Town of Winthrop : Record of Deaths 1919-1921, Part 68

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 68

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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 he, with the eause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to havo 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 havo given bedside caro during a last illness from disease unrelated to any form of injury.

(2) Board of Heaith 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 homo 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 disabied by recognized disease, and those of persons found dead.

IR-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County. ....

City or Town

Mithran

No.

State

Registered No. 6

St.,

Ward

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

2 FULL NAME

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

(a) Residence.

No ...

15 Junmadame Rif 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

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH Jau ( Month:)

3 1920 (Year)

(Day)

7 AGE

Years

Months

Days

If LESS than

If STILLBORN, enter that fact bere

If STILLBORN, stale period of uterogestation

mcs.

1 day, ...... hrs. or ........ min.

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

.. (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 ?..

200

Was there an autopsy ?

What test confirmed diagnosis ?

Sympatinão

(Signed)

, M.D.

( Address)

Raven masa

Date.

(Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

(Cemetery)

(City or town)

w9 1975

20 UNDERTAKER

ADDRESS

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issned

8 am

Official position

22 Date of issue of horial or transit permit.

gun 9/20

12 MAIDEN NAME

OF MOTHER

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

Informant

(Address)

15 Jan. 2. 1920

Marjorie DEay

(Month) (Day) (Year)

asst REGISTRAR

MEDICAL CERTIFICATE OF DEATH

1920

16 DATE OF DEATH.

(Month)

(Day)

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

19.2.0 , to

. , 192.

that I last saw her alive on

, 19.20,

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

. m.

The CAUSE OF DEATH was as follows :

9 BIRTHPLACE (City)

( State or country)

Hanthrow

10 NAME OF

FATHER

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

PARENTS

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

100,000.

Date of

1920

( Usual place of abode)

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 relativo 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 tho 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) tho 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 tho 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 nisEASE CAUSINO 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 NEATH (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 definito synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid uso of "Croup"); Typhoid fever (never rsport "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" (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., wlien a definite discase can be ascertaincd as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittce 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, erysipolas, 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 otlicr 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 belicf the name of the deceased, his supposed agc, ths discase 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 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 thero 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 recordsd, 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 thereafterfurnish 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 requirs. - 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 bs, 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 physicians will certify to such dsaths 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 whoss physician is absent from heme when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. Thess 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, tho suddsn 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. 7

City or Town

No. 21

State Grover Que

St ...

.Ward

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

Charles. H. Murphy-

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

(a) Residence.

No.22

(Usual place of abode)

Length of resideoce io city or town where death occorred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male White

4 COLOF OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Marked

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

Jan

6 DATE OF BIRTH

( Month)

(Day)

(Year)

7 AGE 42 Years

Months

Days

If STILLBORN, eoter that fact bere

If STILLBORN, state period of oterogestation.

... mos.

If LESS thao

I day, ........ hrs.

or ........ min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kiod of work

(b) General nature ofiodostry,

business, or establishmeot in

which employed ( or employer)

9 BIRTHPLACE (City)

(State or country)

10 NAME OF

FATHER

PARENTS

11 BIRTHPLACE OF

FATHER (City).

(State or country)

12 MAIDEN NAME

OF MOTHER

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

Nonasvi

Sau ..

17.

1920

( Month)

(Da)

(Year)

Informant.

(Address)

2% the rn. 14 1.

M.S.

(Cemetery)

(City or town)

DATE OF BURIAL Jan 191920

ADDRESS

15 Jan, 2, 1920

(Month) (Day) (Year)

1 aset. REGISTRAR

150,000.

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

Official position

Date of issue of permit

............

No .......

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

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

MEDICAL CERTIFICATE OF DEATH

Stan ... 75

1920

16 DATE OF DEATH

(Month)

(Day)

(Year)

17 I HEREBY CERTIFY, That I attended deceased from Lles. 15 1919 te Stac .. 15, 1920

that I last saw h. alive on gan ... 15, 1920

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

7.95P m.

The CAUSE OF DEATH was as follows : dente rification

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

.. ma

19 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

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

alvary

marjorie theay

20 UNDERTAKER Heating - Mitchell

Permit

2 FULL NAME

Grover Que

St.,

Ward.

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

1878

( duration) Seplie Bunchr.

Indian Og

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, 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, Houscwork, 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 diseasc. 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.

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 [defined so that it can be classified under the international classification of causes of deatlı], 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. 892.

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 thero 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 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 v -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. 88.

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 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

mais

State .

Registered No. 8

No. 22 almeno

St ....

.Ward

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

@ cely Batty

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

(a) Residence. No.

(Usual place of abode)

Length of residence io city or town where death occorred

years

X moths

days.

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

years

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Day)

(Year)

17 I HEREBY CERTIFY, That I attended deceased from

Dec 29

, 19.ºf .,to

Jam 15

, 1920,

that I last saw h &

alive on

Jan

15 , 19 -¢, and that death occurred, on the date stated above, at /1. 30 A m . The CAUSE OF DEATH was as follows :

Com

1 Bladden

(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 ?

(Sigoed).

R . B . Parku

, M.D.

(Address) ..

Date

( Month)

(Day)

1920

( Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

Belleview

(Cemetery)

(City or town)

1920

20 UNDERTAKER

ADDRESS

(Month) (Day) (Year)

asst. 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

Official position

22 Date of issue of burial or transit permit

City or Town 2 FULL NAME 3 SEX Temel 6 DATE OF BIRTH (c) Name of employer 10 NAME OF FATHER PARENTS should be carefully supplied. AGE should be stated EXACTLY. ITSICIANS should state CAUSE OF DEATH 9 BIRTHPLACE (City) (State or country) 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

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

White

Char. Bally-

1830

( Month)

(Day)

( Year)

7 AGE 79 Years

Months 25 Days

If LESS thao

I day, . brs.

min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(h) Geoeral nature of industry,

business, or establisbmeot io

which employed (or employer)

at Home

England

James Robinson

11 BIRTHPLACE OF

FATHER (City)

(State or country)

12 MAIDEN NAME

OF MOTHER

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

14 W. E. Robinson

Informant

(Address)

22 adrama Sh Wetank

15 Jan. 2 1920

Marjorie Dran.

100,000.

22 acham.

St.,

Ward.

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

mooths

days

PERSONAL AND STATISTICAL PARTICULARS

5a If married, widowed, or divorced

HUSBAND of

for) WIEE &f

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Town of Winthrop : Record of Deaths 1919-1921, Part 68

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

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