USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 215
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RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
RM R-303
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonturalth of Massachusetts
MEDICAL EXAMINER'S CERTIFICATE OF DEATH (ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)
(City or town)
1 PLACE OF DEATH
County
Suffolk
State
Registered No. V2, Collage Parki Read
Ward
(If deatfi occurred in a hospital or iustitution (give its NAME instead of street and number)
2 FULL NAME
Edward Perley Morse
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No. 52 Collage Park Road
(Usual place of abode)
(If non-resident give city or town and State)
Length of residence in city or town where death occurred
years
months
days
How long in U. S., if of foreign birth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
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
Cecilia & moore.
Days
If LESS than 1 day, . .. .. brs. or min.
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work.
architec
(b) Name of employer
Nashua
8 BIRTHPLACE (City) (State or country) New Hampshire 9 NAME OF FATHER Perley more
PARENTS
10 BIRTHPLACE OF FATHER (City) .
Mashua
(State or country)
11 MAIDEN NAME OF MOTHER
Lucy de alden Claremont
12 BIRTHPLACE OF MOTHER (City) (State or country)
New Hampshire Date
( Monthi)
(Day
( Year)
18 PLACE OF BURIAL, CREMATION, or REMOVAL
(Cemetery)
(City or town)
19 UNDERTAKER
Filed (Month) (Day) (Year)
REGISTRAR
20 Burial permit
issued by
A-C-Family
Official position
in Health officer
21 Date of of 10/25/24 Permit No. 820
MARGIN RESERVED FOR BINDING
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information for extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,
(See reverse side for description for unknown person)
17 Where was injury sustained if not at place of death ?.......
, M.D.
Medical Examiner for duftthe
1924
13 Informant
(Address)
52 Cottage Du Rd Nathrop
14
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH.
(Month)
26
1924 (Year)
(Day)
16 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows :
Years
75
Months 8
9
natural Causes Cardiovascular disease
(Sudden death)
DATE OF BURIAL Oct 28 1924 (Month) (Day) ( Year) ADDRESS
13,701
City or Town Winthrop
No.
Ward.
6 AGE
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 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 certifieate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died (defined so that it can be classified under the inter- national classification of eauses of death), 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. . . . - General Laws, Chapter 46, Section 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 elerk 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 . . . by a satis- factory certificate of the attending physician, if any, as re- quired by law, or in lieu thereof a certifieate 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 phy- sician who is a member of the board of health, or em- ployed 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 regis- tration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the elerk or registrar may require. - General 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. If a medical examiner has notice that there is within his county the body of such a person, he
shall forthwith go to the place where the body lies and take eharge of the same. . . . Gen. Laws, Chap. 38, Sec. 6.
. He shall in all eases certify to the town elerk or regis- trar in the place where the deceased died his name and resi- denee, if known; otherwise a deseription as full as may be, with the eause and manner of death. - General Laws, Chap. 38, Sec. 7.
RULES OF PRACTICE
The fulfilment of the purpose of these laws ealls for the observanee 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 eare 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 medieal attendance or whose physician is absent from home when the certifieate of death is needed.
(3) Medical Examiners will investigate and eertify to all deaths supposably due to injury. These include not only deaths eaused directly or indirectly by traumatism (ineluding resulting septieemia), and by the aetion of chemieal (drugs or poisons), thermal, or eleetrieal agents, and deaths following abortion, but also deaths from disease resulting from in- jury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medieal Examiners in eertifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the eli cumstanecs when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) eaused by a steam railway aeeident." "Pistol shot wound of the chest with associated hemorrhage, homi- eidal." "Asphyxiation by suspension, suicidal." "Syn- eope while under the influence of ether administered as a surgical anæsthetie." "Fraeture of the skull with associated internal injury sustained under eireumstanees unknown."
If investigation shows the death to have been due to dis- ease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indieate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary selerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
Oct. 26. 1924.
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained. - General Laws, Chap. 38, Sect. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-301 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
(City or town)
Registered No.
St. _Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Betty Gordon, DE. NamegyEl
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No.
(Usual place of abode)
Froux Banks
St.,
Ward.
(If non-resident give city or town and state)
Langth of residenco in city or town where death occurrod
years
Ă—
months
24
days.
How long in U. S., if of foreign birth?
years
months days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
October
27
1924
(Year)
(Month)
(Day)
5a If married, widowed or divorced
HUSBAND of
(or) WIFE of
Felix. de, nemegyer
6 AGE
86 =
Years
Months
Days
5
If LESS thon 1 day .__ hrs. or ___ min.
If STILLBORN, onter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Nama of omplayer
8 BIRTHPLACE (City)
Washington
(State or country)
Q.C :
9 NAME OF
FATHER
noble. Young
10 BIRTHPLACE OF
FATHER (City)
Ballmant
(State or country)
11 MAIDEN NAME OF MOTHER adelaida Mc Williams.
12 BIRTHPLACE OF St Many to White Han
MOTHER (City)
(State or country)
Maryland
13 Bela. de nemEquei
Informant
(Address)
2015- R. St Washington D.C.
14
Filed (Month) (Day) (Year)
REGISTRAR
20 | HEREBY CERTIFY that a satisfactory stan- dord certificate of death was filed with mo BEFORE tha burial or transit permit was issuod A.C.Daniela
Official position
Dato of issue
Health office to, per mit/
10/27 /24
Permit NO. 819
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
1 PLACE OF DEATH
County
City or Town
Wanthook
No.
State Fort Banks
(duration)
_yrs ...
mos.
7
ds.
6 home parenchy matous he phritis.
CONTRIBUTORY
(SECONDARY)
Museum (duration)
.yrs.
mos ..
.ds
17 Where was disease contracted
if not at place of death?
Same
Did an operation precede death?
200
Date of
Was there an autopsy?
no
What test confirmed diagnosis?
Clinical Laboratory
(Signed)
(Address)
For Banks, mas
Date
Och.
27
1924
(Month)
(Day)
(Year)
18 PLACE OF BURIAL, CREMATION DR REMOVAL
Congresoin Camely Washington D.C.
(Cemetery)
(City or town)
DATE OF BURIAL
10/31/24
19 UNDERTAKER
C.R. Bennison
ADDRESS
3.100.000
3 SEX
female
4 COLOR OR RACE
while
5
SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Widow
.
16
I HEREBY CERTIFY, That I attended deceased from
to.
Det.27
194
Oct. 3 -
1924
Oct. 26
that I last saw her
alive on
,
and that death occurred, on the date stated above, at
4 a. m.
The CAUSE OF DEATH was as follows:
uremia -
PARENTS
M. D.
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, 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- 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 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 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 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.
302
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1924,
BOSTON (City or town)
1 PLACE OF DEATH
County
Suffolk
State
Massachusetts
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
SADIE RUBIN
M.A.S.S.
City or Town
WINTHROP
No.
140 CLIFF AVE.
St .--
Length of residence in city or towo where death occurred
years
months
days.
How loog in U. S., if of foreign birth ?
years
mooths
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED ( write the word)
S
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 AGE
2.7
Years
Months
2
Days
20
1 day ........ hrs.
or ........ min.
If STILLBORN, eater that fact here
7 OCCUPATION OF DECEASED
(a Trade, profession, or
particular kind of work
BOOK -KEEPER
8 BIRTHPLACE (city or town)
(State or country)
RUSSIA
9 NAME OF
FATHER
LOUIS RUBIN
10 BIRTHPLACE OF
FATHER (city or town)
(State or country)
RUSSIA
11 MAIDEN NAME
OF MOTHER
RACHAEL COHEN
12 BIRTHPLACE OF
MOTHER (city or town)
(State or country)
RUSSIA
13
Informant
M. L. GOOD MAN
Filed NOV . 1 , 1924 Ermelenen Registrar of city or town where death occurred
Filed
Dec. 3, 1924
Registrar of city or towo where deceased resided
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
OCT.29.
(Month )
{ Day}
( Year)
16
I HEREBY CERTIFY, That I attended deceased from
OCT. 27
19.24 . to ..
OCT.29
, 1924
If LESS thao
that I last saw h
ERalive on
OCT. 29
, 19 24
and that death occurred, on the date stated above, at
3.50A
m.
The CAUSE OF DEATH was as follows :
CHR . MYOCARDITIS
(duration)
8
. yrs ..
mos.
de.
CONTRIBUTORY
MITRAL STENOSIS
(SECONDARY )
(duration)
2
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 ?
What test confirmed diagnosis ?
(Signed)
B .H.MASON
. M.D.
Date
(Address) .
OCT. 29. 1924
(Month)
(Day)
(Year)
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
MANCHESTER. N. H. (HEBREW CEM ) OCT.29
(Cemetery)
(City or town)
19 UNDERTAKER
JOS.P.DEVINE
ADDRESS
MANCHESTER
. 3799.
3 SEX F PARENTS (Address) 14 of certificate. carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, (b) Name of employer so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
8869
Registered No.
(Place of death)
City or Town
Boston
No.
PETER BENT BRIGHAM HOSPT.
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. State.
(Usual place of abode)
1924
[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) tho naturo 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 inore precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are ongaged in the duties of tho house- hold only (not paid Hlousekcepcrs 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, Es Servant, Cook, Housemaid, otc. If the occupation lias 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, eto., Carcinoma, Sarcoma, etc., of .. .. (name origin; "Cancer" is less definito; avoid uso 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 ean be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia,"" PUERPERAL peritonitis," etc.
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