Town of Winthrop : Record of Deaths 1919-1921, Part 34

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 34

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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 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 cxaminers 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 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.

IR-301

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

100,000.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County.

SUFFOLK

State

11.1:

Registered No.

St ..

Ward

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

2 FULL NAME

CORNELIUS J FLYNN

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

(a) Residence.

No.

IEPRESCOTT

St.,

Ward.

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

Leogth of resideoce in city or town where death occorred

years

mooths

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

1/1 / 12 / 11/13 1)

NAME

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

MARGARET

FLYNN

6 DATE OF BIRTH

( Month)

(Day)

(Year)

7 AGE

Ycars 3 Months

Days

If LESS than

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

or ...... min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Geoeral oature ofindustry,

bosiness, or establishment in

which employed ( or employer)

RETIRED

9 BIRTHPLACE (City)

BOSTON

(State or country)

10 NAME OF

FATHER

JOHN

FLYNN

PARENTS

11 BIRTHPLACE OF

FATHER (City).

(State or country)

IRELAN.

12 MAIDEN NAME

OF MOTHER

CATHERINE

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

Informant

JOSEPHINE

ELVIN

(Address)

IN PRESCOTT

Filed Jury 2 1917

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH.

JUNE

(Month)

(Day)

17.9

(Year)

I HEREBY CERTIFY, That I attended deceased from

1919, 80

June 28

1., 19 /. 9

that I last saw h MMM alive on

June 27

, 1919

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

9.25,- m.

The CAUSE OF DEATH , was asfollows :

Chronic Nephritis

, ( duration)

yrs

mos ........

... ds.

CONTRIBUTORY

Chrome Mitral Insufficientist

(SECONDARY)

.. (duration)

lyst

mos.

ds.

18 Where was disease contracted

if not at place of death ?

Date of ...

Did an operation precede death ?.

Changes . +

Was there an autopsy ?

Exame Unic + Secondary B't

What test conffm

Horace & brogdon

, M.D.

(Signed).

(Address I Central Agt East Boston

Date

Month)

(Day)

1919, -

DATE OF BURIAL

4 ..

(Cemetery)

(City or town)

20 UNDERTAKER

ADDRESS Samesulla

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the borial or transit permit was issued .... J.a. Maury 9.8

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

CROSS

Official Wealth Ofice 32

Date of issue of burial or transit permit ...

July 2 1919

MARCH

If STILLBORN, eoter that fact here

If STILLBORN, state period of nterogestation

mos.

( Usual place of abode)

City or Town

KINTHIRODE

No ...

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, 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 Ilousckeepers who receive a definite salary), may be entered as Housewife, Hlousework, 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, Ilousemaid, 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 respcet to time and causation), using always the same accepted term for the same discasc. Examples: Cere- brospinal fever (the only definite synonym is "Epidemie cercbrospinal 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); Mcasles; Whooping cough; Chronic valvular heart discase; 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 ascertaincd 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- inittee 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, eryslpelas, meningitis, miscar- rlage, 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 deccased, his supposed age, the discase of which he died [defined so that it can be classificd 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 shail 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 thercafter furnish for registration any other necessary information which can be obtained as to the deccased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Sec. S8.

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.

(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 disabied by recognized disease, and those of persons found dead.

R-301

should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH 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.

100,000,

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County

City or Town

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

Edwin Raymond Quing

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

(a) Residence.

No.

6 4 moore

St.,

Ward.

· (If non-resident give city of town and State)

Length of residence in city or town wbere death occurred

years

months

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

mooths days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Man

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

White

DIVORCED (write the word)

Manuel

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH

May 3 - 1860

( Montfi)

(Day)

( Year)

7 AGE

59 Years

Months 25 Days

If LESS than

If STILLBORN, enter that fact here

If STILLBORN, state period of uterogestatico

mos.

I day,

brs.

min.

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

Partant ze

10 NAME OF

FATHER

Daniel Burno

PARENTS

11 BIRTHPLACE OF

FATHER (City)

Cannot be learned

(State or country)

12 MAIDEN NAME

OF MOTHER

Cannot be learned

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

Cannot be learned

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Day)

1919

(Year)

I HEREBY CERTIFY, That I attended deceased from

april

, 1919, to

June 28

, 1919

that I last saw h ~~ alive on

Jane 27

, 19/9,

and that death occurred, on the date stated above, at 2A m. The CAUSE OF DEATH was as follows : Cancer of Bladder

Sadefuite

(duration)

yrs. .

.......

.mos.

ds.

CONTRIBUTORY

( SECONDARY)

Hommage

(duration) yrs ...

mos ..

ds.

18 Where was disease contracted

if not at place of death ? .

Did an operation precede death ?

Date of

June 1919

Was there an autopsy ?

What test confirmed diagnosis ?

4 g tracin, Hospitais Lebronty

(Signed) ..

(Address)

2/8 Luni R

Date

(( Month)

(Dây)

1959

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

(Cemetery) 11

(City or town)

1919

20 UNDERTAKER

C.R.B ....

ADDRESS

15 July 2, 1919

Filed (Month) (Day) (Year)

REGISTRAR

21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was Gled with me BEFORE the borial or transit permit was issued I.C. Maury

Official positio plaîta office 2

22 Date of issue of burial. or transit permit

, M.D.

14 Racph. H. Bums

Informant

(Address)

(Jon) 64 move 8 / Woche-

State

...

64 More Rt

Registered No.

St ...

Ward

2 FULL NAME

( Usual place of abode)

9 BIRTHPLACE (City)

(State or country)

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. Tbe question applies to each and every person, irrespective of age. For many occupations a single word or term on tbe 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) tbe 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 sbould be used only wben 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 bome, who are engaged in tbe duties of tbe bouse- bold only (not paid Housekeepers wbo receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Carc 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 bas 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, tbe DISEASE CAUSING DEATH (tbe primary affection with respect to time and causation), using always tbe same accepted term for the same disease. Examples: Cere- brospinal fever (tbe 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, peritoneum, etc., Carcinoma, Sarcoma, etc., of .. . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing deatb), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atropby," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital," "Senile,"" etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., wben 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 deatb 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 wbom be has attended during his last illness, at the request of an undertaker or otber authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of deatb, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of wbich be died [defined so that it can be classificd under tbe international classification of causes of death], where contracted, the duration of bis last illness, wben last seen alive by tbe physician, and the date of his death. . . . - Revised Laws, Chap. 29, Sccs. 10 and 1, as amended by Acts of 1910, Chap. 822.

No undertaker or other person sball bury a human body . . . until be has received a permit from the board of health or its agent, . . . or . . . from tbe 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 ... sball be accompanied by a satisfactory certificate of tbe at- tending physician, if any, as required by law, or in lieu tbereof a certifi- cate as bereinafter 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 wbom tbe per- mit is so given and the physician who certifies to the cause of death shall thereafter furnisb for registration any otber necessary information which can be obtained as to the deceased, or as to tbe manner or cause of the deatb, wbich tbe clerk or registrar may require. - Revised Laws, Chap. 78, Scc. 38.

Medical examiners shall, in all cases, certify to tbe city or town clerk or to the city registrar in tbe 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 . -

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

(1) Attending physicians will certify to such deatbs only as tbose 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 deatbs only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or wbose physician is absent from home wben tbe certificate of deatb 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 tbe action of chemical (drugs or poisons), thermal, or electrical agents, and dcatbs 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.

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

Massachusett

Registered No. 205 Panchine

St ..

Ward

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

Joseph Lyman

necoton

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

(a) Residence. No ..

( Usual place of abode)

205 Paulines

Ward.

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

Length of residence io city or town where death occurred

years

months

days.

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

mand

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH Feb. 17 1854 ( Month) (Day)

7 AGE 65 Years

Months

Days

If LESS than 1 day, ....... hrs. or ........ min.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (h) General nature ofindustry, hnsiness, or establishment in which employed ( or employer).

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Town of Winthrop : Record of Deaths 1919-1921, Part 34

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

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