Town of Winthrop : Record of Deaths 1922-1924, Part 218

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 218

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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; Broncho pneumonia ("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- mittce 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 discase unre- lated to any form of injury, have dicd 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-305

The Commonwealth of Massachusetts

MEDICAL EXAMINER'S CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH

County

SUFF Q.L.K State

Registered No.

MA.S.S. . Registered No. .. 9224

City or Town

BOSTON

No. CHILDRENS

HOSPT.

St.,

Ward

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

2 FULL NAME ..

FREDERIC LOOMIS

(If ini the Ariny or Navy of the United States, give rank, organization, etc.)

(a) Residence:

No.

(Usual place of abode)

12 PALMYRA.

AVE,

St.,

.Ward.

WINTHROP MASS.

(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

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH (Month)

(Day)

( Year)

Years

Months

Days

If LESS than I day ......... brs. or ....... min.

8 OCCUPATION OF DECEASED (a) Trade, professioo, or particolar kind of work (b) General ilaturė of industry, business, or establishment in which employed (or employer) (c) Name of employët

9 BIRTHPLACE (City)

FITCHBURG

(State or country)

10 NAME OF

FATHER

FREDERIC C.

11 BIRTHPLACE OF

FATHER (City)

WINSTEAD

(State or country)

CONN.

12 MAIDEN NAME

OF MOTHER

ANNIE L, PARKHURST

13 BIRTHPLACE OF MOTHER (City) EVERETT

(State or country )

FATHER

Filed

NOV. 13

&W. megleren

Registrar of city or towo where death occurred

Filed

Dec 3. 1924

(Month) (Day) (Year)

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

NOV.9.

( Month)

(Day)

1924

(Year)

17 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows : ABSCESS OF ILIAC REGION , LEFT , WITH

ASSOCIATED PERITONITIS, CAUSE UN-

KNOWN (JURISDICTION TAKEN BECAUSE OF HISTORY OF MINOR INJURIES SUS- TAINED FOL: A MOTOR VEHICLE ACCI - DENT ON AUG. 16) (See reverse side for additional space)

18 Where was injury sustained

if not at place of death ?

(Signed)

GEORGE BURGESS MAGRATH

M.D.

( Address)

Medical Examiner for

SUFFOLK CO.

Date

NOV . 10 .1924

(Month)

(Day)

( Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL FITCHBURG

20 UNDERTAKER

J. S. WATERMAN & SONS CO.

DATE OF BURIAL

NOV. II

(Month) (Day) (Year)

ADDRESS

21 Burial permit issued by

Official position

22 Date of issue

3 SEX M 7 AGE PARENTS 14 Informant (Address) 15 should be carefully supplied. AGE should be stated EXACTLY. MEDICAL EXAMINERS should state CAUSE OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information @ See reverse side for extracts from the laws of the Commonwealth and instructions. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. 3

(ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTERS 24 AND 29)

(Place of death)

(Place of residence)

BOSTON

If STILLBORN, enter that fact bere

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 stand- ard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by 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 containing the facts required by law to be returned and recorded, which ... shall be accompanied 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 purpose, or is insuffi- cient, 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 permit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary infor- mation 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, Chap. 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 be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are sup- posed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.

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 discase 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 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.

COPIES OF RECORDS OF DEATHS OF NON-RESIDENT DECEDENTS

The clerk of each city and town shall forthwith make certi- fied copies of the records of all . . . deaths recorded during the previous month, if the . . . deceased [was a resident] of any other city or town in this commonwealth or in any other state at the time of said . . . death, and transmit them to the clerk of the city or town of which such . . . deceased person [was] resident at the time of the said ... death ... and the clerk of a city or town in this commonwealth so receiving such certified copies, or certified copies of ... deaths, from the clerk of a city or town without the commonwealth, shall record the same. - Revised Laws, Chap. 29. Sec. 13, as amende! by Acts of 1910, Chap. 93, Sec. S.

DESCRIPTION (for unknown person).

...

Nov. 7 1924

M R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

(City or town)

State.

Registered No

City or Town

95 mais Str

St., Ward

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

Marion Forest. Milne

(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

days.

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

(If non-resident give city or town and state) 1 years 4 months days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEAT

(Month)

1924

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from inquest- 15 , 1914 to. Amembre 16, 1924

that I last saw h IV Novembre 16, 1924 alive on and that death occurred, on the date stated above, at 4 4 m. The CAUSE OF DEATH was as follows: Chronic Vienasmati nephritis

Unknown (duration) 0 .yrs. .mos .. .ds.

CONTRIBUTORY

Cardiac Fuilunes Quer

(SECONDARY) water. Con tensduration) .yrs. 1.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?

(Signed)

Nary à Halsall.

M. D.

(Address)

587 )levant To Winthe

Data

(Month)

" (Day)

(Year)

13 Cennie. S. Trendale

(Address)

95 Mainot Wanthope

Filed Dec-3.24 (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. IL. C. Daniela

Official of Health officer Date of issua of permit 11/19/24

Permit ND 827

-100 000

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, DR

DIVORCED (write the word)

widow

5a If married, widowed or divorced

HUSBAND OF

(or) WIFE of

of William. R. Milne

6 AGE

Years

Months 10

Days

Hf 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

8 BIRTHPLACE (City)

(State or country)

Scotland

9 NAME OF

FATHER

Robert Kelly

10 BIRTHPLACE OF

FATHER (City)

(State or country)

Scotland

11 MAIDEN NAME

OF MOTHER

mary Plellent

12 BIRTHPLACE OF

MOTHER (City)"

(State or country)

Scotland

1724

18 PLACE OF BURIAL, CREMATION DR REMOVAL

Winchof

Wiechert

DATE OF BURIAL 200 19/24

(Cemetery) (City or town)

19 UNDERTAKER

ADDRESS .

2 FULL NAME 3 SEX female PARENTS Informant 14 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 (b) Nama of employer

The Commonwealth of Massachusetts

I PLACE OF DEATH County

95 Main.

.St.

Ward.

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 healtbfulness of various pursuits can be known. Tbe 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) tbe 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. Tbe 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 bome, wbo are engaged in the duties of the bousehold 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 tbe occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation bas 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 wbo bave no occupation whatever, write None.

Statement of cause of death .- Name, firet, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always tbe same accepted term for the same disease. Exam- ples: Cerebrospinal fever (tbe 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. Tbe 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 "Astbenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- baustion," "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 deatb 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 dieeasee, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscarriage, necrosis, peritonitis, ph lebitie, 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 fortb- witb, after the death of a person whom be has attended during his last illness, at the request of an undertaker or otber 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, bis supposed age, tbe disease of which he died, defined as required by section one, where same was contracted, the duration of bis last illness, wben last seen alive by tbe physician or officer and the date of bis deatb. . .- Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury a human body. .. until be bas received a permit from the board of bealth or its agent. .. or ... from the clerk of the town wbere the person died ;. .. No euch permit ehall be ieeued until there ehall 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 tbe attending physician, if any, as required by law, or in lieu tbereof a certificate as bereinafter 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 ie a member of the board of health, or employed by it or by the selectmen for the purpose, ehall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make euch certificate. .. Tbe person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any otber necessary information which can be obtained as to the deceased, or as to tbe 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 tbe dead bodies of only such persons as are supposed to bave died by violence .- Gen. Laws, Chap. 38, Sec. 6.

... He shall in all cases certify to the town clerk or registrar in tbe 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 deatb .- 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 tbose of persons to wbom tbey bave 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 wbo, though disabled by recognized disease unre- lated to any form of injury, bave died witbout recent medical at- tendance or wbose physician is absent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths suppoeably due to injury. These include not only deatbs 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 deatbs from dieease resulting from injury or infection related to occupation, the eudden deaths of pereons not disabled by recognized disease, and those of persons found dead.

RM R-301

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.

2 FULL NAME

3 SEX

female

6 AGE

Years

(State or country)

PARENTS

in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See

(State or country)

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

Charles G.Craib

Months

Days

If STILLBORN, anter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

none

8 BIRTHPLACE (City)

Boston Mass.

9 NAME OF

FATHER

Thomas Cass

10 BIRTHPLACE OF

FATHER (City)

Ireland,

11 MAIDEN NAME

OF MOTHER

Adeline L.Richardson

12 BIRTHPLACE OF

MOTHER (City)

Boston Mass

(State or country)

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH.

(Month)

Nov.17 1924

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

apul 12

24 to Nav-17

1924

that I last saw her alive on

If LESS than

1 day ...

hrs.

or ..._ min.

Non 17

,1924

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

11.150

The CAUSE OF DEATH was as follows:

Pulmonary tuberculosis

(duration)

_yrs.

mos.

ds.

CONTRIBUTORY.

Valvular heart disease

(SECONDARY)

(duration)

.yrs.

mos .. .ds

17 Where was disease contracted

if not at place of death?

FOR WHAT?

Did an operation precede death?

Date of

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Town of Winthrop : Record of Deaths 1922-1924, Part 218

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

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