Town of Winthrop : Record of Deaths 1919-1921, Part 50

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 50

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[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 he sufficient, e. g., Farmer or Planter, Physician, Campasitor, Architect, Locomative engineer, Civilengineer, Stationary fireman, etc. Butin many eases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the husiness or industry, and therefore an additional line is provided for the latter statement; it should he used only when needed. As examples: (a) Spinner, (b) Cattan mill; (a) Salesman, (b) Grocery; (a) Fareman, (b) Autamabile 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 laborcr, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Hausekeepers who receive a definite salary), may be entered as Housewife, Housewark, or At home, and children, not gainfully employed, as At school or At hame. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Caak, 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 husiness, that fact may hc 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- braspinal fever (the only definite synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumania; Branchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculasis af lungs, men- inges, peritoneum, ete., Carcinoma, Sarcama, ete., of .......... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whaaping caugh; Chranic valvular heart discase; Chranic interstitial nephritis, ete. The contributory (secondary or inter- current) affection need not he stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchapneumonia (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 causc. Always qualify all diseases resulting from childhirth 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 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 hy the physician, and the date of his death. · . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts af 1910, Chap. 322.

No undertaker or other person shall bury a human hody . . . 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- staining 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 hodies 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 ohservance 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 traumatisin (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.

-302

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

BOSTON

(City or town)

8639 .........

1 PLACE OF DEATH

Registered No.

(Place of death)

Registered No.

City or Town

Boston

No.

MASS .HOMEO .HOSPT.

St.,

Ward

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

2 FULL NAME

MEYER ZIMMERMAN

MASS

City or Town

WINTHROP

No.

370 SHIRLEY

St.

(a) Residence.

State

(Usual place of abode)

Length of residence in city or town where death occurred

Fears

mooths

days

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

years

mooths

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

MAR

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH (month, day, and year) JUNE 15.1870

Years

Months

If LESS thao

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

or ....... mio.

If STILLBORN, eoter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, professioo, or

TRAVELLING SALESMAN

particolar kiod of work

(h) Geoeral nature of industry,

business, or establisbmeot in

which employed (or employer)

(State or country)

(duration)

... yrs ............ mos ................ ds.

10 NAME OF FATHER

ISAAC

18 Where was disease contracted

if not at place of death?

Did an operation precede death?

Date of

Was there an autopsy?

12 MAIDEN NAME OF MOTHER

HANNA

NUT

What test confirmed diagnosis ?

(Signed)

H.FRANKOIN WOOD

M.D.

, 19 19 (Address)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

ADATH JESHURUN

DATE OF BURIAL

SEP . 1119

Filed SEP . 1, 89 19

20 UNDERTAKER

MYER SOLOMON

ADDRESS

Registrar of city or towo where death occurred Filed Oct. 15 19' 19- Eulalie Churchill asst Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year) SEPT.14 1919

I HEREBY CERTIFY, That I attended deceased from

SEPT.12

19.19 ....... , to

SEPT .14

19 .. 19

that I last saw h

alive on

SEPT.14

19.19

and that death occurred, on the date stated above, at II P. .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.) DIABETIS ACETONAEMIA

9 BIRTHPLACE (city or town)

RUSSIA

.(duration).

... yrs ................. mos ................. da.

CONTRIBUTORY

(SECONDARY)

COMA

11 BIRTHPLACE OF FATHER (city or town)

(State or country)

RUSSIA

13 BIRTHPLACE OF MOTHER (city or town)

(State or country)

RUSSIA

Informant

WALTER ZIMMERMAN

3 SEX

7 AGE

PARENTS

( Address)

carefully supplied. AGE should be stated EAAGILT. PHYSICIANS should state CAUSE OF DEATH In plain terms,

so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions ou back

of certificate.

County

Suffolk

State Massachusetts

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

....

........

(Place of residence)

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 ean 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- itor, Architect, Locomotive engincer, Civil engineer, Stationary fireman, cte. 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," "Dcaler," ete., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the houseliold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- eifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of 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.

Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affeetion with respect to tiinc and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, 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- eurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia."

"Anemia" (merely symptomatie), "Atrophy," "Col-

(“Con- lapse," "Coma," "Convulsions,"" "Debility"

genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease ean be ascertained as the eause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway truin - accident; Revolver wound of head - homicide; Poisoned by curbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated

under the head of "Contributory." (Recommendations on statement of eause of death approved by Committee on Noinenelature of the American Medical Association.)

Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:

1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.

2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.

3. Sudden deaths of persons not disabled by recognized discase, as A death upon the street, or one supposed to be duc to Alcoholism, etc.

4. Deaths under circumstances unknown, as A person found dead, etc.

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY

PHYSICIAN.

R 303. 6-18. 50.000

R-301

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH Suffek

County ..........

State ..

Registered No.

City or Town

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

2 FULL NAME-

Daniel inescott. Grosvenor

(a) Residence.

No.

(Usual place of abode)

274 Brodom Str

Leogth of resideoce in city or towo where death occurred

years

mooths

days.

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

years

mooths days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

man 1

5a If married, widowed, or divorced

HUSBAND of

() WIFE f

many. a.

6 DATE OF BIRTH

Left-6-1836

( Month)

fDay)

(Year)

7 AGE 83 Years

Months

#49 Days

If LESS thao I 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. (b) General nature of industry, business, or establishment in which employed (or employer).

9 BIRTHPLACE (City)

(State or country)

mais

10 NAME OF

FATHER

Daniel? Governor

11 BIRTHPLACE OF

FATHER (City)

(State or country)

12 MAIDEN NAME OF MOTHER

Namnet. Plance

13 BIRTHPLACE OF

MOTHER (City)

(State or country)

mais

Informant

(Address)

274 Bowdon 8to

15 Soft 18 Filed (Month) (Day) (Ycar)

REGISTRAR

21 | HEREBY CERTIFY that a satisfactory stao- dard certificate of death was filed with me BEFORE the borial or transit permit was issued L'

Maury 9.81

Official position:

Healthio fuci

22 Date of issue of horial or transit permit

Sept 17 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.

00,000.

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH.

(Month)

Left

5/1919

(Year)

I HEREBY CERTIFY, That I attended deceased from

Bof Guy 25, 199

, to

Left

,19

that I last saw h was alive on

Left

, 19/9

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

7 00

The CAUSE OF DEATH was as follows :

Fracture of two ribs

(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 ?

Was there an autopsy ?

Clinical

What test confirmed diagnosis ?

(Sigoed)

, M.D.

(Address)

123 Wartung St thingbugh

16/1919

Date

( Month)

(Day)

(Year)

DATE OF BURIAL

(Cemetery)

> (City or town)

19 /9

20 UNDERTAKER

ADDRESS

Left 18-19

Sept

mess

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Date of

Brancho primaria

Paxton

PARENTS

No.

274 Bowdoin St-

St ....

.Ward

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

St.,

Ward.

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

(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 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 he sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationory 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 foctory. The material worked on may form part of the second statement. Never return "Lahorer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Doy loborer, Farm loborer, Laborer -- Cool 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 Servont, 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: Former (retircd, 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 heort diseose; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Meosles (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.)

Bronchopnoumonia: 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: Abortlon, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pysmia, 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 shali 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- talning 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, hls certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physiclan, 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 he, with the cause and manner of his death, and shall make examination upon the view of the dead hodies 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 have 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 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 sgents, 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.

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Town of Winthrop : Record of Deaths 1919-1921, Part 50

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

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