Town of Winthrop : Record of Deaths 1919-1921, Part 53

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 53

Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).

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 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 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 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.

M R-301

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County.

Suffolk

State ... Massachusetts

Registered No.

City or Town

BOSTON

No.

Metcalf Hospital

Ward

(If death occurred in a hospital or institution, give Its NAMEinstead of street and number)

2 FULL NAME

Baby Salario

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

(a) Residence.

No.

16 Dix

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 birth ? years

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male White

4 COLOR OR RACE

5 SINGLE, MARRESO, WIDOWED, OR

DIVORCED (write the word)

Pingle

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH

Sept

(Month)

(Day )

(Year)

7 AGE

If STILLBORN, enter that fact bere

If STILLBORN, state period of nterogestation

...... . mos.

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) (c) Name of employer

.(duration)

.... yrs.

.mos ....

ds.

CONTRIBUTORY

(SECONDARY)

aspolicia.

(duration)

...... yrs .......

mos ..

ds.

18 Where was disease contracted

if not at place of death ?

FOR WHAT?

Did an operation precede death ?

Date of

Was there an autopsy ?

What test confirmed diagnosis ? Frank 7 Sandler

(Signed)

M.D.

(Address)

543 Beach At Perce

Lept 26

1419

(Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAQ

DATE OF BURIAL

Betty Joseph len

(Cemetery,

(City or town)

Wolvery Sext 26 199

15 Soft 27 1919

Filed (Month) (Day) (Year)

REGISTRAR

21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued ?. Maury

Date of

Permit

19. 150,000.

-'19- XXM.)

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK -THIS IS A PERMANENT RECURU. Every item of information

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

PARENTS

11 BIRTHPLACE OF

FATHER (City)

Russia

(State or country)

12 MAIDEN NAME

OF MOTHER

Sarah Wheely

13 BIRTHPLACE OF

MOTHER (City)

Rusai

(State or country)

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

Sept 25

1919

(Day)

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

... to.

1.9

1919

that I last saw h

alive on

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

The CAUSE OF DEATH was as follows :

still for due to

Placenta prouna

9 BIRTHPLACE (City)

Winthrop Mass

(State or country)

10 NAME OF

FATHER

Obicham Salvi

14 Abraham Salaire

Informant

(Address)

1. Difft. Revere

Date

20 UNDERTAKER Manuel Stanetely Boston

- Official /

Position Cattle Officiel permit

9/2/12 19.

ADDRESS

(Usual place of abode)

Years

Months

Stilton

If LESS than

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

or ....... min.

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 be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fircman, 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 "Laborcr," "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 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" (mercly 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- mittec 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.

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 hy 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 dicd; . .. 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 he 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 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 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 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.

M R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County

Suffolk

State Massachusetts. Registered No.

City or Town

BOSTON ...

No.

St ..

.Ward

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

2 FULL NAME

O thering Julen.

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

(a) Residence.

No.

( Usual place of abode)

15 Moore street

St.,

Ward.

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

Length of residence in city or town where death occurred

years

4 months

days.

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

. hite

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Single

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH

Chruary

I.G.

( Month)

(Day)

(Year)

If STILLBORN, enter that fact here

If STILLBORN, state period of nterogestation

.........

mos.

If LESS than

1 day, ...... brs.

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 )

At rome

11 BIRTHPLACE OF

FATHER (City)Lost

(State or country)

12 MAIDEN NAME

OF MOTHER

lian NotMorgon

13 BIRTHPLACE OF

MOTHER (City)

centriing.

(State or country)

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

Seph.

(Mouth)

(Day)

1814

(Year)

I HEREBY CERTIFY, That I attended deceased from

199, to

Cep. 20, 19

19,

that I last saw h ............. alive on

lepo, 25

19 15.

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

m. The CAUSE OF DEATH was as follows:

Dipteturia (normal)

( duration)

... yrs ..

mos.

.ds.

CONTRIBUTORY

( SECONDARY)

(duration)

... yrs.

mos.

ds.

18 Where was disease contracted

if not at place of death ?

FOR WHAT?

Did an operation precede death? 40.

Date of.

Was there an autopsy ?

zu.

What test confirmed diagnosis ?.

clicmint & labor

(Signed)

M.D.

( Address ) ...

maso

26.

1919.

Date

( Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

(Cemetery)

(City or town)

20 UNDERTAKER

R.l. Ruch

ADDRESS

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

REGISTRAR

21 1 HEREBY CERTIFY that a satisfactory stan-

dard certificate of death was filed with me

BEFORE the hnrial or transit permit was issned.

. C. Mowry

Date of Official Lealtre Office permit cept 26,19 No 37 position

Permit

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

3 SEX 7 AGE (c) Name of employer 10 NAME OF FATHER PARENTS 14 Informant (Address ) instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH N. B. - WRITE PLAINLT, WTIn UNTAUING OLAGA THA THIS IS ATT CHIMALTT TILVUND, LIỆT TUIN VI -HUHUUUH (State or country)

9 BIRTHPLACE (City)

Dont Costone

Years

Months

Days

25-

....

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 ags. 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, 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 worksd on may form part of the second statement. Never rsturn "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 he entered as Housewife, Housework, or At home, and children, not gainfully employsd, 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 DEATHI (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 (nover 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 necd 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- lapss,""Coma,""Convulsions," "Debility" ("Congenital,""Ssnile," 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 childhirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.

W. Gorter.

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.

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, ths disease of which he died [defined so that it can be classified under the international classification of causes of death], where contractcd, 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 hs 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 ths per- mit is so given and the physician who certifies to the causs 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 ths 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 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 disahled by recognizsd 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 ths 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.

N. B. - WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,

Sept 26, 1919

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

( City or town)

1 PLACE OF DEATH

Registered No.

(Placc of death)

Registered No

(Place of residence)

City or Town

Boston

No.

MA S.S .HO MEO HOSPT

St.,

Ward

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

2 FULL NAME

WILLIAM F.WEST

MASS.

City or Town

No.

29 MOORE

St.

(a) Residence.

State

(Usual place of abode)

Length of residence in city or town where death occurred

years

months

days

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

WID.

17 I HEREBY CERTIFY, That I attended deceased from

19.19

that I last saw h ....

alive on

19.19

6 DATE OF BIRTH (month, day, and year) AUG.28.1866

7 AGE

Years

Months

Days

If LESS than

1 day.

... brs.

or ....... min.

If STILLBORN, enter that fact bere

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

ASSISTANT BUYER

BILATERAL PNEUMONIA (BRONCHO)

(b) General nature of industry,

business, or establishment in

which employed ( or employer)

(duration)

yrs ...............

.mos.

ds.

(State or country)

OHIO

(SECONDARY)

(duration)

mos ..

ds.

10 NAME OF FATHER

ROBERT WEST

18 Where was disease contracted

if not at place of death ?

11 BIRTHPLACE OF FATHER (city or town)

(State or country)

CONN.

Was there an autopsy?

12 MAIDEN NAME OF MOTHER

MARY ALEXANDER

What test confirmed diagnosis ?.

(Signed)

S.A.CLEMENT

, M.D.

, 1919 (Address)

Informant

(Address)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

MASS. CREMATORY

DATE OF BURIAL

SEP .27 19

Filed

SEP . 399 19

MUMSlenen

Registrar of city or town where death occurred

Filed ..

Oct. 15

19 19 Enlaby Churchill

que Registrar of city or town where deceased resided

20 UNDERTAKER

C.R.BENNISON

ADDRESS

WINTHROP

8916

County

Suffolk

State

Massachusetts

BOSTON

MARGIN RESERVED FOR BINDING

Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.

Town of Winthrop : Record of Deaths 1919-1921, Part 53

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

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