Town of Winthrop : Record of Deaths 1922-1924, Part 38

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 38

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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 sueh 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 examinors 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 disabied by recognized disease, and those of persons found dead.

M R - 301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Winther (City or towny

1 PLACE OF DEATH

County

Suffolk

State. Mass.

Registered No. 96

St.,

Ward

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

Williamin

Franklin Oburg

(Ifin 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

months

×4 years

days.

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED ( write the word)

Masset

5a If married, widowed, or diversed

HUSBAND of

(or) WILL

annie LOburg

6 AGE

Years

Months X

Days 16

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

If STILLBORN, enter that fact bere

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer 2 Herrnci @low Co

8 BIRTHPLACE (City).

(State or country

Mars

9 NAME OF

FATHER

Thu, Oburg

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

11 MAIDEN NAME OF MOTHER

Mary, Ce. Murray

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

Boston Man

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

16 I HEREBY CERTIFY, That I attended deceased from June 17 19 22

to June 20, 1922 C

that I last saw h alive on 20 19 22

and that death occurred, on the date stated above, at 1000 m

The CAUSE OF DEATH was as follows : maquina 1 estoria

(duration)

mos. ds.

CONTRIBUTORY

acute Sud-gratis

(SECONDARY)

.(duration)

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)

, M.D.

(Address)

200 Plivous

Date

(Month)

(Day)

( Year)

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

june 23 22

(Cemetery) Winihut

(City or town)

19 UNDERTAKER

Elias. R. Penuria

ADDRESS

Filed June 241922

(Month) (Day) ( Year)

REGISTRAR

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

Official Healthofficer position

Date of issue of permit. 223/22

Permit

No.

4x 9

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information 1,000.

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

Comme. L. Obara,

Informant

(Address)

128 Course TK Without

No.

128 Collage Pan/ 12/5

City or Town

2 FULL NAME

128 College Park Pavad Ward.

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

(Day)

(Year)

1422

Vice President .

Burton

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) non 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 Ilousekcepers 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 heen 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.

. (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" (mercly 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 discases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)

Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

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

A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertakeror other authorized person or of any member of tho family of the deccased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alivo by the physician or officer and the date of his death. ...- Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury a human body . .. until he has received a permit from the board of health or its agent . . . or ... from the clerk of the town where the person died; . . . No such permit shall be issued until there shall have been delivered to such board, agent or clerk ... a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. ... The person to whom the permit is so given and the physi- cian certifying the cause of 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 elerk or registrar may require. - Gen. Laws, Chap. 114, Sec. 45.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. $8, Sec. 6.

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

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for tho 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.

(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.

A R - 301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Warthurt (City or town)

1 PLACE OF DEATH

County

State Mars

Registered No 9.7

No. 15.5 Paulni SL

City or Town

Elizabet.

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

2 FULL NAME

(a) Residence. No.

(Usual place of abode)

Length of residence in city or town where death occurred

45 years

months

days.

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

ycars

mooths

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

white

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

wider

5a If married, widowed, or dineweed

HUOD

HADAND of for) WIFE of

Warren. Cinerson Belches

6 AGE

Years 74

Months

Days 273

If LESS thao 1 day ........ hrs. or ........ mio.

If STILLBORN, eoter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, professioo, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

(State or country

9 NAME OF

FATHER

Enoch. Small.

PARENTS

10 BIRTHPLACE OF

FATHER (City)

(State or country) Bulon.

11 MAIDEN NAME

OF MOTHER

Sarch, Lakeman

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

13 Warren. Belcher

Informant

(Address)

155 Pauline Sta

Fil June 24.1922 (Month) (Day) ( Year)

REGISTRAR

18-PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

(Cemetery)

(City or town)

19 UNDERTAKER

C-R. Demini

ADDRESS

20 I HEREBY CERTIFY that a satisfactory stao- dard certificate of death was fled with me BEFORE the burial or transit permit was issued. J. G. Moury

Official position

Health officer

Date of issue

6/23/22 Permit No .. 450

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD. Every item of information 000.

MEDICAL CERTIFICATE OF DEATH

que

21 1922

(Year)

15 DATE OF DEATH

(Month)

(Day)

16 I HEREBY CERTIFY, That I attended deceased from may 8 1922 to fun ZI, 19 22.

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

Juez0

. 19 22

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

3 20 am

The CAUSE OF DEATH was as follows :

Cerebral arterio- Salerares

Que (duration)

yrs ..

....... mos ....

.......... ds.

CONTRIBUTORY

(SECONDARY)

Sevicity

Samuel (duration)

yrsmos ds.

17 Where was disease contracted if not at place of death ?. no

Did an operation precede death ?.

Date of

200

Was there an autopsy ?

What test confirmed diagnosis ?

Clinical

(Signed) Quelle & Johnson

M.D.

(Address)

123 Hwwwwy ST

Date

(Month)

(Day)

( Year)

155 Paulai

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

St.,

Ward.

(If non resident give city or town and State)

ACTOCD UNITED STATES STANDARD CERTIFICATE OF DEATH

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

Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) ampton 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 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 tho 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, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ..... . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," otc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)

Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.

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

A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his 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 belief the name of the deceased, his supposed age, the disease of which he dicd, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . .- Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent . . . or ... from the clerk of the town where the person dicd; . . . No such permit shall beissued until there shall have been delivered to such board, agent or clerk ... a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. . . . The person to whom the permit is so given and the physi- cian certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Gen. Laws, Chap. 114, Sec. 45.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. $8, Sec. 6.

. .. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. - Gen. Laws, Chap. 88, 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.

RM R - 301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH Block County

State Mars

Registered No 9.7

City or Town

No. 155 Panami SL

St.,

Ward

2 FULL NAME

(a) Residence.

No.

155 Pauloi

(Usual place of abode)

Length of residence in city or town wbere death occurred

45 years

months

days.

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

years

mooibs

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

white

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

wider

5a If married, widowed, or linesved

HUDA

BAND of

for) WIFE of

Warren. Cinerson Belcher

6 AGE Years 74

Months

Days

273

1 day ........ brs. or ........ min.

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

(State or country

9 NAME OF

FATHER

Enock . Small.

10 BIRTHPLACE OF

FATHER (City)

(State or country) Bulon.

11 MAIDEN NAME

OF MOTHER

Sarah, Lakeman

12 BIRTHPLACE OF MOTHER (City) (Statc or country)

13 Warren. Belcher

Informant

(Address)

155 Paulini Sta

14 Filed Kime 24.1922 (Month) (Day) ( Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Das)

(Year)

I HEREBY CERTIFY, That I attended deceased from

May 8

1922

to fun 21, 19 2.

If LESS than

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

fuera

. 19 22

320 9 m;

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

The CAUSE OF DEATH was as follows :

Cerebral arterio- Solecores

...

Que (duration)

yrs ..

.mog ................ ds.

CONTRIBUTORY

(SECONDARY)

Semicity

Samuel (duration)

.. 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 ?

200

What test confirmed diagnosis ?

Clinical

(Signed X

M.D.

(Address)

123 Harcay

Date

(Month)

(Day)

( Year)

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

(Cemetery) WikiZ

(City or town)

19 UNDERTAKER

C.R. Wenn.

ADDRESS

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

Official position.

Health officer

Date of issne . of permit 6/23/22

Permit

No. 450

2)0,000.

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.

PARENTS

The Commnmmuralth of Massachusetts

(City or town)

(If death occurred in a hospital or institution, gire its NAME instead of street and number) Davis Naimillor Belcher

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

St.,

.Ward.

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

Que 21 1922

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 singlo word or term on the first line wili be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional lino 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 sccond 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 tho 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 no occupation whatever, write None.

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Town of Winthrop : Record of Deaths 1922-1924, Part 38

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

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