Town of Winthrop : Record of Deaths 1922-1924, Part 41

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 41

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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 lastillness, at the request of an undertakeror 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 died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last scen 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 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 licu thereof a certificate as hereinafter provided. If thore is no attonding 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. 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 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 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 persona found dead,

R-302

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

BOSTON

( City or towp). 6322

Registered No ..

(Place of death)

Registered No ..

126

(Place of residence)

St.,

Ward

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

2 FULL NAME

MAX ABRAMOVITZ

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

(a) Residence.

State

(Usual place of abode)

MASS

City or Town

WINTHROP No.

22 WAVEWAY AVE-St.

Length of residence io city or town wbere death occurred

years

mooths

days

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

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

JULY 13

19 22

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

MAR'.

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

SARAH

6 DATE OF BIRTH (month, day, and year)

7 AGE

Years

Months

Days

If LESS thao

I day, ........ hrs.

or ........ min.

If STILLBORN, enter that fact bere

8 OCCUPATION OF DECEASED

(a) Trade, professioo, or

particular kind of work.

TAILOR

(b) Name of employer

9 BIRTHPLACE (city or town)

RUSSIA

(State or country)

10 NAME OF FATHER

SAMUEL ABRAMOVITZ

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)

N.W.FAXON

M.D.

, 19 22 (Address)

JUL. 13

14 WIFE

Informant

(Address)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

BETH ABRAHAM

DATE OF BURIAL

JUL . 13 19 22

Filed

JUL. 15, 19 22.

EumSeinen

Registrar of city or towo where death occurred

Filed: 10,

192 2/

Registrar of city or town where deceased resided

. 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,

PARENTS

11 BIRTHPLACE OF FATHER (city or town)

(State or country)

RUSSIA

12 MAIDEN NAME OF MOTHER HANNAH

13 BIRTHPLACE OF MOTHER (city ort

(State or country)

RUSSTA

1.3

(duration)

yrs

mos.

ds.

BRONCHO-PNEUMONIA

CONTRIBUTORY

(SECONDARY)

(duration)

.yrs.

mos.1 .. 2.

.ds.

HRS

The CAUSE OF DEATH" was as follows:

HEMATEMESIS

(GASTRIC ULCER)

I HEREBY CERTIFY, That I attended deceased from

JULY 3

22.

JULY 13, 19.22

JULY 13

that I last saw h.

alive on

19 .. 22 ...... ,

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

6.20A.

1 PLACE OF DEATH

County

Suffolk

State

Massachusetts

MASS. GEN. HOSPT. .

City or Town

Boston

No.

20 UNDERTAKER

MANUEL STANETSKY

ADDRESS

[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, ete. 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," "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 120 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 "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, 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 sym tomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions," "Lebility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock,". "Uremia,""Weakness," ete., 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.

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

LAIN PROM 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 lastillness, 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 died, defined as re- quired by section onc, 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 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. 38, Sec. 6.

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.

R-302

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Lexington (City or town)

Registered No.

(Place of death)

Registered No

102

(Place of residence)

St.,

Ward

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

2 FULL NAME

Mary .... L ..... Potter

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

(a) Residence. State ....... Ma.s.s.

(Usual place of abode)

City or Town

Winthrop

21 Pleasant

St.

Length of residence in city or town where death occurred

years

months

days

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

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

July 14,

19 22.

3 SEX

female

4 COLOR OR RACE

white

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

widow

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Charles H. Potter

6 DATE OF BIRTH (month, day, and year) Aug 11 1832

7 AGE

Years

Months

Days

1 day, ........ hrs. or ........ min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work.

at home

(h) Name of employer

(duration)

yrs.

mos.

ds.

CONTRIBUTORY

Old age

(SECONDARY)

(duration)

.yrs.

mos.

ds.

10 NAME OF FATHER Thompson Tenney

18 Where was disease contracted

if not at place of death ?

Did an operation precede death?IO

Date of

Was there an autopsy?

12 MAIDEN NAME OF MOTHER Harriet M Coliswhat test confirmed diagnosis ?.

13 BIRTHPLACE OF MOTHER (city or town)

Hontkin

(State or country) New Hampshire

(Signed)

J. Odin Tilton

· M.D.

, 19

(Address)

Lexington,

Mass 7/14/22

Informant Mrs. Frank A. Douglas

(Address) 21 Pleasant St. Winthrop, Mass. East Concord, N. H.

20 UNDERTAKER

Arthur A. Marshall & Son

ADDRESS

Lexington,

-13-'19. 25,000

carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back

of certificate.

Filed

July 1419 22. Arthur W.Hatch

Registrar of city or town where death occurred

Filed NY17, 1922

Registrar of city or town where deceased resided

I HEREBY CERTIFY, That I attended deceased from

May

22 to July 14,

that I last saw h.S.r.

alive on July 13,

and that death occurred, on the date stated above, at 9:30 Am

If LESS than

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. (See reverse side for additional spacc.)

Heart disease

valvular-both aortic & mitral

9 BIRTHPLACE (city or town).

Last Concord

(State or country)

New Hampshire

PARENTS

11 BIRTHPLACE OF FATHER (city or town) ..

.Loudon

(State or country) New Hampshire

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

July 1519 22

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

1 PLACE OF DEATH

County

Middlesex

State.

Mas.s.

City or Town

Lexington,

No ..

29 Waltham

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

Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach 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, Compos- itor, Architect, Locomotive engineer, Civil engineer, 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) Cotton mill; (a) Salcsman, (b) Grocery; (a) Forcman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return

"Laborer," "Foreman," "Manager," "Dcaler," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the dutics of the household only (not paid Housckcepers who receive a definite salary), may be entcred 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 indi- cated 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: Cerebrospinal fever (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- toneum, 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 .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," " Anemia" (merely symptomatic), "Atrophy," "Cof- lapse," "Coma," "Convulsions," ""Debility" ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus,' s," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State causc for which surgical operation was undertaken. For VIOLENT DEATHS 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., scpsis, tetanus) may be stated

under the head of Continuity. on statement of cause of death approved by Committee 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 due to Alcoholism, etc.

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

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY PHYSICIAN.

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

County. Suffolk City or Town Boston Winthrop 2 FULL NAME 054 Seg firam (a) Residence. No. (Usual place of abode) Length of residence in city or town where death occurred months years PERSONAL AND STATISTICAL PARTICULARS 3 SEX Female 4 COLOR OR RACE White 5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (witte the word) Single . 5a If married. widowed, or divorced HUSBAND of (or) WIFE of Jung. 265 1922 6 DATE OF BIRTH (Month) (Day) (Year) 7 AGE Years Months X Days If LESS than X 1 day, ........ hrs. or ....... min. 26 If STILLBORN, enter that fact here 8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) Name of employer (State or country) 10 NAME OF Ward Steams FATHER 11 BIRTHPLACE OF FATHER (City ) ... queria (State or country) 12 MAIDEN NAME OF MOTHER Minnie Garous 13 BIRTHPLACE OF PARENTS MOTHER (City) new york City (State or country) 14 Informant. D. Stearns (Address) 54 Vea Hoam Que 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 I. D. - WHILE FLAINLI, WIIN VITAVINU DAAVA INA INIS IS A PERMANENT RECORD. Every Item of information 9 BIRTHPLACE (City) Winthrop, Make

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop BOSTON (City or Town)

State. Massachusetts

Registered No ... 103

No .... 5H

Leg Hoam

UN. St. .Ward

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

Cyrille Stearns

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

Que,

.. Ward. Winthrop

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

days

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

July

1922

(Day)

(Year)

17 I HEREBY CERTIFY, That I attended deceased from July 20 19 22, to. July 21 19 22 that I last saw h.L.A ....... alive on July 21, 1922 and that death occurred, on the date stated above, at ........................ m. The CAUSE OF DEATH was as follows: .

Prem

Broncho- pneumoma.

(duration)

... yrs ..............

mos. 5 da,

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)

Samuel W Myers

M.D.

(Address) 38 Mckean st

Date.

det 22

19 PLACE OF BURIAL, CREMATION OR REMOVAL adatti lesbury

DATE OF BURIAL

(Cemetery)

ity or ton)

July 23492 ADDRESS

15 Filed Fully 29.1922 (Month)/ (Day) (Year)'

REGISTRAR

20 UNDERTAKER

Manuel Stanetoly Roston

KXM. 00,000

21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued

I. T. Mowry

Official Health officer

Date of issue 7821/ 221

Permit

453

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

months

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

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Town of Winthrop : Record of Deaths 1922-1924, Part 41

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

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