USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 81
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).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121 | Part 122 | Part 123 | Part 124 | Part 125 | Part 126 | Part 127 | Part 128 | Part 129 | Part 130 | Part 131 | Part 132 | Part 133 | Part 134 | Part 135 | Part 136 | Part 137 | Part 138 | Part 139 | Part 140 | Part 141 | Part 142 | Part 143 | Part 144 | Part 145 | Part 146 | Part 147 | Part 148 | Part 149 | Part 150 | Part 151 | Part 152 | Part 153 | Part 154 | Part 155 | Part 156 | Part 157 | Part 158 | Part 159 | Part 160 | Part 161 | Part 162 | Part 163 | Part 164 | Part 165 | Part 166 | Part 167 | Part 168 | Part 169 | Part 170 | Part 171 | Part 172 | Part 173 | Part 174 | Part 175 | Part 176 | Part 177 | Part 178 | Part 179 | Part 180 | Part 181 | Part 182 | Part 183 | Part 184 | Part 185 | Part 186 | Part 187 | Part 188 | Part 189 | Part 190 | Part 191 | Part 192 | Part 193 | Part 194 | Part 195 | Part 196 | Part 197 | Part 198 | Part 199 | Part 200 | Part 201 | Part 202 | Part 203 | Part 204 | Part 205 | Part 206 | Part 207 | Part 208 | Part 209 | Part 210 | Part 211 | Part 212
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATII (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic ecrebrospinal 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 contribntory (secondary or inter- current) affection need not be stated imless important. Example: Meusles (discase causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia,' "Ancmia" (merely symptomatic), "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 can be ascertaincd as the canse. Always qualify all discases 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 train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (c. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature 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 deathis of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc. 1
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PHYSICIAN.
U
-
-.
-
-
-.
R 303. 6-'18. 50,000.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(No. 1016 Shelley
St. .......... .Ward)
Beverly Veryumin Oriente
[If married or divorced woman or widow
give maiden name, also name of husband .!
@RESIDENCE
10% Shirley V'S W enchufe
PERSONAL AND STATISTICAL PARTICULARS
1 PLACE OF DEATH
2 FULL NAME
3 SEX
4 COLOR OR RACE
7 AGE
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment
In
which employed (or employer)
9 BIRTHPLACE
(State or country)
11 BIRTHPLACE
OF FATHER
(State or country)
12 MAIDEN NAME
OF MOTHER
PARENTS
(Informant)
CR Gemma
important. See instructions on back of certificate.
(Address)
N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
...
1
... yrs. ....
11
mos.
ds.
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
.
$ DATE OF BIRTH
mar 23 1 918
(Month)
(Day)
(Year)
If LESS than I day ........ hrs.
or ........ min. ?
10 NAME OF
FATHER
Marchuer, Foicut
mars
13 BIRTHPLACE
OF MOTHER
(State or country)
P. C. Yaland
14THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
16 Filed mch 1, 1920 marjorie DEay .............
asst. REGISTRAR
....
17
I HEREBY CERTIFY that I attended deceased from
Feb 21
19RU to
7-6 23
1920
that [ last saw h ........ alive on
.....
2of 22
1920
and that death occurred, on the date stated above, at
1A
.m.
The CAUSE OF DEATH* was as follows :
Pneu
(Duration)
yrs.
.mos. ..
ds.
Contributory ..
Whooping Cough
(SECONDARY)
(Duration) mos. ds. yrs.
(Signed) :
Tef 24, 19126 (Address)
M.D.
200 pleasaix si
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR
RECENT RESIDENTS).
At place
In the
of death ............ yrs.
.. mos. ............ ds.
State ............ yrs. ............ mos. ............ ds .......
Where was disease contracted, if not at place of death ?.
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL 2/2 0 1920
30 UNDERTAKER
ADDRESS
(City or town.)
[If death occurred in a hospital or institution, give its NAME Instead of street and number.]
Registered No. 3 7
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
23
1920
(Day)
(Year)
JEb. 23, 1920 . STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation 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, Loco- motive 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) Sales- man, (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, cte. Women at home, who are engaged in the dutics of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, ete. 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 oceu- pation whatever, write Nonc.
Statement of cause of death. - Namc, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite); Tuber-
-1
culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
important. See Instructions on back of certificate. N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state .....
$ SEX
.. ale
$ DATE OF BIRTH
PARENTS
(Informant)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
particular kind of work
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
Single.
WIDOWED, OR DIVORCED (Write the word)
November
14th
900
(Month)
(Day)
(Year)
7 AGE 25
yrs.
mos.
ds.
or ....
.min. ?
8 OCCUPATION
(a) Trede, profession, or
Farmer
(b) General nature of industry,
business, or establishment in
which employed (or employer).
Farming
9 BIRTHPLACE
(State or country)
County of Carroll, T.H.
Contributory
(SECONDARY)
/ a Daration
.yrs.
mos. ................ ds.
.....
* If death followed injury or violence the certificate of death must be made ont by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
yrs.
mos.
15
ds.
In the
Stato
.... y:s. ........
... mos ..
......
ds .............
Where was disease contracted,
Fort Banks ,Lass.
If not af place of death ?.
Former or
usual residence.
Nolfboro, N.H.
19 PLACE OF BURIAL OR REMOVAL Sanford, ainc.
DATE OF BURIAL
191
20 UNDERTAKER
L.A.Hurd
acest. REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
February
24th
(Month)
(Day)
....
1920.
....
(Year)
17 I HEREBY CERTIFY that I attended deceased from February 9th . 1920., to. February 24th, 19120,
that | last saw him. alive on
February 24th, 19120,
and that death occurred, on the date stated above, at
10.363
The CAUSE OF DEATH* was as follows :
Broncho-pneumonia.
(Duration)
......
..... yrs ..
...........
.. mos.
14
ds.
10 NAME OF
FATHER
Issac L.Allbee
11 BIRTHPLACE
OF FATHER
(State or country)
Summerset County, loss.
12 MAIDEN NAME
OF MOTHER
Grace Davis
1ª BIRTHPLACE
OF MOTHER
(State or country)
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Issac L.Allbee
(Address)
Wolfboro, T.H.
Filed mch.1 1920 maryour Hear.
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME Charles L. Allbee, Pyt 805th Lotor Transport Corps. [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
St. ;..................... .Ward)
Registered No.
38
PERSONAL AND STATISTICAL PARTICULARS
3
13
If LESS than t day ......... hrs.
....
M.D.
(Signed)
Feb 25th
1970.
(Address).
ort Ban's ...
ADDRESS
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Fort Ben's, Lass.
(No.
Post Hospital.
.... .
JEv. 24, 1920. STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation is very important, so that the relative healthfulness of various pursuits can be known. The question applics to each and every person, irrespective of age. For many occupations a singlo word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, Loco- motive 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 nccdcd. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may forin 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 household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gaill- fully employed, as At school or At home. Care should be taken to report specifically 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 occu- pation whatever, write None.
Statement of cause of death. - Nanie, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never rc- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritonaeum, etc., Careinoma, Sar- eoma, etc., of .... ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronie interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd not be stated unless im- portant. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicacmia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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 violonce, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the strect, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
-
A 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.
39
City or Town
-BOSTON Winthrop
30 Temple Ave.
St., ... .. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Cornelia VanVleck.
(If in the Army or Navy of the United States, give rank, organization, etc.)
30 Temple Ave.
St.,
Ward.
(If non-resident give eity or town and State)
Length of residence in city or town where death occorred
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
widoutethe word)
16 DATE OF DEATH
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
Henry B. VanVleck.
(or) WIFE of
6 DATE OF BIRTH
Sept 30 1838
(Day)"
(Year)
7 AGE
Years
Months
Days
If LESS than
I day, ........ hrs.
cr ........ min.
8 OCCUPATION OF DECEASED (a) Trade. profession, or particular kind of work none.
.. (duration)
.yrs.
mos ...
.I.Q. .. ds.
CONTRIBUTORY
(SECONDARY)
.. (duration)
2
yrs .........
nos ... .ds.
18 Where was disease contracted
if not at place of death ?
FOR WHAT?
no.
Did an operation precede death ? Date of -
Was there an autopsy ?
no
What test confirmed diagnosis ?. Peronal observation
(Signed).
R. B. Palau
, M.D.
(Address)
Winthrop
Date
76
25
1920
( Month)
(Day)
( Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
Hudson N.Y.
Feb 25 1920
(Cemetery)
(City or town)
19
20 UNDERTAKER
ADDRESS Boston.
Official . position.
Health officer
Date of issoe of permit Feb. 25 No ...... 02
Permit
. 150,000. '19-XXM.)
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See
instructions and extracts from the laws on back of certificate.
14
Informant
W. H. VanVleck.
(Address)
141 Milk Street Boston
15 Filed Mch. 1. 1920
marjorie DEan
(Month) (Day) (Year)
asst. REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transil permit was issued I.C. Maury
2:0
MEDICAL CERTIFICATE OF DEATH
726
24
1920
17
I HEREBY CERTIFY, That I attended deceased from
7cb
20
to ..
1920
726 24
, 19 20
24
19 20.
that I last saw
alive on
726
m.
If STILLBORN, enter that fact here
If STILLBORN, state period of alerogestation.
mos,
(b) Generai nature of industry, business, or establishment in which employed (or employer )
(c) Name of employer
9 BIRTHPLACE (City )
Hudson N.Y.
( State or country)
10 NAME OF Cornelius Bortle. FATHER
11 BIRTHPLACE OF
FATHER (City)
(State or country)
Hudson N. Y.
12 MAIDEN NAME
OF MOTHER
unknown
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
Hudson N. Y.
PARENTS
81
4
( Montlı)
83
and that death occurred, on the date stated above, at 11.30 The CAUSE OF DEATH was as follows: Cerebral
Mandown
(a) Residence.
No.
(Usual place of abode)
Feb. 24,1920.
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 varieus 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, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Siotionary fireman, etc. Butin many cases, especially in industrial employments, it is necessary to know (o) 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) Solesmon, (b) Grocery; (a) Forcman, (b) Automobile factory. The matcrial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ete., without more precise specification, as Doy loborer, Farm loborer, Loborer - Cool mine, ete. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receivo a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At homc. Care should be taken to report spe- cifically the oceupations of persons engaged in domestio service for wages, as Servant, Cook, Housemaid, ete. 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 LEATII (tho primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Ccre- brospinal fever (tho only definite synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobor pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, ete., of ...... . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Meosles; Whooping cough; Chronic volvular heart disease; Chronic interstitial nephritis, ete. 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 symptomatie), "Atrophy," "Col- lapse,""Coma,""Convulsions," "Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," otc., when a definite disease can bo aseertained as tho cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- 1.ERAL scpticemio," "PUERPERAL peritonitis," etc.
State cause for which surgical oporatlon was undertaken.
(Recommendations on statement of eause of death approved by Com- inittee 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, pyemla, 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 elassified under the international classification of eauses of death], where centracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Lows, Chop. 29, Secs. 10 and 1, as amended by Acts of 1910, Chop. S22.
No undertaker or other person shall bury a human body . .. until he has received a permit from the board of health or its agent, . . . er . . from the elerk of the eity 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- eate 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 tho physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which ean be obtained as to the deceased, or as to the manner or eause of the death, which the elerk or registrar may require. - Revised Laws, Chop. 78, Scc. 38.
Medical examiners shall, in all cases, certify to the city or town elerk 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 Lows, Chop. 24, Sec. 8.
1
RULES OF PRACTICE
The fulfilment of the purpose of these laws ealls for the observance of the following rules of practice:
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.