USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 196
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Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to havo 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.
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 ahsent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
-
R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County Suffolk
State Lass
Registered No.
158
City or Town
Winthrop
No.38 Reade St.
St .... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Daniel Francis Fuckley
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
29 Rende St.
(Usual place of abode)
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 io U. S., if of foreign birth ?
years
mooths
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
Nov
19 1899
( Month)
(Day)
(Year)
Years
21
Months
IO
Days
25
1 day, ........ hrs. or ....... min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particolar kind of work
Chaffeur
9 BIRTHPLACE (City)
Tinthror
(State or country)
Fass
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?
no
Date of
Was there an autopsy ?
Não or medical
What test confirmed diagnosis?
J. B. Pealhutter
M.D
(Address).
38 Read 0. 53 Shirley los.
Date
Cet.
14
1921 there.
Year)
(Month)
(DẤY)
DATE OF BURIAL
10/15/21
(Cemetery)
(City or town)
20 UNDERTAKER
John F. Cfaley
ADDRESS Winthrop
Official position, Health officer
Date of Assue
110/14/21
Permit No
3100
4.18
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
Det.
13
(Day)
1921
(Year)
17 HEREBY CERTIFY, TIi attended deceased from
Oct. 10
19
21 Oct. 13
2
19
that I last saw h.los alive on Oct. 12 1921 and that death occurred, on the date stated above, at 4-4 SAM.
If LESS thao The Chu AUSE/OF DEATH was as follows : Septicemia (Presumably .....
caused by two abscesses ou leg
.. (duration)
yrs ..
3
mos .. 21 ds.
Urencias
CONTRIBUTORY
(SECONDARY)
(duration)
.... ....... yrs ..
mos ...
3
ds.
10 NAME OF
FATHER Daniel
11 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
12 MAIDEN NAME
OF MOTHER Julia Donovan
(Sigoed)
13 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
Informant
Daniel F. Buckley
(Address )
38 Peade St.
Tinthrop
15 Nov. 3.1921
Filed
(Month) (Day) (Year)
REGISTRAR
21 | HEREBY CERTIFY that a satisfactory stao- dard certificate of death was filed with me BEFORE the burial or transit permit was issued Sile, mowry
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Holy
Gross
Malden
,000
3 SEX Male 7 AGE PARENTS 14 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
(City or Town)
[Approved by U. S. Censos 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, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, 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. '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); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma,""Convulsions,""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 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 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 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 agc, 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, 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 there shall have been delivered to such board, agent or cierk ... 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 thercof 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 mako 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. Laws, 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 all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following 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 persens found dead.
-
-
R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County
70 Boudin St
State mass
Registered No.
159
St ............. ... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
margarett
(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 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
16 DATE OF DEATH.
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY, That I attended deceased from De 16 19 2 to 19
that I last saw h .. ........... alive on 19
and that death occurred, on the date stated above, at
m. The CAUSE OF DEATH was as follows :
If LESS than I day, ........ hrs. or ....... min. Still For
(duration)
yrs.
mos.
ds.
CONTRIBUTORY
( SECONDARY)
(duration)
.. yrs ..
mos.
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?
Date of ..
Was there an autopsy ?
What test confirmed diagnosis ?
(Signed)
.. M.D.
( Address) ...
256 Limeauf 11
Date
( Month)
( Day) (Year)
14
Informant Jane walker Paton
(Address )
7. Bordoist
matter
15 Nov. 3.1921
Filed (Month) (Day) (Year)
REGISTRAR
20 UNDERTAKER
e R Bennison
ADDRESS
winthrop
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
S. Q. Li aury
Official position.
Health Ofice
Date of issue
mit 6/19/2
Permit No 343
00
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
PARENTS
10 NAME OF
FATHER
Walter Starold Crawford
11 BIRTHPLACE OF
FATHER (City ).
nowfoundland
(State or country)
12 MAIDEN NAME
OF MOTHER
game washer paton
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
scotland
Days
If STILLBORN, enter that fact here stillborn
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(h) Name of employer
oct
6 DATE OF BIRTH
( Month)
16 1921 (Year)
(Day)
7 AGE Years stillborn
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
3 SEX
female
4 COLOR OR RACE
white
St.,
Ward.
Winthrop (City or Town)
City or Town
Winthrop
No.
Cranford
....
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Ministerof
DATE OF BURIAL
oct 20 1921
(Cemetery)
(City or town)
14
1121
Months
9 BIRTHPLACE (City)
70 Bordon St-
(State or country)
winthrop muss
16 122
(If non-resident give city or town and State)
[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, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (6) 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, 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. 4
.
Statement of cause of death. - Namo, 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 (tho only definite synonym is "Epidemio cerebrospinal { meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ...... ... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (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, 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 deccascd, 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 samo 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, 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 shali be issued untii there shali 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, shaii upon application make the certificate required of the attending physician. If death is caused by violence, the medicai examiner shali 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.
Medicai 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.
. . . Ho 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.
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 Heaith 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) Medicai examiners will investigato and certify to all deaths sup- posabiy 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 disabied by recognized disease, and those of persons found dead.
.
R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
Winthrop mass. (City or Town)
1 PLACE OF DEATH
County.
49
Sagamore av ta
mass.
Registered No. 160
City or Town
Winthrop mass No ...
49 Sagamne ave.
St ............. .Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Ethel Louise estly
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
49 Sagamne ave
St.,
Ward.
( Usual place of abode)
Length of residence in city or town where death occorred
years
mooths
days. How loog in U. S., if of foreigo hirth ? years
months days
PERSONAL AND STATISTICAL PARTICULARS
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
Ernestfl Estey
6 DATE OF BIRTH July26
( Month)
Years
Months
2
Days
21
If LESS thao 1 day, ........ hrs. or ....... mio.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
house wife
9 BIRTHPLACE (City)
maldan
(State or country)
mass.
Gorham Ring
11 BIRTHPLACE OF
FATHER (City ).
Richmond
(State or country) maine
12 MAIDEN NAME
OF MOTHER
Lucy & Clay
Chester
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
quement.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH.
Oct
17
1921
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
Cect
17
1921
to
Cent
17
1921
that I last saw her
alive on
est
17
19.2 ....
and that death occurred, on the date stated above, at
10:30 P
m.
The CAUSE OF DEATH was as follows :
Cerebral Humorhage
(duration)
yrs.
mos
ds.
CONTRIBUTORY. (SECONDARY)
(duration)
yrs ...
.... .
mos.
ds.
18 Where was disease contracted
if not at place of death ?
ithouse
Did an operation precede death? No
Date of
Was there an autopsy ?
200
Personal Observation
(Signed)
(P. B. Parker
.......... , M.D.
(Address).
Wwwtrop
Date.
lect
18
1421
( Month)
(Day)
(Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Niqueburn (anfredy)
1
DATE OF BURIAL
oct 20 2921.
(Cemetery)
(City or town)
20 UNDERTAKER
C R Bennison
ADDRESS
winthrop
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued P. G. many
Official position
Theatthe Office of permit
Date of issoe Get. 19
Permit No.
3482
000
3 SEX female 7 AGE 43 10 NAME OF FATHER PARENTS 14 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 (b) Name of employer
Informant.
Ernest Hallock Estey
(Address)
49 sagamore are winthrop mass
15 Nov. 3.1921.
Filed
(Month) (Day)' (Year)
REGISTRAR
What test confirmed diagnosis ?.
4/2 hours.
1878 (Year)
(If non-resident give city or town and State)
2 FULL NAME
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