Town of Winthrop : Record of Deaths 1919-1921, Part 29

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 29

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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 deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.

. RULES OF PRACTICE

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

(1) Attending physicians will certify to such deaths only as those of persons to whom they 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 dircetly 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 dlsease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

M R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County.

Suffolk

State Massachusetts Registered No .. . . . .

City or Town

BOSTON Winthrop

70 Prospect Ave.

St.

.Ward

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

2 FULL NAME

John A. W.Silver.

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

(a) Residence. No.

(Usual place of abode)

70 Prospect Avse,.

Ward.

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

Length of residence io 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

May 24 1919

(Month)

(Day)

(Year)

17 HEREBY CERTIFY, That I attended deceased from

Jan 1

19/9, to.

May 24, 1919.

that I last saw head alive on

mach v ...... 1919,

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

6 10 m. The CAUSE OF DEATH was as follows :

Intestinal Carcinoma (sp seu all intritura).

(duration)

... yrs.( .... )

mos .....

ds.

CONTRIBUTORY ..

Cardiac dufry

(SECONDARY)

(duration)

.. yrs.

mos ..

.ds.

13 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 ?

clinical

(Signed)

MX. Parter

, M.D.

(Address)

Hanthrop, Mass

Date.

(Month)

(Day)

1919.

Kearf

DATE OF BURIAL

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

So. Portland Me. May 27

(Cemetery)

20 UNDERTAKER

Waterman pois

ADDRESS

Boston.

9. 150,000. -'19-XXM.)

Informant

Cora B.Silver.

70 Prospect Ave.

Via 18 199

(Month) (Day) (Year)

REGISTRAR

21 I HEREBY CERTIFY that a satisfactory stan-

dard certificate of death was fled with me

BEFORE the burial or transit permit was issued

8h. Maury

official Health Officer

Date of issue of permit

Permit May 26 No. 986

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

Cora B.Silver.

6 DATE OF BIRTH

Dec 28 1866

(Month)

(Day)

(Year)

7 AGE

Years

Months

26ays

If STILLBORN, enter that fact bere

If STILLBORN, state period of nterogestation

mos.

If LESS than

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

or ........ min.

8 OCCUPATION OF DECEASED (a) Trade. profession, or particular kind of work (b) Generai nature ofiodustry, business, or establishment in which employed (or employer)

Garage Owner

9 BIRTHPLACE (City)

Portland Me.

10 NAME OF

FATHER

Aaron Silver.

11 BIRTHPLACE OF

FATHER (City).

England.

(State or eountry)

12 MAIDEN NAME

OF MOTHER

Carrie Jones.

13 BIRTHPLACE OF

MOTHER (City).

Phila Penn

(State or country)

3 SEX mal e (c) Name of employer PARENTS 14 (Address) 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 N. B .- WRITE PLAINLT, WITH ONFADING BLACK INK - THIS IS A PERMANENT RECORD. Every item of information ( State or country)

may 24, 1919 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 pursuite 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, Compositar, Architect, Lacomotive 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) Automabile factary. 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 labarer, Labarer - Caal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definitesalary), may be entered as Hausewife, Ilausework, or At hame, and children, not gainfully employed, as At schaal or At hame. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Coak, Hausemaid, 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 Nane.

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"); Typhaid fevcr (never report "Typhoid pneumonia"); Lobar pneumania; Branchapneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinama, Sarcoma, etc., of .......... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whaaping caugh; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection necd not be stated unless important. Example: Measles (disease causing death), 29 ds .; Branchapneumonia (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.

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 death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, 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 clerk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. ... The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafterfurnish 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 Laws, Chap. 78, Sec. 38.

Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deccased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.

RULES OF PRACTICE -

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

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

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the aetion 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.

RM R-303

The Commonwealth of Massachusetts

MEDICAL EXAMINER'S CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

(ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTER 24)

County

Suffolk

State

Mass.

Registered No.

1184

City or Town

Winthrop

No.

George

St.,

Ward

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

2 FULL NAME

WILLIAM E. STAPLES

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

(a) Residence.

No25 George Street,

(Usual place of abode)

St.

.Ward.

Winthrop.

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

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

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

May

26.

1919.

(Month)

(Day)

(Year)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

mabel Stajetro

6 DATE OF BIRTH

Sept.

(Month)

(Day)

185%

(Year)

7 AGE

Years

Months

Days

If LESS than

1 day, ...... hrs.

If STILLBORN, enter that fact here

If STILLBORN, state period of uterogestatioo.

months

or ....... min.

8 OCCUPATION OF DECEASED

(a) Trade, professioo, or

Carpenter x Builder

9 BIRTHPLACE (City)

(State or country)

mars.

10 NAME OF

William E. Stateles,

11 BIRTHPLACE OF

FATHER (City).

Ellivet

(State or country)

mains

12 MAIDEN NAME

OF MOTHER

abigail J. Friebe

13 BIRTHPLACE OF

MOTHER (City)

Mitury,

(State or country)

Informant

Waller

(Address)

22 Presente So Winters

Filed 08 22

(Month) (Day) (Year)

21 Burial permit

issued by ......

S.a. Moury

Official

position

Health Eficaz Date of May 29

Permit No ..

.. , M.D.

Medical Examiner for.

Suffolk County.

Date

fMonth)

May 27, 1918.

(Day)

(Year)

DATE OF BURIAL

19 PLACE OF BURIAL, CREMATION, or REMOVAL

Wincelery Cem. Wini Mang May 29-1119

(Cemetery)

(City or town)

fMonthy (Day) (Year)

20 UNDERTAKER

Clear. r. Bennison

ADDRESS

REGISTRAR

17 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows : natural Causes : Presumably cardias

vascular

disease,

(Sudden death).

(See reverse side for description for unknown person)

18 Where was injury sustained

if not at place of death?

Serge Burgers Magneti,

(Sigoed

(Address)

MARGIN RESERVED FOR BINDING

10551 .

3 SEX male particular kind of work (b) General nature of iodostry, (c) Name of employer FATHER PARENTS 14 should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information for extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side husiness, or establishment in which employed (or employer)

4 COLOR OR RACE

Weiter

5 SINGLE, MARRIED, WIDOWED OR

DIVORCED (write the word)

married

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 stand- ard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the discase of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.

No undertaker or other person shall bury a huinan 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 clerk, . . . a satisfactory written state- ment containing the facts required by law to be re- turned and recorded, which . . . shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as herein- after 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 permit 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 Laws, Chap. 78, Sec. 38.

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

a 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, Scc. S.

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 electrical 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 known. 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)

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

many 26, 19 19

R-302

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

BOSTON

( City or town)

1 PLACE OF DEATH

Registered No ....

58.87

County

Suffolk

State Massachusetts

Registered No.

(Place of residence)

St.,

Ward

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

2 FULL NAME MICHAEL BRENNAN

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

MASS ... City or Town

WINTHROP

No.

36 TRIDENT AVE

St.

(a) Residence. State

(Usual place of abode)

Lengib of resideoce 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, and year)

MAY 26

1919

17 I HEREBY CERTIFY, That I attended deceased from

19.19 ...

, to.

19.19

that I last saw h.

alive on

19.19

and that death occurred, on the date stated above, at m. The CAUSE OF DEATH* was as follows :

* 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.)

FAILURE OF CLOSURE OF FORAMEN OVALE

.. (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 ?.

YES Date of

MAY 26

Was there an autopsy?

What test confirmed diagnosis ?.

(Sigoed)

T.J.SCANLAN

M.D.

,1919 (Address)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

MAY 2 89 19

CALVARY

20 UNDERTAKER WM.J.DOHERTY

ADDRESS

BOSTON

led Mety 8, 19 19

Filed JUNE 2919 ENOM Stenen

Registrar of city or town where death occurred

Registrar of city or town where deceased resided

City or Town 3 SEX M 7 AGE Years (c) Name of employer (State or country) PARENTS 14 Informant (Address) 15 carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, of certificate. so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back N. B. - WRITE PLAINLY, WITH ONFADING INA - THIS IS A PERMANENT RECORD. Every item of information should be (b) General oature of industry, business, or establishment in which employed (or employer)

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

SIN

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

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

MAY .26. 191

Months

Days

If LESS thao

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

or ....... min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, professioo, or

particular kind of work

9 BIRTHPLACE (city or town).

BOSTON

10 NAME OF FATHER MICHAEL

11 BIRTHPLACE OF FATHER (city or town) (State or country) BOSTON

12 MAIDEN NAME OF MOTHER NORA O GRADY

13 BIRTHPLACE OF MOTHER (city or town) (State or country) BOSTON

FATHER

(Place of death)

Boston

No.

SCOBEY HOSPT.

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]

Statement of occupation. - Precise statement of occupa- tion 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, Compos- ilor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial 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 household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Houscwork, 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

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Town of Winthrop : Record of Deaths 1919-1921, Part 29

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

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