Town of Winthrop : Record of Deaths 1919-1921, Part 193

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 193

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(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 (sccondary or inter- current) affection need not be stated unless important. Example: Mcasles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symnp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" (“Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease 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 suchi, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (c. 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 Examiners. - 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 disease, 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

1 PLACE OF DEATH

County.

Suffolk

City or Town .... inthron

No. 24 River Road

St. Ward

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

2 FULL NAME

Sarah MacNiven

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

(a) Residence.

No.

24 Piver Food

St.,

Ward.

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

Length of residence in city or town where death occurred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

Thite

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Vidowed

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

John MacNiven

6 DATE OF BIRTH Jen 2 1845

( Month)

(Day)

(Year)

Years

Months

Days

If LESS than

1 day, ........ hzs. or ....... min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

At Home

9 BIRTHPLACE (City)

Sydney

( State or country)

C.B.

10 NAME OF

FATHER

Donald Morrison

11 BIRTHPLACE OF

FATHER (City)

Scotland

(State or country)

12 MAIDEN NAME OF MOTHER Mary MacDonald

(Signed)

(Address).

350 Muchos

Date

( Month) ( Day) ( Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

Winthrop

Tinthro

(Cemetery)

(City or town)

8/28/21

15 Ock. 4.192:

Filed (Month) (Day) (Year)

REGISTRAR

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

4.2%

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

Sift

1426

(Day)"

(Year)

17 I HEREBY CERTIFY, That I attended deceased from 19 .... 22/ Scht 1, 19 21 to.

that I last saw h alive on Soft 26 1921. and that death occurred, on the date stated above, at. 10.45 Am.

The CAUSE OF DEATH was as follows :

.. (duration)

yrs ........ .. mos ..

.. ds.

CONTRIBUTORY

antero policiais

( SECONDARY)

(duration)

.yrs ..

Inos ...

ds.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death ?

100

Date of

Was there an autopsy ?

What test confirmed diagnosis ?

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

Scotland

Informant

Mrs. Tones

(Address)

24 Piver Poed

ADDRESS

20 UNDERTAKER

John F. C. maler Minttirol

Official position.

Health office

Date of issue 9/26/21 No. 3$6

Permit

3 SEX Female 7 AGE PARENTS 14 should be carefulny supplied. AGE should be stated LAAVILI. PHYSICIANS should state CAUSE OF DEAin (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)

State Vass

Registered No.

146

( Usual place of abode)

ADDED UNRED DIBILO SIANDARD CERTIFICATE OF DE 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 Planter, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Stotionory fireman, ete. 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) Salesmon, (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 - 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 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 "Epidemie cerebrospinal - meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. 's indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of .. . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Meosles; Whooping cough; Chronic volvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Meosles (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," 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, erysipeias, meningitis, miscar- riage, necrosis, peritonitis, phiebitis, 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 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, the duration of lis 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 dicd; . . . No such permit shall be issued until thereshali 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, shali 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 whichi 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 dicd 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 those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized 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 ali 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 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.

301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

BOSTON (City or Town)

1 PLACE OF DEATH

Suffolk

State.

Massachusetts

Registered No. 152

St.

Ward

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

Sanc. S

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

(a) Residence.

No.

( Usual place of abode)

Length of residence in city or towo wbere death occurred

years

mooths

days.

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

years

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

What

5 SINGLE, MARRIEO, WIDOWED, OR

DIVORCED (write the word)

manuel

5a If married, widowed, or divorced

HUCDAND CT

(or) WIFE of

allón. F. Dow

Left 25- 1859 (Day) ( Month)

( Year)

7 AGE

Years

Months

Days

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

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

at Home

9 BIRTHPLACE (City)

(State or country)

10 NAME OF

FATHER

James Bece

11 BIRTHPLACE OF

FATHER (City)

(State or country)

12 MAIDEN NAME

OF MOTHER

mary Gray

Portland

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

14 allows. F. Saw

Informant.

(Address)

Der. 14, 1921

Filed

(Month) (Day) (Year)

S. a. Maury

REGISTRAR

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

Official position Health Oficer

Date of issue Oct. 3

Permit

No .... 33.6

00.

in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important, vot instructions and extracts from the laws on back of certificate.

....

Indefinite (duration) yrs .. Ch Byoccurditas

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 ?

2 . Date of

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed).

( Address).

218 main & mitles

Oate Come

( Month)

(Day)

2 1921 (Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

mans

(Cemetery) 2 online

(City or town)

20 UNDERTAKER

ADDRESS

County.

City or Town.

nellie

2 FULL NAME

11 chemi un

St.

Ward.

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

months

days

MEDICAL CERTIFICATE OF DEATH

1921

16 DATE OF DEATH

(Montini

(Day)

I HEREBY CERTIFY, That I attended deceased from

,192, to

Cara

, 19 21

Car 1.

, 19 21.

that I last saw h. 4L., alive on

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

4,35 mm

6 DATE OF BIRTH

If LESS than The CAUSE OF DEATH was as follows : Ch. Interstitial Reflection

PARENTS

7 9. 5mm.

. M.D.

DATE OF BURIAL 10/4/21

The Commonwealth of Massachusetts

No.

11 Cheses

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 fireman, etc. Butin 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: (0) Spinner, (b) Colton mill; (a) Solesmon, (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 inore precise specification, as Doy laborer, Form laborer, Laborer - Cool mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spo- 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 he indicated thus: Former (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 the same disease. Examples: Cere- brospinal fever (the only definite synonyin 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, ctc., of .. ... (namno origin; "Cancer" is less definite; avoid usc of "Tumor" for malignant ncoplasms); Meosles; Whooping cough; Chronic volvular heurt diseosc; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection necd 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," "Ancmia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""IIemorrhage,""Ina- nition," "Marasınus," "Old age," "Shock," "Urcmia,""Weakness," etc., when a definite disease can be ascertained as tho cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operatlon 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 causo.

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 deceased, furnish for registration a standard certificate of deatlı, stating to the best of his knowledge and helief the name of the deceased, liis supposed age, the disease of which he dicd [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 scen alive hy the physician, and the date of his death. . .. - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.

No undertaker or other person shall bury a human body .. . until he has received a permit from the board of health or its agent, . . . or . . from the clerk of the city or town in which the person died; . . . no such permit shall be issued until there shall have been delivered to such board, agent or elerk, ... 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 physicfan, 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, Chop. 78, Sec. 38.

Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the 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 these 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 these 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 by tho action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths front 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.

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

Malien

(City or town)

1 PLACE OF DEATH

Registered No.

527

County

Middlesex

....

State

Ma.s.s ...

Registered No.

City or Town

Malden

No.

Malden ..... Hospital

St.,

3 Ward

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

2 FULL NAME

Nell James Mathes

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

(a) Residence. State

(Usual place of abode)

Mass.

City or Town

Winthrop

89 Somerset Ave. St.

Length of residence in city or town where death occurred

years

mooths

days

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Female

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

John T. Mathes

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

June 11, 1870

7 AGE

Years

Months

Jf LESS than

1 day, ........ hrs.

or ....... min.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work

(h) General nature of industry,

business, or establishment in

which employed (or employer )

.(duration)

.yrs.

.mos.

ds.

CONTRIBUTORY

Pelvis abscess in left

(SECONDARY)

broad ligt.

(duration)

..... yrs.

mos.

10 ds.

10 NAME OF FATHER

James R. Hughes

18 Where was disease contracted

if not at place of death ?

Fibroids

Did an operation precede death ?.

Yes Date of Sept . 19121

Was there an autopsy ?.

What test confirmed diagnosis? Inspection of tumor

(Signed)

Chas. E.Prior

M.D.

13 BIRTHPLACE OF MOTHER (city or town) (State or country) Tenn. Oct . 411981ss) Malden , Mass.

Informant

John T. Mathes

(Address)

Winthrop, Mass.

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Winthrop,

Mass.

DATE OF BURIAL

Oct . 6, 1921

Filed.

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Town of Winthrop : Record of Deaths 1919-1921, Part 193

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

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