Town of Winthrop : Record of Deaths 1919-1921, Part 203

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 203

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Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceascd died, his name and residence, if known, otherwise

a descriptio. 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 sup- posed 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 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 supposably 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 clectrical agents, and deaths following abortion, but also deaths from disease resulting from in- jury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

STATEMENT OF CAUSE OF DEATH

Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are kucwn. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homi- cidal." "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."

If investigation shows the death to have been due to dis- ease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal gangloid) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"

DESCRIPTION (for unknown person)

Nov. 21.1921

NOTICE TO UNDERTAKERS : No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have come to his death by violence, until a permit in writing, signed by the Medical Examiner, has first been obtained. - Revised Laws, Chap. 24, Sec. 20.

THIS CERTIFICATE CONSTITUTES SUCH PERMIT

R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County

Suffolk

State Mars

(City or 'Town)

Registered No.

City or Town

Winchof

No.

Gorro

are

St ...

.Ward

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

2 FULL NAME

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

(a) Residence.

No.

9 Severo. Cere

.St.,

Ward.

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

Leogth of resideoce 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

male

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

2videre-

5a If married, widowed, or divorced

HUSBAND of

(ou) WIFE-of

Chraback. Mon

6 DATE OF BIRTH

(Month)

"(Day)

( Year)

Years

Months

Days

If LESS thao 1 day ......... bis. or ...... min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

Relireit

.. (duration)

1 yrs. +

mos.

.ds.

CONTRIBUTORY

( SECONDARY)

(duration)

.. yrs.

mos.

ds.

18 Where was disease contracted

if not at place of death ?

at home

Did an operation precede death ?

,no

Date of .. -

Was there an autopsy ?

What test confirmed diagnosis ?..

Pasqual observation

(Signed)

R. R. Pukler

.. ..

., M.D.

( Address)

Winthrop

mais

Date

1921

( Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL IN25-1921

(Cemetery) Named(City or town)

20 UNDERTAKER

ADDRESS

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. a. maury

Official Health oficer .... position/

Date of issue tur of permit 11/23/21

Permit No ..

361

instructions and extracts from the laws on back of certificate.

PARENTS

12 MAIDEN NAME

OF MOTHER

Unable to obtain-

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

14 Cacherue Milne

Informant

(Address )

9 Graveer ave merchart

Filed Nov. 30.1921

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

2 2

(Day)

1921

(Year)

I HEREBY CERTIFY, That I attended deceased from

Nov 29

192.0

.. , to ..

un 22

19.21

that I last saw hV ...... alive on

19.2/

.....

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

The CAUSE OF DEATH was as follows : Chronic Valvular Heart Disease

.....

9 BIRTHPLACE (City)

(State or country)

10 NAME OF

FATHER

Rofest Such

11 BIRTHPLACE OF

FATHER (City ).

(State or country)

7 AGE

1855 - July

( Usual place of abode)

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

The Commonwealth of Massachusetts

[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 cach 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 "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 ncoplasms); 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, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

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, furnishi for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccased, 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, 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 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 elerk 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 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 persona found dead.

R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

EVinthron

BOSTON (City or Town)

1 PLACE OF DEATH

County

Suffolk

State

Massachusetts

Registered No.

176

City or Town

Minthonda

No.

Belcher

St., ... Ward

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

2 FULL NAME

Julia J. Steed

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

(a) Residence.

No.

54 Belcher

St.,

Ward.

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

Length of residence ta city or town where death occurred

years

months

18 days.

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

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

Female White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

George a. Steed

6 DATE OF BIRTH

april

( Month)

(Day)

(Year)

7 AGE

Years

Mon*1:₹

Days

If LESS than

1 day, ........ hrs. or ....... min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a> Trade, profession, or

particular kind of work

(h) Name of employer

none

9 BIRTHPLACE (City)

(State or country)

bonn.

10 NAME OF

FATHER

Regan

11 BIRTHPLACE OF

FATHER (City)

(State or country)

Ireland

12 MAIDEN NAME

OF MOTHER

Unkown

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

treland

Fioremet Steld

Informant

(Address)

54 Belcher' 88 Winthech

Filed

nov. 30.1921

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Day)

17 I HEREBY CERTIFY, That I attended deceased from 2.77.126 19

., to. 1921. that I last saw h ............... alive on Len. LI 1921 and that death occurred, on the date stated above, at 6.30A m. The CAUSE OF DEATH was as follows :

Chama Interstitial heeftsites.

.. (duration) yrs ...... .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 ?

Date of

Was there an autopsy ?

What test confirmed diagnosis ?.

(Signed)

, M.D.

(Address).

Date

( Month)

(Đay)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Holy Gross Malden

(Cemeter))

(City or town)

DATE OF BURIAL Pev 20192

ADDRESS

20 UNDERTAKER William 1. lunch laskosten

aMe atthe fficer nous 23/21 36 0

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

instructions and extracts from the laws on back of certificate.

M. 00

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

Official ....... position.

22 1

(Year)

1865

1721.

PARENTS

( Usual place of abode)

The Commonwealth of Massachusetts

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., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, ctc. 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- eifically 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 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 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, peritoncum, 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 (sccondary), 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," "Urcmia,""Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all discases 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- mittce on Nomenclature of the American Medical Association.)

Bronchopneumonla: If primary cause, write the word "pri- mary" ; if secondary, glve 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, homorrhage, gangrone, 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 belicf 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 whero the person dicd; . .. 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 ease of an original interment, by a satisfactory eerti- ficate of the attending physician, if any, as required by law, or in licu 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 causod by violence, the medical examiner shall make such certi- ficate. ... The person to whom the perinit 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 tho 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 aro 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 lis namo and residenee, 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 sueh 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 Physiclans 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.

STANDARD CERTIFICATE OF DEATH

DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS

County

Suffolk.

State

MASSACHUSETTS.

Registered No. 177

Township

Winthrop

Village

No.

Station Hospital Ft. Banks, Mass.

St., ..

Ward

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

2 FULL NAME

Michael P.Kearney

(a) Residence. No.

270 720 Main Street

St.,

Ward.

Winthrop lass.

(If nonresident give city or town and State)

Length of residence in city or town where death occurred

yrs.

mos.

ds.

How long In U. S., If of foreign birth ?

yrs.

mos.

ds.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year) nov . 25, 1921

I HEREBY CERTIFY, That I attended deceased from

Nov. 11th

19 ...... 1

19.

Nov.25

that I last saw h_im alive on

Nov. 24

195

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

12.03 a

--- m.

The CAUSE OF DEATH* was as follows:

If LESS than

1 day, ---- hrs.

or ---- mln.

Acute Lymphatic Lukemia ,complic. ted by

Diabetes and Nephritis.

over

(duration) .

yrs.

mos.

ds.

Cardiac & respiratory fait-

CONTRIBUTORY

ure

18 Where was disease contracted

(duration)

yrs. ______ mos. .

ds.

if not at place of death ?

Boston

Vicinity

Did an operation precede death ?

Date of

Was there an autopsy?

TTO

Blood Test.

What test confirmed diagnosis ?

(Signed) west mr. mous, M. D.

11/2519(Address)

Captain, M.C.,Fort Banks, "a.s

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

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Piedmont I. Va

DATE OF BURIAL

Nov 28921

ADDRESS

File nov 30, 1921

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Town of Winthrop : Record of Deaths 1919-1921, Part 203

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

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