Town of Winthrop : Record of Deaths 1922-1924, Part 209

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 209

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24.

that Mast saw h _

alive on

,19

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

The CAUSE OF DEATH was as follows:

Hent Viseira

(duration)

_yrs.

mos.

ds.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs.

17 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.

26 1924

Data

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION OR REMOVAL

Cabray. Gloucester

DATE OF BURIAL Lefost 2/2

(Cemetery)

(City or town)

19 UNDERTAKER

James lo Greely

ADDRESS Sementes

Official

Date of issue of permit Sept 26/24 Permit NO.

808

-100.000

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

Registered No.

o.365 Shirley

St.,

Ward.

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

.mos ds

9 NAME OF

FATHER

Dosefale Sundero

10 BIRTHPLACE OF

FATHER (City)

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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, 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 statsment; it should be used only when nesded. 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," "Fore- man," "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 House- wife, Housework, or At home, and children, not gainfully 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, stats occupa- tion 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. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite) ; Tuberculosis of lungs, meninges, 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 intercurrent) affection need not be statsd unless important. Example: Measles (disease causing death), 29 da .; Bronchopneumonia (secondary), 10 ds. Naver report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "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 "PUERPERAL 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 "primary"; 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, miscarriage, 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 forth- with, 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 registra- tion a standard certificate of death, stating to the best of his knowl- sdge and belief the name of the deceased, his supposed age, the disease of which he died, definsd as required 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 con- taining the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate 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 pur- pose, or is insufficient, a physician 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 certificate. .. The person to whom the permit is so given and the physician 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 ths manner or cause of the death, which the clerk or registrar may re- quire .- 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 casss certify to the town clerk or registrar in the place where the deceased disd his name and residence, if known; otherwise 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 unre- lated to any form of injury, have died without recent medical at- tendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths supposably 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.

M R-301 OFFICE OF THE SECRETARY OIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

I PLACE OF DEATH

County

Jiffolk

State

Maso

(City or town)

121

City or Town

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

2 FULL NAME

Edward Churchill Blossom

(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

100 Fremont

.St.

Ward.

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

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Mall

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, DR

DIVORCED (write the word)

5a If married, widowed or divorced

HUSBAND of

(or) WIEE of

Ida. M.

Blossom

If LESS thao 1 day, ._ hrs. or _._. min.

If STILLBORN, enter that fact here

(Ch hyrcondition; Ch antesleted with)

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Duggento (Phammer)

(b) Name of employer

K. C. Brown Wintlust

Indefinite

(duration)

.yrs.

.mos.

ds.

8 BIRTHPLACE (City)

(State or country)

maso

CONTRIBUTORY (SECONDARY)

(duration)

yrs.

mos.

17 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)

(Address)

215 Miami

Date

LA291924,

(Month)

(Day)

(Year)

Informant

Y da. M. Blossom

(Address)

100 Fumant St. Wurstel

(Cemetery)

(City or town)

19 UNDERTAKER

C.R. Bunun

wünschent

DATE OF BURIAL

9/20/24

14 2124

Filed __

(Month)

(Day) (Year)

REGISTRAR

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

Official position

Date of issue

9/29 34

Permit NO 809

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

PARENTS

10 BIRTHPLACE OF Wert Barnscalls

FATHER (City)

(State or country)

-mars

11 MAIDEN NAME

OF MOTHER

Commi. M. Gardner

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Mantivebel -

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Sift.

(Month)

(Day)

I HEREBY CERTIFY, That I attended deceased from

1927, to

19 24.

that I last saw him

_alive on

. 19

6 AGE

Years

Months 20

Days

years

months

days.

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

years

Registered No.

No.

100 Freemont- fh

St., Ward

ADDRESS mars

-100.000

18 PLACE OF BURIAL, CREMATION DR REMOVAL

West Barnstable - Barnstable

M. D.

9 NAME OF

FATHER

Henry. C. Blossom

and that death occurred, on the date stated above, at 3-15 p.m. The CAUSE OF DEATH was as follows: Cardio- Renal

1924

(Year)

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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Pianter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, 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," "Fore- man," "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 House- wife, Housework, or At home, and children, not gainfully 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 occupa- tion 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. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite) ; Tuberculosis of lungs, meninges, 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 intercurrent) 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," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "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 "PUERPERAL 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 "primary"; 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, miscarriage, necrosis, peritonitis, ph lebitls, pyemia, septicemla, tetanus.

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

A physiclan or registered hospital medical officer shall forth- with, 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 registra- tion a standard certificate of death, stating to the best of his knowl- edge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required 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 dellvered 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, in case of an original interment, by a satisfactory certificate 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 pur- pose, or is Insufficient, a physician 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 certificate. . . The person to whom the permit is so given and the physician 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 re- quire .- 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; otherwise 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 physiclans 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 Physiclans will certify to such deaths only as those of persons who, though disabled by recognized disease unre- lated to any form of injury, have died without recent medical at- tendance or whose physician is absent from home when the certificate of death is needed.

M R-301 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH Suffolk

Massachusetts

(City or town)

Registered No.

254 Main Street Wi thrSt.,

Ward

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

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

(a) Residence. No

254 Lain Street

St.,

Ward.

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

deys.

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

yeers

months

days

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Out

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

July 26

19 zy, to let 6

that I last saw him

alive on

1924.

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

P. m.

The CAUSE OF DEATH was as follows:

Quasi interstitial mejerites

(duration)

5 yrs.

_mos. ds.

asthma

CONTRIBUTORY

(SECONDARY)

(duration)

10 yrs

_. mos.

17 Where was disease contracted

if not at place of death?

acteFOR Y

mans.

Did an operation precede death?

no Date of

Was there an autopsy?

What test confirmed diagnosis ?.

(Signed)

1 Pay W Lay ton

M. D.

(Address)

wrathrap mass

Dete

(Month)

(Day)

(Year)

DATE OF BURIAL

18 PLACE OF BURIAL, CREMATION OR REMOVAL

Haly Cross

Idon Cov 9th 1924

(Cemetery)

(City or town)

14 da lat 23 192Cl Filed (Month) (Day) ' (Year)

REGISTRAR

20 | HEREBY CERTIFY thet e satisfactory sten- dard certificate of death wes filed with me BEFORE the burial or transit permit was ietued

IL. OSMaricela

Official nocition

Date of Health officeis

of permit 1/10/9 24 Permit 8,0

Boston

City or Town

Winthrop

2 FULL NAME

John Driscoll

(Usual place of abode)

Length of residence in city or town where death occurred

3 SEX

4 COLOR OR RACE

TThite

Ferried

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

Marion Winn

6 AGE

Years

Days

Months

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(e) Trade, profession, or

particular kind of work

Retired

8 BIRTHPLACE (City)

(State or country)

Ir land

10 BIRTHPLACE OF

FATHER (City)

(State or country)

Ireland

11 MAIDEN NAME

OF MOTHER

Mary Mahoney

12 BIRTHPLACE OF

PARENTS

MOTHER (City)

(State or country)

Ireland

Informant

Mrs. Mariem Driscoll

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

(b) Name of employer

Cigar Man'f.

5 SINGLE, MARRIED, WIDOWEO, OR

DIVORCED (write the word)

If LESS than 1 dey,_hrs. of_min.

9 NAME OF

FATHER

John Driscoll

(Address)

254 Main Street Vinthron

ADDRESS

19 UNDERTAKER Richard & Heilen das Beste

BOSTON

State

No.

years

months

PERSONAL AND STATISTICAL PARTICULARS

1424

8 1924

bit. 6.1924.

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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, 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," "Fore- man," "Manager,""Dealer," etc., without more precise specification, 88 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 House- wife, Housework, or At home, and children, not gainfully 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 CAUSINO DEATH, state occupa- tion 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 CAUSINO DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, 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 intercurrent) 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," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "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 "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.

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Town of Winthrop : Record of Deaths 1922-1924, Part 209

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

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