Town of Winthrop : Record of Deaths 1922-1924, Part 30

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 30


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121 | Part 122 | Part 123 | Part 124 | Part 125 | Part 126 | Part 127 | Part 128 | Part 129 | Part 130 | Part 131 | Part 132 | Part 133 | Part 134 | Part 135 | Part 136 | Part 137 | Part 138 | Part 139 | Part 140 | Part 141 | Part 142 | Part 143 | Part 144 | Part 145 | Part 146 | Part 147 | Part 148 | Part 149 | Part 150 | Part 151 | Part 152 | Part 153 | Part 154 | Part 155 | Part 156 | Part 157 | Part 158 | Part 159 | Part 160 | Part 161 | Part 162 | Part 163 | Part 164 | Part 165 | Part 166 | Part 167 | Part 168 | Part 169 | Part 170 | Part 171 | Part 172 | Part 173 | Part 174 | Part 175 | Part 176 | Part 177 | Part 178 | Part 179 | Part 180 | Part 181 | Part 182 | Part 183 | Part 184 | Part 185 | Part 186 | Part 187 | Part 188 | Part 189 | Part 190 | Part 191 | Part 192 | Part 193 | Part 194 | Part 195 | Part 196 | Part 197 | Part 198 | Part 199 | Part 200 | Part 201 | Part 202 | Part 203 | Part 204 | Part 205 | Part 206 | Part 207 | Part 208 | Part 209 | Part 210 | Part 211 | Part 212 | Part 213 | Part 214 | Part 215 | Part 216 | Part 217 | Part 218 | Part 219 | Part 220 | Part 221 | Part 222 | Part 223 | Part 224 | Part 225 | Part 226 | Part 227 | Part 228 | Part 229


(1) Attending physicians wili 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 wili 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-302


The Commonwealth of Massachusetts


CERTIFICATE OF DEATH OF NON-RESIDENT ....


Lynn


1 PLACE OF DEATH


Registered No.


(Place of death)


Registered No.


86


City or Town


Lynn


No.


Union Hospital


St.,


. Ward


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


2 FULL NAME


Isaac C ... Bunnell


Mass


City or Town ..


Winthrop


No.


99 Main


St.


(a) Residence. State.


(Usual place of abode)


Length of residence in city or town where death occorred


years


months


12 days


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


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


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


May 8,


19 22


17


I HEREBY CERTIFY, That I attended deceased from


19.


22


Apr. 26


1922, to May 8


that I last saw h ...


im


alive on


May 8


19 ... 2.2,


and that death occurred, on the date stated above,


8.05 p.


.m.


The CAUSE OF DEATH* was as follows :


* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (Sce reverse side for additional space.)


Pernicious anemia


.(duration)


2


mos.


de.


9 BIRTHPLACE (city or town).


(State or country)


Penna


CONTRIBUTORY


(SECONDARY)


(duration)


.. yrs. ................ mos ..


ds.


........


10 NAME OF FATHER


Barton Bunnell


11 BIRTHPLACE OF FATHER (city or town)


(State or country)


Penna.


12 MAIDEN NAME OF MOTHERSarah Bird


13 BIRTHPLACE OF MOTHER (city or town)


(State or country)


Penna.


519 , 19 2 [Addres) 221 Broadway, Revere


Informant


Stuart Bunnell


( Address)


yy Main St., Winthrop


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


Glenwood,


Everett


DATE OF BURIAL


May 11, 1922


Filed. June 5 .19 22


Registrar of city or town where death occurred Filed June 14, 1922


Registrar of city or town wbere deceased resided


18 Where was disease contracted


if not at place of death ?


Did an operation precede death?


no


Date of


Was there an autopsy ?.


no


What test confirmed diagnosis?


blood


(Signed)


Frank F. Rome


M.D.


20 UNDERTAKER


John P. Costello


ADDRESS


Boston


3 SEX M 7 AGE 59 PARENTS 14 15 carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, of certificate. so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions ou back N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be (h) General nature of industry, business, or establishment in wbich employed (or employer) (c) Name of employer


4 COLOR OR RACE


W


5 SINGLE, MARRIED. WIDOWED, OR


DIVORCED (write the word)


Divorced


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


Cannot be learned


6 DATE OF BIRTH (month, day, and year) Dec. 26, 1862


Years 4 Months 12 Days


If LESS than


I day, ........ hrs. or ....... mio.


If STILLBORN. enter that fact here


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


Real Estate


... yrs ...


(City or town)


County


Essex


State


Mass


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


(Place of residence)


REVISED UNITED STATES STANDARD CERTIFICATE OF DLAIN [Approved by U. S. Census and American Public Health Association]


Statement of occupation. - Precise statement of oecupa- tion is very important, so that the relative healthifulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or terin on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engincer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is neecssary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Forcman," "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 Housckcepers who receive a definite salary), may be entered as Houscwifc, Houscwork, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifieally 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 DEATII, state occupation at beginning of illness. If retired from business, that fact may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write Nonc.


Statement of cause of death .- Name, first, the DISEASE CAUSING DEATHI (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fcvcr (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, etc., of.


(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms); 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: Mcasles (disease causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report merc symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" (“Con-


genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- Inus," "Old age," "Shock," "Urcmia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all diseases resulting from child- birthi or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHIS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (c. g., sepsis, tetanus) may be stated


under the head of


on statement of cause of death approved by Comunittee on Nomenclature of the American Medical Association.)


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.


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


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


-


ADDITIONAL SPACE FOR FURTHER STATEMENTS BY


PHYSICIAN.


R 303. 6-'18. 50,000.


M R-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


Winthrop BOSTON


(City or Town)


1 PLACE OF DEATH


County.


Suffolk


State


Massachusetts


Registered No.


77


City or Town


"Boston


Winthrop


62 Lowell Road.


St.


Ward


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


2 FULL NAME


Sarah S. Tracy


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


(a) Residence. No.


( Usual place of abode)


36 Wilshires. Readward.


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


Length of residence in city or town where death occorred


8


years


months


days.


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


47


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH.


May 9 1922


(Month)


(Day)


(Year)


17


I HEREBY CERTIFY, That I attended deceased from


1922, to.


9,1922


9, 1922


that I last saw h


alive on


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


m.


The CAUSE OF DEATH was as follows :


a Lungo


.. (duration)


.. ds.


CONTRIBUTORY


(SECONDARY)


(duration)


.......


.yrs ...


mos ..


........


.ds.


18 Where was disease contracted


if not at place of death ?


FOR WHAT?"


Did an operation precede death ?


Date of.


Was there an autopsy ?


What test confirmed diagnosis ?


(Signed)


M.D.


(Address).


200 TCourant SI


Date


(Month)


(Day)


(Year)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL Forest Hills Boston May 11 (Cemetery)


(City or town)


20 UNDERTAKER


Malerman & 2000.


ADDRESS Boston.


Official position.


Hatte Slicer


Date of issue of permit. 51022


Permit


XXM. .00,000


3 SEX


female


7 AGE


Years


(b) Name of employer


(State or country)


(State or country)


13 BIRTHPLACE OF


PARENTS


MOTHER (City)


(State or country)


Informant


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


N. B. - WRITE PLAINLY, WITH ONFADING DLAGR INN THIS IS A PERMANENT NEVOND. Every Item of information


82


4 COLOR OR RACE


white


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


widowed


5a If married, widowed, or divorced


HUSBAND of


Daniel Tracy


(or) WIFE of


6 DATE OF BIRTH


Feb 26 1840


(Month)


(Day)


(Year)


Months


2


Days


13


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


If STILLBORN, enter that fact here


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work.


none


9 BIRTHPLACE (City)


St. John N. B.


10 NAME OF


FATHER


Austin A . Hopey


11 BIRTHPLACE OF


FATHER (City )


France


12 MAIDEN NAME


OF MOTHER


Margaret A.Godsaw


St. John N. B.


14 Wellington Tracy


(Address)


36 Wilshire Road. It.


15 may 20, 1922


Filed


(Month) (Day) (Year)


REGISTRAR


21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued . J. i. Mowry


Na 435


J.D


10


1922


No.


D ...


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH


[Approved by U. S. Census and American Public Health Association]


Statement of occupation. - Precise statement of oceupation 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. Butin 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 he 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 house- hold only (not paid Housekeepers who receive a definite salary), may he entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, ete. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None. 1


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 "Epidemio cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. 's indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, ete., of .. . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. 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 childhirth 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 soie 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 forthwith, after the death of a person whom ho has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and helief the name of the deceased, his supposed age, the discase of which he died, defined as re- quired hy 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 hury a human hody . . . 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 shail 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 he 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 shail 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 he 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 dicd 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 he, 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.


(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 ahortion, 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.


R-302


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


BOSTON (City of town)


Registered No ... 4851


County


Suffolk


State


Massachusetts


Registered No ..


78


(Place of residence)


St.,


Ward


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


RICHARD FRANCIS RACINE


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


City or Town


WINTHROP


No.


St.


(a) Residence.


State


(Usual place of abode)


MASS.


Leogth of residence io city or town where death occurred


years


months


days


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


years


months


days


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


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 DATE OF BIRTH (month, day, and year) MAR. 4. 1922


7 AGE


Years


Months


2


Days


8


If LESS thao 1 day, ... hrs.


or ........ min.


If STILLBORN, eoter that fact here


8 OCCUPATION OF DECEASED


(a) Trade, professioo, or


particolar kind of work.


(b) Name of employer


9 BIRTHPLACE (city or town)


(State or country)


B.O.S.T.O.N.


10 NAME OF FATHER FREEMAN RACINE


PARENTS


11 BIRTHPLACE OF FATHER (city or town)


WOODSTOCK


(State or country) CONN.


12 MAIDEN NAME OF MOTHER


MARY A. DUFFY


13 BIRTHPLACE OF MOTHER (city or town)


(State or country)


14 MOTHER


Informant


(Address)


15 may 19. EumSeinen Filed 19 22


2.5.1982


Registrar of city or towo where death occorred


Filed MAY +, 19


Registrar of city or town where deceased resided


I. 20,000


of certificate.


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


(duration)


2


yrs ...


mos ..


ds.


CONTRIBUTORY


TERMINAL BRONCHO-PNEUMONIA


(SECONDARY)


(duration)


.yrs.


mos ..


ds.


18 Where was disease contracted


if not at place of death ?


Did an operation precede death ?.


Date of


Was there an autopsy?


What test confirmed diagnosis?


(Sigoed)


HENRY A. KONTOFF


M.D.


, 19 22 (Address)


MAY 13


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


MT . HOPE CEM.


DATE OF BURIAL


MAY 22


19 22


20 UNDERTAKER R. & E.F.GLEASON


ADDRESS


19 22


17 I HEREBY CERTIFY, That I attended deceased from APR. I MAY 12


TM


19


MAY 12


19 .. 22


that I last saw h


alive on


19 .. 22


...


8.08P


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


.m. The CAUSE OF DEATH* was as follows :


PYEMIA


1 PLACE OF DEATH


(Place of death)


City or Town


Boston


No.


EVANGELINE BOOTH HOSPT.


2 FULL NAME


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


MAY 12


22


to


BOSTON


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. Butin 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 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 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 (retired, 6 yrs.). For persons who have ro 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 sym tomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Lebility" ("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.)




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.