Town of Winthrop : Record of Deaths 1919-1921, Part 49

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 49

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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 dicd, 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 mako 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 physlclans will certify to such deaths only as those of persons to whom they havo given bedside care during a last illness from discase unrelated to any form of injury.

(2) Board of Health Physlclans will certify to such deaths only as those of persons who, though disabled by recognized discaso unrelated to any form of injury, have died without recent medical attendance or whose physician is absont from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. Theso includo 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 infectlon related to oecupatlon, the sudden deaths of porsons not disabled by recognized disease, and those of persons found dead.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH County ..

State

Registered No.

City or Town

No. 22 Watsier ane

St ...... ..

..... Ward

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

2 FULL NAME

Richard. Eugena.

Bear

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

(a) Residence. No.

( Usual place of abode)

22 Maskeli cuSt.,

Ward

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

Length of resideoce io city or town wbere death occurred

years

9 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

(Montti)

(Day)

1414

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

, 19, to.

., 19

11.

that I last saw h wy alive on , 19 / 5,

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

The CAUSE OF DEATH was as follows :

Brancho merania

(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).

Date

Salt

( Month)

(Day)

(Year)

(Factor)

Informant

(Address)

22 Vardas de am

15 Soll 15- Filed (Month) (Day) (Year)

REGISTRAR

21 I HEREBY CERTIFY that a satisfactory stao- dard certificate of death was filed with me BEFORE the borial or transit permit was issued . S.R. Vinoum 4.8

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

wanehart County

DATE OF BURIAL Left- 18/ 199

(Cemetery) Nicht

(City or town)

20 UNDERTAKER

ADDRESS

Official posi of Health Officie

22 Date of issue of borial or transit permit

Seket. 11, 1919

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

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

12 MAIDEN NAME

OF MOTHER

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

I day, .... hrs. or min.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) General oature of industry, business, or establishment io which employed (or employer ). (c) Name of employer

9 BIRTHPLACE (City) (State or country)

10 NAME OF

FATHER

David R. Bean

(Year)

7 AGE

Ycars

Months

Days

If LESS thao

If STILLBORN, eoter that fact here

If STILLBORN, state period of uterogestation

mos.

Dec- 3-1918-

6 DATE OF BIRTH

{ Monthi)

(Day)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

3 SEX

Shall

14.4

100,000.

(

R-301

VISED 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, c. g., Farmer or Planter, Physician, Compositor, 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 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, 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 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, ete., Carcinoma, Sarcoma, etc., of .......... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; 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," ete.), "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," ete.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittee on Nomenclaturc 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 [defincd 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 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 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 persens found dead.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH County ...

State ..

Registered No.

No. 19 2220020 cfh St. .Ward

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

2 FULL NAME

William

amnes .

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

(a) Residence. No.

(Usual place of abode)

19 moreal

St.,

Ward.

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

Length of residence in city or town where death occorred

5 years

mooths

days.

How loog io U. S., if of foreigo hirth ?

years

-5 months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

white

5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word) Таллик

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH

( Month)

(Day)

(Year)

7 AGE 68 Years

Months

Days

If LESS thao 1 day, . hrs.

If STILLBORN, enter that fact here

If STILLBORN, state period of nterogestatioo

mos.

or min.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kiod of work (h) General oature of industry, business, or establishment in which employed (or employer) (c) Name of employer

9 BIRTHPLACE (City) (State or country)

10 NAME OF

FATHER

Daniel Nowany

PARENTS

11 BIRTHPLACE OF

FATHER (City).

(State or country)

12 MAIDEN NAME

OF MOTHER

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

14 Mary ann. Howard

Informant

(Address)

with - 19 more

15 Seht 18 (Month) (Day) (Year)

REGISTRAR

21 I HEREBY CERTIFY that a satisfactory stao- dard certificate of death was filed with me BEFORE the horial or transit permit was issued S. t. Maury

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

(Cemetery) (City or town)

20 UNDERTAKER

ADDRESS

Official Realthe Office" position

,22 Date of issue of burial or transit permit

Sept 21, 19/9

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.

00,000.

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

(Day)

1914

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

19/9

to. felt 10 , 1975

that I last saw he alive on

, 19 ...... «,

and that death occurred, on the date stated above, at 3 A. m. The CAUSE OF DEATH was as follows :

Istar Premionia.

(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) 336 Uncher

Date

(Month)

(Day)

(Year)

Mary ann Nowat

Molder

Inplant

R-301

City or Town

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, ete. 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 "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 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.

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 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.

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.

R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County .... .

State.

Registered No.

City or Town

No.

236 Percola SL

St ....

.Ward

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

2 FULL NAME

Newell. Gware Slone

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

(a) Residence.

No. 236 tinción

St.,

.Ward.

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

Length of residence in city or towo where death occurred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

Mute

5 SINGLE, MARRIEO, WIOOWEO, OR

OIVORCEO (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Clara. L. ottone

6 DATE OF BIRTH

( Month)

(Day)

(Year)

7 AGE

Years

Months

Days

If LESS than

1 day, .... brs.

If STILLBORN, enter that fact here

If STILLBORN, state period of uterogestatioo

mos.

or .... mio.

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

Swampscott

9 BIRTHPLACE (City)

(State or country)

maso

10 NAME OF

FATHER

Henry. 8. Storia

11 BIRTHPLACE OF

FATHER (City)

(State or country)

12 MAIDEN NAME

OF MOTHER

Kamer. 13 Smick

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

Wife, Clara. f. Stone

Informant

(Address)

236 Rucola I'd Winwhich has

Scht 18

Filed

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH ..

September

1.3

(Month)

(Day)

1914

(Year)

I HEREBY CERTIFY, That I attended deceased from

Sept.

, 19/9, to LeKT 13

, 1919.

that I last saw h y alive on .

Les 13

, 1919,

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

5.20 Am.

The CAUSE OF DEATH was as follows: Serebral hemorrhage

(duration)

yrs ...

-... .. mos. ... /

ds.

Shows infestation nephritis

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 ?

200

What test confirmed diagnosis ?

Personal Observation

(Signed) ...

R. B. Parlam

, M.O.

( Address)

Winthrop, mass

Oate

Sup T

J'(Month)

(Day)

1919.

Years

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

(Cemetery)

(City or town)

DATE OF BURIAL

Sell. 15

19 /7

20 UNDERTAKER

ADDRESS

Official position 250

22 Oate of issue of horial or transit permit

1/3,19.9

instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classifled. Exact statement of OCCUPATION is very important. See

100,000.

21 | HEREBY CERTIFY that a satisfactory stao- dard certificate of death was filed with me BEFORE the borial or transit permit was issued .: € S.t. Mowy

.....

( Usual place of abode)

Sec 23

1864

merchant

PARENTS

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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Town of Winthrop : Record of Deaths 1919-1921, Part 49

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

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