Town of Winthrop : Record of Deaths 1922-1924, Part 124

Author: Winthrop (Mass.)
Publication date: 1922
Publisher:
Number of Pages: 1202

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 124

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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- posurc, 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.

-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

BOSTON (City or town)

Suffolk

State

Massachusetts

Registered No. 140

St., Ward

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

2 FULL NAME

andrew L. Green

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

(a) Residence. No.

(Usual place of abode

Length of residence in city or town where death occurred

years

months

Sp nevada St Wants. of

Ward.

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

days.

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

months days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE |

White

5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word)

married

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

Years

Dorothy a. 7 Months 27

Days

If LESS than

1 day,

brs.

min.

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work

Saluman

8 BIRTHPLACE (City) (State or country)

9 NAME OF

FATHER

Canada Thomas green

10 BIRTHPLACE OF

FATHER (City)

(State or country)

11 MAIDEN NAME OF MOTHER

Canada

Ellen Larrion

12 BIRTHPLACE OF MOTHER (City) (State or country) Canada

13 Dorothy a green

(Address) 36 navadela Sy Winthrop

File ana 2323 (Month) (Day) ( Year)

REGISTRAR

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

StMowry.

Official position

Heath Ofun Date of issoe Of permit

(City or town) aug 30,'23 ADDRESS Boston

Permit

any 29-23 No. 626

1923 Fear)

16 I HEREBY CERTIFY, That I attended deceased from aug. 21 ,191.3,to Quequet, 1923

that I last saw h Am alive on ing . 2% , 19 and that death occurred, on the date stated above, at

/ 0033

m. The CAUSE OF DEATH was as follows : Subacute glomerular nephritis

(duration) yrs. / U mos. ds.

CONTRIBUTORY (SECONDARY)

(duration) yrs

mos. 7 ds.

17 Where was disease contracted

if not at place of death ?.

FOR WHAT?

Did an operation precede death ?

Mu Date of

Was there an autopsy ?

What test confirmed diagnosis"

(Signed)

(Address)

638 Bear

Culpatuck M.D.

Date

(Monthy

1.923,

(Day)

( Year)

DATE OF BURIAL

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Forest Hills

(Cemetery)

19 UNDERTAKER W. H. Graham

M1.

3 SEX Male 6 AGE 46 PARENTS Informant 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. FISICIANS should state CAUSE of DEATH (h) Name of employer instructions and extracts from the laws on back of certificate.

City or Town

Boston Winthrop

No. 36 havada

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH aug (Month)

( Day)

Uralma.

aug. 28, 1923.

R - 301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

Winthrop (City or towny 14/1

1 PLACE OF DEATH(

County

Suffolk

Mass

Registered No.

City or Town Winthrop

No /39.

State ... Cliff fue

St., ........... Ward (Jf death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME

(a) Residence.

No.

139 Cliff Ave

(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 hurth ?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR ORRACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Widower

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Rossetti

6 AGE

Years

Months

Days

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Arttome

(h) Name of employer

8 BIRTHPLACE (City) Amsterdam (State or country

Holland

PARENTS

10 BIRTHPLACE OF FATHER (City) Chusterdans (State or country)

11 MAIDEN NAME OF MOTHER

Holland Betsy Van Wezel

12 BIRTHPLACE OF MOTHER (City (State or country)

Amsterdam Holland

Mrs Bessieof Cable

Informant!

(Address)

139kliff Ave Winthrop

14 Ck, 4 1923

Filed.

(Month) (Day) (Year)

REGISTRAR

19 UNDERTAKER

Frank 6. Brown

ADDRESS Casa Gostava

Permit

No .. 627

20 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was Gled with me BEFORE the burial or transit permit was issued à S. i- Moury

Official a) leatthe Officer

Date of issue .of permit 4

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

CONTRIBUTORY.

chronic myocarditis

(SECONDARY)

yrs

mos. ............... ds.

17 Where was disease contracted

if not at place of death ?

Did an operation precede death ?

Date of

Was there an autopsy?

-720

What test confirmed diagnosis ?

(Signed)

Nathaniel V. Shannon

.... , M.D.

(Address).

7 Cheriton 7.

Date

Sept.

, 1923

(Month)

(Day)

( Year)

18 PLACE OF BURIAL, CREMATION, OR, REMOVAL

Knollwood Canton Mais

(Cemetery)

(City or town)

DATE OF BURIAL Sept 5-1923.

15 DATE OF DEATH

(Month)

Seht

1923

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

1971

to.

Soft 2

. 1923

Sept 2

19.

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

3,30A

. m.

The CAUSE OF DEATH was as follows :

Chronic Parenchymaton nephewlig .. (duration) Come

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

The Commonwealth of Massachusetts

Solomon Sehryver

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

St.,

„Ward.

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

MEDICAL CERTIFICATE OF DEATH

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

If LESS than

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

or ....... min.

9 NAME OF

FATHER

Sekt. 3. 1973 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, 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 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 bouse- 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 DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (rctired, 6 yrs.). For persons who have no occupatien whatever, write None.

Statement of cause of death. - Name, first, tbe DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always tbe 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 "Astbenia," "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., wben 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 or registered hospital medical officer shall fortbwith, 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 tho 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 as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . .. - Gen. Laws, Chap. 46, Sec. 9.

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 town where 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 containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate 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, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. ... The person to whom the permit is so given and the physi- cian certifying the cause of deatb 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. - Gen. Laws, Chap. 114, Sec. 45.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.

. . . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. - Gen. Laws, Chap. 38, Sec. 7.

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for tbe 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 deatbs only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or wbosc 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.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County

Barnstable

State

Ma.s.s

Registered No.

142

(Place of residence)

St.,

Ward

City or Town

No.

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

2 FULL NAME

Browning Kelley Baker

142 Pleasant

(If inthe Afmy Ar Novy of the United States, give rank, organization, etc.)

(a) Residence. State

(Usual place of abode)

City or Town

No.

St.

Length of residence in city or town where death occurred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Single

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

Days

If LESS than

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

or ..... min.

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Furniture Dealer

(b) Name of employer

Dennis

8 BIRTHPLACE (city or town)

(State or country)

Mags

9 NAME OF

FATHER

Browning K.Baker

10 BIRTHPLACE OF

FATHER (city or town)

(State or country)

Dennis

11 MAIDEN NAME

OF MOTHER

Abbie Theresa Baxter

12 BIRTHPLACE OF

MOTHER (city or town)

Dennis

(State or country)

Mass

Informant

Adelbert Baker

(Address)

14 Filed 9/6/23, Bem FR

Registrar of city or town where death occurred

fect 8

.. , 1923

Registrar of city or town where deceased resided

About

(duration)

2 .... yrı.

..... mos ..

.......

ds.

CONTRIBUTORY

Pyloric Obstruction

(SECONDARY)

(duration)

.yrs

mos.

ds.

17 Where was disease contracted Unknown

if not at place of death ?.

Did an operation precede death ?

Date of

Was there an autopsy ?.

What test confirmed diagnosis ?

X-Ray.

(Signed)

G.H.Gray

M.D.

10/12/123 (Address)

Hyannis Mass

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

South Dennis

DATE OF BURIAL

Sept 15/23

19 UNDERTAKER

M.H.Crowell

ADDRESS

So Yarmouth

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

of certificate.

Dennis

DENNIS

(City orange

Registered No.

(Place of death)

Sept 12,1923

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

Aug 20

Sept 12

19 ...

Sept 9

that I last saw h

alive on

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

The CAUSE OF DEATH was as follows :

Cancer-pylorus

Mass

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

[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, 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 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 - Coul 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 serviee 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 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" (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.

EXTRACTS

FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his lastillness, at the request of an undertakeror other authorized person or of an y 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 as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . .. - Gen. Laws, Chap. 46, Sec. 9.

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 town where the person died; . .. No such permit shall beissued until thereshall have been delivered to such board, agent or clerk ... a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate 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, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. ... The person to whom the permit is so given and the physi- cian certifying 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. - Gen. Laws, Chap. 114, Sec. 45.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.

. . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. -Gen. Laws, Chap. 38, Sec. 7.

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.

R - 301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

(City or town)

Registered No ... 14 3

City or Town

tt. No. Ward (If death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME

Pena. anm. Thompson

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

NEH. Shore Que

St.,

Ward.

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

months days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

widow

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Edward, M. Thompson

Years

Months

Days

If LESS than 1 day ......... hrs. or ........ min.

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

at Home

8 BIRTHPLACE (City).

Sackville

(State or country

New Brunswick

9 NAME OF

FATHER

James. a anderson

10 BIRTHPLACE OF

FATHER (City)

Canada

(State or country) cenathe lo ablation

11 MAIDEN NAME

OF MOTHER

Cuma, Tingley

12 BIRTHPLACE OF

MOTHER (City)

Canada

(State or country)

13 M. C. H. M. Jean

004 4 1923

Filed .!

(Month) (Day) ( Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Self.

(Month)

( Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from on Sepr. 12 19. ., to.

, 19 ..***... ,

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

.. 19

6.20 (?) A

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

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Town of Winthrop : Record of Deaths 1922-1924, Part 124

Author: Winthrop (Mass.) Publication date: 1922 Publisher: Number of Pages: 1202

Author: Winthrop (Mass.)
Publication date: 1922
Publisher:
Number of Pages: 1202