USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 44
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I. G. Maury
Official
Date of
8/5/22 No.
Permit 4697
1-XXM. :00.000
3 SEX 7 AGE 10 NAME OF FATHER PARENTS Inform 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 (h) Name of employer
5,
1922
(Day)
(Year)
( Usual place of abode)
5 1961
3
[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, Campasitor, Architect, Lacomative engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industriai 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) Catton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Autamobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Deaicr," etc., without more precise specification, as Day laborer, Farm laborer, Labarer - Caal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Hausekeepers who receive a definite salary), may be entered as Hausewife, Housework, or At home, and children, not gainfully employed, as At school or At hame. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Caok, 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 Nane. .
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 pneumania; Branchapneumonia ("Pneumonia," unqualified, is indefinite); Tuberculasis af 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; Chranic valvular heart disease; Chranic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchapneumonia (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 ali 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 soie cause of death: Abortion, celiuiitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipeias, meningitis, miscar- riage, necrosis, peritonitis, phiebitis, pyemia, septicemia, tetanus.
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shali forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or otherauthorized 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 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 . . . untii 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 thereshaii have been delivered to such board, agent or cierk .. . a satisfactory written statement containing the facts required by iaw to be returned and recorded, which shall be accompanied, in case of an originai 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 heaith, 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 shali make examination upon the view of the dead bodies of only sueh persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.
. . . He shall in ali 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 fuli 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 Heaith 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 ali 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.
1 PLACE OF DEATH
(Dist. No.
To be inserted by Registrar
County.
Saratoga
Town
marta
STANDARD CERTIFICATE OF DEATH STATE OF NEW YORK
Village
Registered No.
City. (No.
St .:
Ward)
[lf death occurred in a hospital or institution, give its NAME instead of street and number]
2 FULL NAME
John Mac Quarrie
(18a) Residence No.
Winthrop thass Ward.
(If nonresident, give city or town and State)
Length of residence in city or town where death occurred
yrs.
mos.
ds.
How long in U. S., if of foreign birth ?
yrs.
mos.
ds,
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (Write the word) married
5a IF MARRIED, WIDOWED OR DIVORCED HUSBAND OF. (OR) WIFE OF
annie Me Rae
6 DATE OF BIRTH may 1 1853
(Month) (Day)
(Year)
7 AGE
Years
69
Months
3
Days
7
If LESS than 1 day, how many ... hrs. or .. ...... min .?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Real Estate
9 BIRTHPLACE (City of Town)
(State or Country)
Prince Edward Island
10 NAME OF
FATHER
Don't know
11 BIRTHPLACE OF FATHER (City or Town)
11
(State or Country)
12 MAIDEN NAME
OF MOTHER
11
13 BIRTHPLACE OF MOTHER (City or Town)
(State or Country)
16 DATE OF DEATH aug 8 1922 (Year)
(Month)
(Day)
17 | HEREBY CERTIFY, That I attended deceased from
Case, 19 ........ , that I last saw h .. .alive on .....
19 .... and that death occurred on the date stated above, at 11:30AM The CAUSE OF DEATH * was as followsf De deman of fun ci
.DurationY ..
Chr: Endocarditis
(SECONDARY)
(Duration).
-yrs
- mos ......... ....
ds
18b 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)
Roth B. Castra Corner, V. D.
Guy 8
, 19 %V (Address).
Ballston Spa Ky
*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
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Miss Grace Mac Quarrie
) 455 Shirley St. Northrop MassWinthrop, mass.
15 Filed.
aug. 8
, 1922 Emma Mekcan REGISTRAR
20 UNDERTAKER Robert L. Carter
ADDRESS
Ballston Spa
Burial Ar ( Permit issued by ....
Transit '
Emma nickean Date of Issue
aug. 8-1922 ny
aug. 28. 100
See Instructions on Other Side
108.
or
4560,
new York State Department of health DIVISION OF VITAL STATISTICS
PARENTS
(b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
CONTRIBUTORY
Hampton
.mos ....
19 PLACE OF BURIAL, CREMATION OR
DATE OF BURIAL
Clica. 11. 1922
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
VISIVAAL JUALL' UP DEATH
Statement of occupation .- I'recise statement of occupation is very important, so that the relative heaithfulness 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, Physician, Stenographer, Composi- tor, Architect, Locomotive engineer, Civil engineer, Station- ury firemun, etc. But in many cases, especially in indus- trial 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 cxampies : (a) Spinner, (b) Cotton mill; (a) Salesman (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on inay formu part of the second statement. Never return " Laborer," " Foreman," " Manager," " Dealer," etc., with- out more precise specification, as Day laborer, Farm laborer, Laborer - Coal minc, etc.
Women at home, who are engaged in the dutles of the household only (not paid Housekeepers who receive a definite salary), may be entered as House- wife, Housework, or At home, and children, not gainfully employed, as At school or At home. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of iilness. If retired from business, that fact may be indicated thus : Farmer (retired, 6 yrs.). For persons who have no occu- pation whatever, write None.
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 fever (the only definite synonym is " Epidemic cerebrospinal meningitis ") ; Diphtheria (avoid use of "Croup ") ; Typhoid fever (never report " Typhold pneumonia ") ; Lobar pneumonia, Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tu- berculosis of lungs, meninges, peritoneum, etc. Curcinoma, Sarcoma, etc., ot .. (name origin ; "Cancer" is less definite ; avoid use of " Tumor " for malignant neoplasms) ; Mcasles; 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 symptonis or terminai conditions, such as " Asthenla," " Anemla " (merely symptomatic), "Atrophy," " Collapse." " Coma," "Convulsions," " Debility "" (" Con-
genital," " Senile," etc.), "Dropsy," "Exhaustion," " Heart failure," " Hemorrhage," " Inauition," "Marasmus," " Old age" " Shock," " Urcmia," " Weakness," etc., when a defi- uite disease can be ascertained as the cause. Aiways quallfy as " PUERPERAL septicemia," " PUERPERAL perito- nitis," etc., ali discases resulting from childbirth or mis- carrlage. State cause for which surgical operation was undertaken. For VIOLENT DEATHIS state MEANS OF INJURY and quallfy as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Ex- amples : 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 (e. g., sepsis, tetanus) may be stated under the head of "Contributory." ( Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
SECTION 377, CHAPTER 619 OF THE LAWS OF 1913.
Certificate of death .- The particulars called for by items one to thirteen inclusive shall be authenticated by the signature of the informant, who may be any competent person acquainted with the facts.
The statement of facts relating to the disposition of the body shall be slgucd by the undertaker or person in charge of the corpse.
The medical certificates shaii be made and signed by the physlclan, if any, last in attendance on the deceased, who shali specify the thune In attendance, the time he last saw the deceased allve and the hour of the day at which death occurred. He shall further state the cause of death, so as to show the cause of discase or sequence of causes re-
The secondary cause, if and the duration of each. Indefinite terms, denoting symptoms of disease or conditions resulting from dise shall not be heid sufficient for the issuance of a buria removai permit. Any certificate stating the cause of de in terms which the state commissioner of health s have declared indefinite, shall be returned to the physl or person making the medical certificate for correction more definite statement. Causes of death which may the result of either disease or violence shall be expiic defined ; and if from vloience, the means of injury sl be stated, and whether apparently accidental, suicidal, homicidai. For deaths in hospitais, Institutions, or nonresidents, the physician shail supply the informat required under Item 18, If he is able to do so, and n state where, In his opinion, the disease was contracted.
§ 378. Registration of deaths occurring without medi attendance .- In case of any death occurring without me cai attendance, it shall be the duty of the undertaker other person to whose knowiedge the death may come notify the locai heaith officer of such death, and when notified the health officer shaii immediately investigate a certify as to the cause of death; provided that if t health officer has reason to believe that the death in have been due to unlawful act or neglect he shaii th refer the case to the coroner or other proper officer for investigation and certification. The coroner or other prop officer whose duty it is to hoid an inquest on the bo of a deceased person, and to make the certificate of dea required for a burial permit, shali state in his certifica the name of the disease causing death, or if from extern causes, the means of death; whether probably accident: suicidai or homicidai; and shall, in any case, furnish su information as may be required by the state commission of health in order properly to classify the death.
§ 379. Duties of undertaker .- In each case the unde taker, or person having charge of the corpse, shall file ti certificate of death with the registrar of the district : which the death occurred and obtain a burial or remove permit prior to any disposition of the body. He shali ol tain the required personai and statistical particulars from a person qualified to supply them, over the signature an address of his informant. He shail then present th certificate to the attending physician, who shali forthwit fill out and sign the medical certificate of death, or to th health officer or coroner, for the medicai certificate of th cause of death and other particulars necessary to complet the record for the registration of deaths, as speclficd i this article, if no physician was in attendance upon th deceased. Ile shall then state the facts required relativ to the date and place of burial, cremation or removal over his signature and with his address, and present the completed certificate to the registrar in order to obtain a permit for burial, removal or other disposition of the body The undertaker shall deliver the burial permit to the per son in charge of the place of burial, before interring of otherwise disposing of the body; or shall attach the re. mnovai permit to the box containing the corpse, when shipped by any transportatlon company ; sald permit to accompany the corpse to its destination, where if within the state of New York, it shall be delivered to the person in charge of the place of burlai.
§ 381. Interments .- No person In charge of any prem- ises on which interments or cremations are made shall inter or permit the intermuent or other disposition of any body unless it is accompanied by a burial, cremation or transit permit, as herein provided. Such person shail en- dorse upon the permit, the date of interment. or cremation over his signature, and shall return ali permits so endorsed to the registrar of his district within seven days from the date of interment or cremation. He shall keep a record of ali bodies interred or otherwise disposed of on the premises under his charge, in each case stating the name of each deceased person, place of death, date of burial or disposal, and name and address of the undertaker; which record shaii at all times be open to officiai inspection ; pro- vided that the undertaker or person having charge of the corpse, when burying a body in a cemetery or burial ground having no person in charge, shall sign the hurlal or re- movai permit, giving the date of burial, and shall write across the face of the permit the words "No person in charge," and file the burlai or removal permit within three days with the registrar of the district in which the ceme- tery is located.
R - 301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
Anthrop
(City or town)
Registered No.
109
St.
.. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number) Stiles
(If in the Army or Navy of the United States, give rank, organization, etc. )
(a) Residence. No.
20 Sargent
.St.
Ward.
X
Length of residence in city or town wbere death occurred
3
years
10 months
29 days.
How long in U. S., if of foreign birth ? years
months days
PERSONAL AND STATISTICAL PARTICULARS
1 PLACE OF DEATH
1000
City or Town
Stinthrop
(Usual place of abodc)
3 SEX
Female
4 COLOR OR RACE
White
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 AGE
3
Ycars
Months
Days
29
1
0
If STILLBORN, enter that fact bere
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Name of employer
It in throp
8 BIRTHPLACE (City)
(State or country
Mars.
9 NAME OF
FATHER
10 BIRTHPLACE OF
FATHER (City).
11 MAIDEN NAME
OF MOTHER
12 BIRTHPLACE OF
PARENTS
MOTHER (City)
Chelsea,
(State or country )
Mars.
Informant
(Address)
20 Sargent St.
instructions and extracts from the laws on back of certificate.
14
Filed ana10-1222
(Month) (Day) (Year)
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
(State or country)
mass.
Zadok Lyman Stiles.
Dorchester Rolley
Emma PDcan.
13 Zadok . Stiles
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
(Most)
any
8
1922
(Day)
( Year)
16
*
I HEREBY CERTIFY, That I attended deceased from
any 4
1922
ang 8
:, to
1922
22
that I last saw her alive on
19
and that death occurred, on the date stated above, at 12.28 A.m.
The CAUSE OF DEATH was as follows : auchsia
(duration)
yrs ..
mos
4
ds.
CONTRIBUTORY
(SECONDARY )
(duration)
nd
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 ?
consultation
What test confirmed diagnosis ?..
(Signed)
(3)metral)
M.D.
(Address)
174 Withmy 1st
97
1922
Date
Mouth)
(Bay)
( Year)
18 PLACE OF BURIAL, CREMATION, OR REMOVAL) .
Strinthrop
Furtherp
DATE OF BURIAL Quq 10.
(Cemetery)
(City or town )
19 UNDERTAKER
P. IT. Benson
ADDRESS/
47
Winthrop.
Northrop
20 1 HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued.
Official position ... Health Ofin Date of issue
Permit
Quy 9-22 No. 462
,000.
County
Suffolk
State
: mars
No.
20 Sargent
2 FULL NAME
trances
Dean
(If non-resident give city or town and State )
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
If LESS than 1 day ... .... hrs. or ........ min.
aug. 8, 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 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, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. But in many cases, especially in industriai 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 repert 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.
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 (discase 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 ali diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.
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