Town of Winthrop : Record of Deaths 1919-1921, Part 45

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 45

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Medical examiners shall, in all cases, certify to tho 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 theso 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 & 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, havo died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical examiners will investigato 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 disabicd 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.

mads

Registered No.

City or Town

Minthogy

No 66 Pleasant

St., ...

.. Ward

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

2 FULL NAME

Helen Josephine Medholdl-

(a) Residence.

466 Pleasant

St.,

.Ward.

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

( Usual place of abode)

(ff non-resident give eity or town and State)

Length of residence in city or town where death occurred

10 years

mooths

days.

How loog io U. S., if of foreign birth ?

years

mooths

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Single

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Single

6 DATE OF BIRTH

('Monthi)

(Day)

7 AGE

Years

Months 14 Days

If STILLBORN, eoter that fact here

If STILLBORN, state period of uterogestatioo

mos

If LESS thao

1 day, ........ brs.

or ........ min.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (h) General nature of industry, business, or establishmeot in which employed ( or employer)

9 BIRTHPLACE (City) (State or country)

10 NAME OF

FATHER

Louis- Medhold

11 BIRTHPLACE OF FATHER (City ) .... (State or country)

12 MAIDEN NAME

OF MOTHER

Than Bruce

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

Lancaster Da-

Date

august-21-

1919

(Year)

( Mouth)

(Day)

14 Louis- Medhotel

Informant.

(Address)

400 Pleasant SP

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

anthrop. Withup

(Cemetery)

(City or fown)

DATE OF BURIAL 8-23-1917

ADDRESS

15 Filed Cruy 30 1919 (Month) (Day) (Year)

Eulalie Churchill

assi

REGISTRAR

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the horial or transit permit was issued 8. 1. Maury 9.8

Official Health affects position»,

22 Date of issue of horial or transit permit

Cuar 22

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.

PARENTS

Wilmington

(duration)

Pulmonary Embolus

. yrs ...

mos ....

ds.

CONTRIBUTORY.

(SECONDARY)

(duration)

yrs.

mos ... ds.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death ?.

Date of

Was there an autopsy ?

What test confirmed diagnosis ?

Mass. Tate Boards Lite

(Signed)

Many

6. Italiace

M.D.

5.87 Pleasant H. Hanthinh

(Address)

16 DATE OF DEATH

august

21,

(Month)

(Day)'

(Year)

,19

HEREBY CERTIFY, That I attended deceased from

Jefitimbre

august 21, 1919

, 19

that I last saw her

alive on

august 21, 1919.

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

6 a.

The CAUSE OF DEATH was as follows :

Pulmonary

Intucularis

MEDICAL CERTIFICATE OF DEATH

1919

20 UNDERTAKER

M.C. Skaggs

100,000.

Suriden

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 he 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 he sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotire 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 thercforc an additional line is provided for the latter statement; it should ho used only when needed. As cxamples: (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 tho duties of the house- hold only (not paid Il ousekcepers who receive a definite salary), may be entercd 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 heen changed or given up on account of the DISEASE CAUSING DEATH, state occupation at heginning 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 discase. 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, peritoneum, etc., Carcinoma, Sarcoma, etc., of .. . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection nced not he stated unless important. Example: Measles (discase causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (mcrely 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 he 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 hy 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 hest of his knowledge and helief 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. 822.

No undertaker or other person shall bury a human body . . . until he has received a permit from the hoard 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 heen 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 he accompanied hy a satisfactory certificate of the at- tending physician, if any, as required by law, or in licu 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 tho 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. 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 dicd, his name and residence, if known, otherwise a description of such person as full as may he, with the cause and manner of his death, and shall make examination upon the view of the dead hodics of only such persons as are supposed to have come to their death hy violence. - Revised Laws, Chap. 24, Sec. 8.

RULES OF PRACTICE

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

(1) Attending physicians will certify to such deaths only as those of persons to whom they havo 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 disahlcd by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH County ...

Registered No. ... State Man

City or Town

No.

19 Locuste JL

St.

.. Ward

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

2 FULL NAME

Nellie I della

Bowser

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

(a) Residence. No.

( Usual place of abode)

St.,

Ward.

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

Length of residence in city or town where death occurred× years months

days.

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Day)

19.4

(Year)

I HEREBY CERTIFY, That I attended deceased from

, 1917, to

meg 2.2, 1914,

that I last saw h ~~ alive on

, 19 .1 ....... ,

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

9.15 Pm

The CAUSE OF DEATH was as follows :

Pularmany Tubeless

(duration)

yrs.

mos.

.... .

ds.

CONTRIBUTORY

( SECONDARY)

(duration)

yrs

mos.

ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death?

Date of.

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed).

, M.D.

(Address)

356 Umthe As It

Date

( Montti)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Jackviele n.B.

(Cemetery)

(City or town)

DATE OF BURIAL

Cup 26 1919

ADDRESS

Filed aug. 30, 1919.

(Month) (Day) (Year)

Enlalie Churchill

asit 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 ...

2. I. Cnauy.

Official position Re

Health Effects 2

22 Date of issue of horial or trausit permit

Rua. 25/919

5a If married, widowed, or divorced HUSBAND of (or) WIFE of Clarence, Baver

6 DATE OF BIRTH

( Month)

( Year)

7 AGE 39 Years 2 Months 12 Days

If LESS than

1 day, .. hrs.

If STILLBORN, enter that fact here

If STILLBORN, state period of uterogestation

mos.

or . min.

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

9 BIRTHPLACE (City)

(State or country)

10 NAME OF

FATHER

William Llaman

11 BIRTHPLACE OF

FATHER (City)

(State or country)

12 MAIDEN NAME

OF MOTHER

Dorcas. Babcock

Pachuca

13 BIRTHPLACE OF MOTHER (City) (State or country) 2.3.

Larende, Konzer

20 UNDERTAKER BR Semana

19. -

100,000.

3 SEX PARENTS 14 Informant (Address) should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE Of DEATH (c) Name of employer 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

19 Pocush

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

manuel

11 + 1880

(Day)

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 he known. The question applies to each and every person, irrespective of age. For many occupations a single word or term ou the first line 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 cxamples: (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 heen changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of .. .. (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can he 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.

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 helief the name of the deceased, his supposed age, the disease of which he died [defined so that it can he 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 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 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 hy 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 hy 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.

R-302

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)

State Mars

Registered No ..

City or Town 00 Winthrop

No.

332 Revere

St., ...

.Ward

Uf dcath occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME

Frederick

W Boyunca

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

(a) Residence.

No.

332

Rever SK

(Usnal place of abode)

Length of resideoce io city or town where death occurred years

months

days

How loog in U. S., if of foreigo birth?

years

mooths

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

ang

22 1419

(Day)

(Year)

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 :

Achtgyration by derwoning accidental

(See reverse side for additional spacc)

18 Where was injury sustained

if not at place of death?

(Sigoed)

., M.D.

(Address)

Medical Examioer for

Date

(Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

20 UNDERTAKER

DATE OF BURIAL amy 15- 1419 (Month) (Day) (Year) ADDRESS

21 Burial permit issued by 2. poury

Official position

faith officer

22 Date of issue Rug. 2 4 19.9

3. SEX PARENTS See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. should be carefully supplied. AGE should be stated EXACTLY. MEDICAL EXAMINERS should state CAUSE OF (c) Name of employer

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

manuel

5a If married, widowed, or divorced HUSBAND of (or) WIFE of

Boynton

6 DATE OF BIRTH

(Month)

(Day)

(Year)

7 AGE 3 5 Years 2 Months 22 Days

If LESS thao I day. ..... . brs. or ....... mio.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work Elechociano

(h) Geoeral nature of industry,

business, or establishment io

which employed (or employer)

9 BIRTHPLACE (City)

Lyn

(State or country)

man

10 NAME OF

FATHER

11 BIRTHPLACE OF

FATHER (City)

Peabody

(State or country)

12 MAIDEN NAME

OF MOTHER

Lenni Carr

13 BIRTHPLACE OF

MOTHER (City)

Prova Parler

(State or country)

14 Informant (Address) 332 Revine St Wuthe

15 Filed 949.30 1919 Eulalie Churchill (Month (Day) (Year) auf REGISTRAR

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Town of Winthrop : Record of Deaths 1919-1921, Part 45

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

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