Town of Winthrop : Record of Deaths 1925-1927, Part 143

Author: Winthrop (Mass.)
Publication date: 1925
Publisher:
Number of Pages: 1340

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1925-1927 > Part 143

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State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved hy 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 sball fortbwitb, 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 the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belicf the name of the deceased, his supposed age, tbe 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 hy the physician or officer and the date of his death. . ..- Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person sball 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 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 licu thercof a certificate as bercinafter 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 tbe deccased, 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 hodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Scc. 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; otber- wise a description as full as may he, with the cause and manner of deatb. - Gen. Laws, Chap. 38, Sec. 7.

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given hedside 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 wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home wben 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, tbe sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

M R-303

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

Medical Examiner's Certificate of Death (ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)

(City or town)

1 PLACE OF DEATH

Suffolk.

County

City or Town Willing

State .. Yacht club-

St.,

· Ward

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

and Cook

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

.V .. St.,

Ward.

(If non-resident, give city or town and state)

months

days

How long in U. S., If of toreign birth?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

2 FULL NAME

3 SEX

Male

6 AGE

Death. See reverse side for extracts from the laws relative to the return of certificates of death.

(State or country)

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Nellie B.

Years

Months

Days

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

IF STILLBORN, enter that fact hera

7 OCCUPATION OF DECEASED

(2) Trade, profession, or

particular kind of work

Retired ..

(b) Name of employer

R.R, Employee.

8 BIRTHPLACE (City)

Bradford,

(State or country)

Vt.

9 NAME OF

FATHER

Rodney R. Crook.

10 BIRTHPLACE OF

FATHER (City)

Vermont:

11 MAIDEN NAME

OF MOTHER

Matilda Unknown

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Unknown:

Informant

Rowland Crook ..

(Address) 66 B. Huntington Ave, Boston

Flied,

Sept 11/2 6

(Month) / (Day) (Year)

REGISTRAR

20 Burial permit lasued by

Official position

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

august

1926

{ Month)

(Day)

(Year)

16 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows :

natural Causes: Cardio- vascular disease, probably Coronay Sclerosis

(rid Suddenk )

(See reverse side for description for unknown person)

17 Where was injury sustained

if not af place of death ?

(Signed)

M.D.

Medical Examiner for

Dale.

(Month)

(Day)

1926. (Year)

18 PLACE OF BURIAL, CREMATION, or REMOVAL Woodlawn ... Cem ..... Everett ... (Cemetery) (City or town)

DATE OF BURIAL Aug. 31.,1926 (Month) (Day) (Year) ADDRESS Boston.

19 UNDERTAKER J.J. Hatermang Ions.

21 Date of

Permit

No.

412-9

DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS

Registered No.

arthur

(a) Residence. No.

(Usual place of abode)

Length of residence in city or town where death occurred

years

Whiltrup.

15,161

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 at- tended during his last illness, at the request of an under- taker 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 so that it can be clas- sified under the international classification of causes of death), 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. . . .- General Laws, Chapter 46, Section 9.

No undertaker or other person shall bury or other- wise dispose of a human body in a town, or remove there- from a human body which has not been buried, until he has received a permit from the board of health . . . , or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, or from one cemetery to another, until he has received a permit from the board of health . . . or from the clerk of the town where the body is buried. No such permit shall be Issued until there shall have been delivered to such board, . . . or clerk .. .. a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied . . . by a satisfac- tory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as herein- after provided. If there is nc attending physician, or if, for sufficient reasons, hls 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 certificate. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The per- son to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the man- ner or cause of the death, which the clerk or regls- trar may require .- General Laws, Chap 114, Sec. 45 @8 amended.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are sup- posed to have died by violence. If a medical examiner has notlce that there is within his county the body of such a person, he shall forthwith go to the place where the body lles and take charge of the same. . . . General Laws, Chap, 38, Sec. 6.

. He shall in all cases certify to the town clerk or registrar In the place where the deceased died his name and residence, If known; otherwise a description as full as may be, with the cause and manner of death .~ General 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 physi- cian is absent from home when the certificate of death is needed.

(3) Medical Examiners will investigate and certify to all deaths supposably due to violence. These include not only deaths caused directly or indirectly by traumatism (In- cluding resulting septicemia), and by the action of cheml- cal (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease re- sulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

STATEMENT OF CAUSE OF DEATH

Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its productlon together with the circumstances when these are known. For ex- ample: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam rallway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under cir- cumstances unknown."

If investigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemor- rhage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"

DESCRIPTION (for unknown person)

aug. 28. 1926.

NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.

THIS CERTIFICATE CONSTITUTES SUCH PERMIT

302

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

State Infirmary Tewksbury, Mass. (City or town) Registered No. 357

(Place of death)

Registered No.

(Place of residence)

St.,

Ward

Starta in a Longital af in Hilton, give its NAME instead of street and number)

2 FULL NAME

Maurice J. Sipple

(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.

St.

Length of residence in city or town where death occurred

1 years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

Male

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Single

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

---

6 AGE

Years

Months

Days

If LESS than

1 day, ____ hrs.

M STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Laborer

(b) Name of employer

8 BIRTHPLACE (city or town)

Boston

(State or country)

Mass.

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? Phys. Diag

(Signed)

G. H. Cleary

, M. D.

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

Ireland

(Address) State Infirmary, Towkabury,

Aug. 30,

1926

Date

Mass. ..

STATE

Informant

ilsanitAi Rolo

(Address)

Filed Aug. 30, 1926

- NICHOLS S

Registrar of city or bewa where death occurred

Filed

Jack. 1.1926

Registrar of city or lown where deceased resided

1 0,000

PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified.

WRITESPI BINI

AGE should be stated EXACTLY. Exact statement of OCCUPATION Is very Important. See Instructions on back of certificate.

PARENTS

10 BIRTHPLACE OF

FATHER (city or town)

Not learned

(State or country)

Ireland

11 MAIDEN NAME

OF MOTHER

Julia Barry

Not learned

15 DATE OF DEATH

Aug. 30,

1926

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from Aug. 13, , 1925, to Aug. 30, , 19 26,

that I last saw h

alive on

Aug.

30,

,19 26

and that death occurred, on the dated stated above, at8 ; 1QA.

The CAUSE OF DEATH was as follows:

Anterio sclerosis

(duration) + yrs.

mos.

ds.

CONTRIBUTORY . Chr. Myocarditis

(SECONDARY)

(duration) +

.yrs.

ds.

DATE OF BURIAL

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Winthrop Cem.

winthrop 9/2

TEWKSBURY (Cemetery) (City or town) 19 UNDERTAKER

, 19

ADDRESS

C. R. Bennison

by Gibbons

Winthrop

1 PLACE OF. DEATH

County

Middlesex

State_

Mass

State Infirmary

_ No.

City or town

Tewksbury

(If death beot

9 NAME OF

FATHER

John

Sipple

(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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Composi- tor, 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 state- ment; 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 state- ment. Never return "Lahorer," "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 household only (not paid Housekeepers who receive a defi- nite salary), may be entered as Housewife, Housework, or Athome, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically 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 heginning 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 (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 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.

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 stand- ard certificate of death, stating to the best of his knowledge and belicf the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the du- ration 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 perniit from the board of health or its agent. . or ... from the clerk of the town where the person died ;.. . No such permit shall be issued until there shall have been delivered to such board, agent or clerk .. . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which shall he accompanied, in case of an original interment, by a satis- factory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insuffi- cient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon ap- plication make the certificate required of the attending physi- cian. If death is caused by violence, the medical examiner shall make such certificate ... The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can 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 died by vio- lence .-- 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 hedside 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 ahsent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poison), thermal, or electrical agents, and deaths following abortion, hut 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 - 301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH

County

Suffolk

State Mass.

Registered No.

City or Town

Winthrop

No. Winthrop. Hospital .,

St., Ward

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

2 FULL NAME Mary Cazale 9 Nahant Ave Revere

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

(a) Residence. No.

(Usual place of abode)

Length of resideoce in city or town where death occurred

years

mooths

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

mooths days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX 4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED ( write the word)

Female

White

5a If married, widowed, or divorced HUSBAND of (or) WIFE of

6 AGE

Years

Months

Days

If LESS than

moin.

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 )

Winthrop

PARENTS

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

11 MAIDEN NAME

OF MOTHER

Cecelia Holland

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Chelsea

Informant

Mr. John Cazale

(Address)

9 NahenthAve Revere

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Holy Cross Malden

(Cemetery)

(City or town)

DATE OF BURIAL 9/2/26

19 UNDERTAKER

William D. Casey

ADDRESS

Chelsea

14 Sep. 10/26 Filed (Month) (Day) ( Year)

REGISTRAR

20 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the berial or trans't permit was issued

N. D. Childress

Official position

Health Office

Date of issue of permit 9/2/26

Permit

No. 1129

I HEREBY CERTIFY, That I attended deceased from dept 1

,19/

26 rep

that I last saw h

alive on

, 19

3,1017

The CAUSE OF DEATH was as follows :

Coophyxia Neonatorum

(duration)

yrs.

mos.

ds.

CONTRIBUTORY (SECONDARY)

(duration)

.yrs

mos.

de.

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) 6

Vep tramber / Date

( Month) (Day)

1476

( Year)

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

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Town of Winthrop : Record of Deaths 1925-1927, Part 143

Author: Winthrop (Mass.) Publication date: 1925 Publisher: Number of Pages: 1340

Author: Winthrop (Mass.)
Publication date: 1925
Publisher:
Number of Pages: 1340