Town of Winthrop : Record of Deaths 1919-1921, Part 201

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 201

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State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittce 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 certificate of death, stating to the best of his knowledge and belief the name of the deccascd, his supposed age, the disease of which he dicd, 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 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 tbe manner or cause of the death, which the clerk or registrar may require. - Gen. Laws, Chap. 114, Scc. 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. 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 these 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 persons found dead.

The Commonwealth of Massachusetts

M R-301 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

Winthrop BOSTON (City or Town)

1 PLACE OF DEATH

County ..

Suffolk

State

Massachusetts

Registered No.

170

City or Town

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

2 FULL NAME

Elizabeth Rachel Wormelle

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

(a) Residence.

61 Bunch Road

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

12 years +

months

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

William charles wormelle

6 DATE OF BIRTH

June ( Month)

14. 1844 (Day) (Year)

7 AGE

Years 77

Months

Days

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

If STILLBORN, enter tha! fach bere

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kiod of work.

(b) Name of employer

9 BIRTHPLACE (City)

Boston

(State or country) mass

10 NAME OF

FATHER

James Lumley

11 BIRTHPLACE OF

FATHER (City).

(State or country)

London

England

12 MAIDEN NAME

OF MOTHER

Elizabeth musgrave

donot know

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

14 mande ~ Shyttahonson

Informant.

(Address)

61 Barch Kd.

nov 141921

Filed

(Month) (Day) (Year)

REGISTRAR

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

35,000. -XXM.

instructions and extracts from the laws on back of certificate.

PARENTS

What test confirmed diagnosis ?. augustushe caman

(Signed)

. M.D.

(Address ).

9 Princeton et Efectos

Date

Nov.

(Month )

192%.

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

wordlawn Cemetery

DATE OF BURIAL nov. 10112

(Cemetery)

(City or town)

ADDRESS

20 UNDERTAKER

& R Bennison winthrop

Permit

Official- Health office Date of 11/10/21 No. 353

S.K. Maury

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

Não.

. Day, 1921. Year)

17 HEREBY CERTIFY, That I attended, deceased from 1

July 121

19 .2.1, to.

Nov 7(me), 1921

that I last saw h WW . alive on

Nov 7ª

, 19 2 /.

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

10 P. m

The CAUSE OF DEATH was as follows :

Valvular Discar ontheart.

.. (duration) . yrs Interstitial Dethrite CONTRIBUTORY (SECONDARY) (duration) 1 yrs. ~ mos ... 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 ?

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK -THIS IS A PERMANENT RECORD. Every item of information 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

No.

61 Birch Road

St .....

.Ward

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, Architeet, Locomotive engineer, Civilengineer, Stationory fireman, etc. Butin many eascs, 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 cxamples: (0) Spinner, (b) Cotton mill; (o) Solesman, (b) Grocery; (a) Foremon, (b) Automobile foclory. 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 loborer, Loborer - 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 cinployed, as At school or At home. Caro should bo taken to report spe- cifically the occupations of persons engaged in domcstie 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: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death. - Namc, 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- brospinol fever (the only definite synonyni is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid usc of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobor pneumonio; Bronchopneumonia ("Pneumonia," unqualificd, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ..... ... (name origin; "Cancer" is less definite; avoid uso of "Tumor" for malignant ucoplasms); Measles; Whooping cough; Chronic valvulor heort disease; Chronic interstitiol 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, sueli as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Scnile," ete.), "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- inittce on Nomenclature of the American Medical Association.)

Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortlon, 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 hc 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 belicf 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 contracted, the duration of his last illness, when last scen alive by the physician, and the date of his death. . . . - Revised Laws, Chop. 29, Secs. 10 and 1, os amended by Acts of 1910, Chop. S22.

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 untii there shaii 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, shail upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner oniy shali 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 eause of the death, which the clerk or registrar may require. - Revised Lows, Chop. 78, Sec. 38.

Medical examiners shall, in all cases, ecrtify to tho eity 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 aro supposed to have come to their death by violence. - Revised Laws, Chap. 24, Sce. 8.

RULES OF PRACTICE

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

(i) 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 iujury.

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

(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 dcatlis 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 R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

............

(City or Town)

1 PLACE OF DEATH

County

City or Town

Margaret Rose

No. 146 Panchina Sh

St ...............

Ward

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

2 FULL NAME

0146 Paulini

.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

3 SEX

tiemme

4 COLOR OR RACE

what

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If mamied widowed, or divercod HUSBAND of ( or) WIFE f

of Edward Youth, Whole

6 DATE OF BIRTH

June 16

( Month)

(Day)

(Year)

7 AGE

Years 66

Months 4

Days

1 day ......... hrs. If LESS than The CAUSE OF DEATH was as follows : Catal Cerchial stemontag ) or ....... min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work.

as tomme

(h) Name of employer

CONTRIBUTORY ( SECONDARY)

(duration)

.yrs ..

mos.

ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death? The Date of - -

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed)

Harry all elG

( Address ).

200 pleurant 4.

Date ..

....

( Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

200 11-1921

(Cemetery) Wmely

(City or town)

20 UNDERTAKER

ADDRESS

15 Nov. 14. 1921

Filed (Month) (Day) (Year)

REGISTRAR

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

Official position

JTHOFFIC Fie

Date of

Permit

) II

No ...

354

0,000

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

Urlhun Cleager withheld

11 BIRTHPLACE OF

FATHER (City)

(State or country)

Beckett

12 MAIDEN NAME

OF MOTHER

Roze Bran

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

14 Mrs. Elle Nickerson

Informant

(Address )

Sampler 146 Parchi SL

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

Nov

1921

(Year)

I HEREBY CERTIFY, That I attended deceased from

Nor >

1921

prov 8, 1921

that I last saw he

alive on

Nor 8

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

(duration)

.yrs ..

mos ..

.ds.

9 BIRTHPLACE (City)

(State or country)

England

1856

The Commonwealth of Massachusetts

State. Mans

Registered No.

171

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

(a) Residence. No ....

(Usual place of abode)

(Day)

...

of permit

[Approved by U. S. Census and American Public Health Association]

Statement of occupation. - Precise statement of occupation is very important, so that the relative healtbfulness 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 lino will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. Butin many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. Tbe material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., witbout more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at bome, who are engaged in the duties of tbe bouse- 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 tbe 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 wbo have no occupation whatever, write None.

Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (tbe primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (tbe only definite synonym is "Epidemio cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typboid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of. .....

... (name origin; "Cancer" is less definito; 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 terminai conditions, such as " Astbenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma,""Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy,""Exbaustion,""Heart failure,""Hemorrbage,""Ina- nition," "Marasmus," "Old age," "Sbock," "Uremia,""Weakness," etc., when a definite disease can be ascertained as tbe 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 foliowing diseases, without explanation, as the soie cause of death: Abortion, celiulitis, childbirth, convuisions, hemorrhage, gangrene, gastritis, erysipeias, meningitis, miscar- riage, necrosis, peritonitis, phiebitis, pyemia, septicemia, tetanus.

DAIRACIO FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forthwitb, after the death of a person whom be has attended during his last illness, at the request of an undertakeror other authorized person or of any member of tbe family of the deceased, furnish for registration a standard certifieate 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 as re- quired by section one, wbere 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 buman body . .. until he bas 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 untii 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 eerti- ficate of the attending physician, if any, as required by law, or in licu thercof a certificate as bereinafter provided. If there is no attending physician, or if, for sufficient reasons, his cortificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of heaith, 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 vioience, the medicai examiner shall make such certi- ficate. ... The person to whom the permit is so given and the physi- cian certifying the cause of death sball thereafter furnish for registration any other necessary information which can be obtained as to the deecased, 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, Scc. 6.

. . . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his namo 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 tbe following rules of practice:

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

(2) Board of Health Physicians will certify to such deaths only as those of persons wbo, though disabled by recognized disease unrelated to any form of injury, have died witbout recent medical attendance or whose physician is absent from home wben 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 caused directly or indirectly by traumatism (including resulting septicemia), and by tbe action of chemical (drugs or poisons), thermal, or clectrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, tbe sudden deaths of persons not disabled by recognized disease, and those of persona found dead.

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Town of Winthrop : Record of Deaths 1919-1921, Part 201

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

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