence in city or towo where death occurred

years

months

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

mouths

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

female

white

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH

Januar ( Month)

20 (Day)

1921

( Year)

7 AGE

Ycars

Months

Day's

1 day, ........ his. or ...... min.

If STILLBORN, efter that fact herc

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work.

child

(h) Name of employer

9 BIRTHPLACE (City)

(State or country)

Cliftondale

10 NAME OR

FATHER

Edward albert Blunt

11 BIRTHPLACE OF

FATHER (City).

Poibury

(State or country)

mass

What test confirmed diden sis ?

(Signed)

( Address).

Date

(Month)

31.

(Year)"

19 PLACE OF BURMA, CREMATION, OR REMOVAL

With

(Cemetery) (City or town)

20 UNDERTAKER

C.R. Bennison

DATE OF BURIAL Sept 2, 1921

ADDRESS 147 26 intherape IL. Winthrop, mais

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

.i.

instructions and extracts from the laws on back of certificate.

PARENTS

12 MAIDEN NAME

OF MOTHER

Ruth Hazel Ullven

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

Ruth Hazel UllmanBlunk

Informant.

(Address) 100 Park Que hanthe mother)

15 Lepto H Bessie & Dodge (Monti) (Day) (Year)

asst, REGISTRAR

S. a. Mowry

Official health Office of position

Date of issue

Permit

8/31/2/

No 32.7

Month)

(Day)

I HEREBY CERTIFY, That I attended deceased from

amy 3/

,19.2)

that ! last saw halive on

, 19.

and that death occurred, on the date stated above, at ... 7.20,40

If LESS than The CAUSE OF DEATH was as follows : Convulsions

mos ...

CONTRIBUTORY

( SECONDARY)

duration) Improves

.yrs .. feeling

(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 ?

. M.D.

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

The Commonwealth of Massachusetts

winthrop BOSTONass.

(City or Town)

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

( Usual place of abode)

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

auf

aug- 31. 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 each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Former or Planter, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Stotionory fireman, 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) Salesman, (b) Grocery; (o) Foreman, (b) Automobile foctory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," ""Dealer," etc., without more precise specification, as Doy laborer, Form laborer, Loborer - Cool mine, etc. 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 spc- cifically the occupations of persons engaged in domestic service for wages, as Servont, Cook, Housemaid, etc. If tho occupation has been changed or given up on account of tho 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 110 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 tho same diseasc. Examples: Cere- brospinol 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 ... .. (namo origin; "Cancer" is less definite; avoid uso of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic volvulor heart discase; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Examplo: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma,""Convulsions,""Debility" ("Congenital,""Senile," ete.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertaincd 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 he has attended during his last illness, at the request of an undertaker or otlier authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the discase 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 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 perinit from the board of health or its agent, . . . or . . . from the clerk of the city or town in which the person died; . . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . . . The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Lows, 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 Laws, Chop. 24, Sec. 8.

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for the observaneo 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. 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 abertion, 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 1

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County ..

Suffolk

State

mass

Registered No .. (Place of death)

....

Registered No ..

140

(Place of residence)

Ward

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

2 FULL NAME

Sarah C Smith

mass

City or Town.

Mintharol

No.

163 Jewall Que se

(a) Residence.

State

(Usual place of abode)

Length of residence in city or town where death occurred

7 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, GR

DIPORCED (write the word)

married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Daniel

6 DATE OF BIRTH (month, day, and year) June 151849

7 AGE

Years

Months

Days

/¥

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

If STILLBORN, enter that fact bere

8 OCCUPATION OF DECEASED

None

9 BIRTHPLACE (city or town) ...

Halifax

10 NAME OF FATHER John Elliott

11 BIRTHPLACE OF FATHER (city or town) ...

Halifax

(State or country)

12 MAIDEN NAME OF MOTHER Jarah Coleman

13 BIRTHPLACE OF MOTHER (city or town)

(State or country)

Halifax

Informant makel m Wallace

(Address) 163 Sewall ave. Wintheroch Man

15 Fixed pt 3 .. 19 21 Bessie L. Douge asst Registrar of city or town where death occurred

Filed .. 19

Registrar of city or town where deceased resided

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

Cept 2

19 21

I HEREBY CERTIFY, That I attended deceased from

19.10

Sext 2

.....

....

to ......

, 1921

that I last saw h &M alive on

aux 31,

1921.

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

1. A. m. The CAUSE OF DEATH" was as follows :

Cerebral Hemorrhage

(duration).

... yrs .. ..........

mos. 15 de.

CONTRIBUTORY

arterio Sclerosis

(SECONDARY)

(duration) 10.

.. yrs.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death? 220

Date of

Was there an autopsy?

What test confirmed diagnosis ?..

(Signed)

Carl a Lindquist

. M.D.

,19

(Address)

24 Westland ale Bustin Jmars

19 PLACE OF BURIAL, CREMATION, OR REMOVAL DATE OF BURIAL Mithral Withrok Jest. 501921

20 UNDERTAKER arthur F. Denglass

ADDRESS Chelsea

32 g

000.

. 3 SEX female (a) Trade, profession, or particular kind of work. (b) Name of employer PARENTS 14 of certificate. so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back (State or country)

Waithrot 20 (City or town)

City or Town.

Winthrop

No. 163, Sewall ave

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

....

MEDICAL CERTIFICATE OF DEATH

.. mos ...

ds.

.......

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH Sept 2 1921 [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 Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The 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, 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 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 disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of .......... (name origin; "Cancer" is less définite; 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 sym tomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Lebility" ("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- 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 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 other authorized person or of any member of the family of the deceased, furnish for registration a standard certificato 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, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . ..- Gen. Laws, Chap. 46, Scc. 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 beissued 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, 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 be 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 the 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. Laws, Chap. 38, Sec. 7.

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Town of Winthrop : Record of Deaths 1919-1921, Part 189

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

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