Town of Winthrop : Record of Deaths 1919-1921, Part 98

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 98

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Official position,

Health offici", 22 Date of issue of borial "transit permit

May 15/1920

2 FULL NAME 3 SEX Ternale 6 DATE OF BIRTH 7 AGE 65 Years (c) Name of employer 10 NAME OF FATHER 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 Filed N. D. - WATTE PLAINLT, WITH ONFADING DLAGR INA THIS IS A PERMANENT NEVUng. Every trent of information 9 BIRTHPLACE (City) (State or country)

100,000.

City or Town

Withopp

No.

66. Summit Ave

Coolfran.

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

Summit Que

St.,

Ward.

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

may 13

19 20

Months

4 Days

If LESS than

I day. . brs.

may 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 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., Former or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stotionory firemon, 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 necded. As examples: (a) Spinner, (b) Cotton mill; (a) Solesman, (b) Grocery; (a) Foremon, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Lahorer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Doy laborer, Farm laborer, Loborer - 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 he entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should he taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servont, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at heginning of illness. If retired from husiness, that fact may he 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); Meosles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not he 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,""Dehility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""‘Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., 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.)

Bronchopneumonia: If primary cause, write the word "pri- mary " ; if secondary, give primary cause.

Certificates will he 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- rlage, 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 hest of his knowledge and helief 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 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 he accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hercinafter 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, Chop. 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 bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chop. 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 direetly or indirectly by traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut 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.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Tanthrop (City or town)

1 PLACE OF DEATH

Township

Huethiop

No. 20.

or Village.

Myrtle are

St.,

Ward

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

Netitia

Letitia Freland.

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

(a) Residence.

No.

20 myrtle Cx

St.

.Ward.

(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

4 COLOR OR RACE

Female cohete

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Hodno.

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Robert & Ireland

6 DATE OF BIRTH (month, day, and ycar) 1835

Years

Months

Days

If LESS than

1 day, ........ hrs.

or ........ min.

8 OCCUPATION OF DECEASED

Tone

9 BIRTHPLACE (city or town)

Ir John

(State or country) 2.0

10 NAME OF FATHER John Mc Tavish

11 BIRTHPLACE OF FATHER (city or town) enventas (State or country) Scotland

12 MAIDEN NAME OF MOTHER

Mary Mac Elroy

13 BIRTHPLACE OF MOTHER (city or town) ....

(State or country)

Inveneto Scotland.

Informant

Robert Ireland

(Address)

20 Myrtle avec.

15 Filed May 17, 1920 Bessie 1. Dodge-

asst REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year)

IN my 12 1920

I HEREBY CERTIFY, That I attended deceased from

7 c

Illan 14 1920

that I last saw h

alive on

III ay 13

, 19 20.

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

430

..... m.

The CAUSE OF DEATH* was as follows :

(duration)

yrs ..

......

.mos.

ds.

CONTRIBUTORY

Jeremy arteria Salario

(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.

5/15.1920 (Address)

200 DEcuvant St

* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (i) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

In Hallaction- Lucy

DATE OF BURIAL

May 17 1920

20 UNDERTAKER

Leis Jones VSan

ADDRESS

Boston.

County City 2 FULL NAME 3 SEX 7 AGE (a) Trade, profession, or particular kind of work PARENTS 14 of certificate. 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, N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be (b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer

State

Massachusetts

Registered No.

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

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 oceupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, 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 ma- terial worked on may form part of the second statement. Never return "Laborer,"

"Foreman," " Manager," "Dealer," 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 household 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, 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

(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 .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatie), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility"? ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ete. State eause 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 (e. 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, ete.

3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to bc due to Alcoholism, etc.

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

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY PHYSICIAN.

R 15. 2-'18. 100,000.

R-302

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County

......

Suffolk

State ............

Registered No.

(Place of residence)

St.,

Ward

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

2 FULL NAME ...

John Parry

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

(a) Residence.

State ...

Mass.

(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

3 SEX

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Carried

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Louise

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

May 26

1853

7 AGE

Years

Months

Days

If LESS than

- 11

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

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work.

Mone

(b) Name of employer

9 BIRTHPLACE (city or town).

Yarmouth

(State or country) N. S.

PARENTS

11 BIRTHPLACE OF FATHER (city or town).Yarmouth

(State or country)

I. S.

12 MAIDEN NAME OF MOTHER Lucinda Durkee

13 BIRTHPLACE OF MOTHER (city or town) Yarmouth

(State or country)

5/119

( Address)

Boston

Informant

(Address)

15 Ley 17 , 20

Filed ..

Registrar of city or town where death occurred

File May 18, 1920 Bessie 2. Dodge

Oral Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year)

5/16

I HEREBY CERTIFY, That I attended deceased from

Max ...... 1.0

1920, to 0723

19 ... 20,

that I last saw h.,

alive on.

Na7 76

19 ... 2.0,

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

11.55 p.

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.)

Myocarditis (chronic)

.(duration)

.. yrs.

mos.

ds.

CONTRIBUTORY

Enlarged prostate

(SECONDARY)

(duration)

yrs.

............... mos ..

ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death ?.. / S

Date of AV .15 '20

Was there an autopsy?

What test confirmed diagnosis ?

ned) .2.C Crencon

M.D.

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

wint hrop

DATE OF BURIAL

May 18

20 UNDERTAKER

Berrison

ADDRESS

Winthrop

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

of certificate.

19. 25,000

carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,

Chelsea

(City or town)

Registered No.[ 3]

(Place of death)

City or Town

Chelsea

No. " S. Frost Hospt

City or Town

Winthrop

No ..

59 Crystal Cove Cure St.

Male

10 NAME OF FATHER Stephen Parry

May 16 .1980 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 can be known. The question applies to each and every person, irrespective of agc. 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, 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 linc 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," "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 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 Scrvant, 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 fromn 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 affection with respect to timc and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fcver (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- toneum, etc., Carcinoma, Sarcoma, etc., of_

genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus,' s." "Old age," "Shock," " Uremia," "Weakness," ctc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. Statc 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 (e. 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.)

Casas 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 disease, as A death upon the strcet, or one supposed to bc due to Alcoholism, etc.

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

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY

PHYSICIAN.

M R-301

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

County.

Suffolk

State

Massachusetts

Registered No ...

City or Town

BOSTON

No.

25 Tewksbury Street Winthrop

Ward

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

2 FULL NAME

Catherine F. Melvin

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

(a) Residence.

No.

25 Tewksbury Street

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

115 my

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

May 16, 1920

. ,

that I last saw he

alive on

111 day 15, 1920,

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

2 4 m.

The CAUSE OF DEATH was as follows:

Carcinony of Stomac!

( 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? ^

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed)

, M.D.

(Address).

5ª

Date

( Month)

(Day)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Holy Cross, Malden

(Cemetery)

(City or town)

DATE OF BURIAL Jay 19,20

20 UNDERTAKER

ADDRESS East Boston

Dale of

Permit

Official position

Health Offices

To: May 1, 19,20 0 144 ....

1 PLACE OF DEATH

(Usual place of abode)

3 SEX

Female

4 COLOR OR RACE

White

6 DATE OF BIRTH

Unknown

( Month)

7 AGE

Years

Months

If STILLBORN, eoter that fact bere

If STILLBORN, state period of nterogestation

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Town of Winthrop : Record of Deaths 1919-1921, Part 98

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

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