Town of Winthrop : Record of Deaths 1925-1927, Part 198

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 198

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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. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite) ; Tuberculosis of lungs, meninges, 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 intercurrent) 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," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "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 "PUERPERAL 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 "primary"; 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, miscarriage, 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 forth- with, 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 registra- tion a standard certificate of death, stating to the best of his knowl- edge and belief 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 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 con- taining the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory 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 pur- pose, or is insufficient, a physician 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 person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration auy 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 re- quire .- 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; otherwise 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 unre- lated to any form of injury, have died without recent medical at- tendance or whose physician is absent 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 poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

RM R-301 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS I PLACE OF DEATH

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Suffolk

State Massachusetts

Winthrop BOSTON

(City or town)

County

City or Town

Boston- Winthrop

2 Upland Road.

St., Ward

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

2 FULL NAME

Felix Vergona

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

(a) Residence. No.

(Usual place of abode)

2 Upland Road. St.,

Ward.

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

Length of residence in city or town where death occurred

years

months

days.

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

years

months days

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

Nancy Vergona

6 AGE

Years

Months 11

Days

If LESS than 1 day, ____ hrs. Of __ min.

If STILLBORN, enter that fact hore

7 OCCUPATION OF DECEASED

(a) Trada, profession, or

particular kind of work

Clerk.

(b) Nama of employer

8 BIRTHPLACE (City)

Italy

(State or country)

PARENTS

(State or country)

11 MAIDEN NAME

OF MOTHER

Mary Costa

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Italy

Informant

Mrs. Vergona

( Address)

2 Upland Road.

apr 25/2)

(Month) (Day) (Year)

REGISTRAR

19 UNDERTAKER

gratisman/ 2010

ADDRESS

Boston

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

Hing St. Childress

Date of issue

official Position seattle Slikiceros perman 7/15/27

Pormit NO. 12+3

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.

-20M.

3-200,000

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

April 16 1927

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from april 9 1922, to abril 16 1922.

that I last saw herme alive on

april 16

2).

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

4.40 Pm.

The CAUSE OF DEATH was as follows:

Carinary artery

(duration)

_yrs.

mos.

8 ds.

CONTRIBUTORY

artéria Selerasia

(SECONDARY)

Scutduration :

.yrs.

-mos ..

17 Where was disease contracted

if not at place of death?

FOR WHAT ?

Did an operation precede death 2 20

Date of

200

Was there an autopsy?

UI under one year, was Infant Breast Fed ?...... What test confirmed diagnosis? Cliccacat

(Signad)

M. D.

(Address)

123 Vielnettil ST

Dato

(Month)

(Day)

(Year) 220020

18 PLACE OF BURIAL, CREMATION OR REMOVAL

St. Michaels Com. Boston April 19, 1997

(Cemetery)

(City or town)

DATE OF BURIAL

9 NAME OF

FATHER

Felix Vergona

10 BIRTHPLACE OF

FATHER (City)

Italy

Registered

No.

april 16, 110/-

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

(Approved by U. S. Census and American Public Health Association)

Statement of occupation .- Preciss statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question appliss 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, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Fore- man," "Manager," "Dsaler," 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 definite salary), may be entered as House- wife, Housework, or At home, 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 occupa- tion 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. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, 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 intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 da. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "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 "PUERPERAL 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 "primary"; 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 forth- with, after the death of a person whom hs 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 deceassd, furnish for registra- tion a standard certificate of death, stating to the best of his knowl- edgs and belief 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 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 con- taining the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate ag hereinafter provided. If . there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the pur- pose, or is insufficient, a physician 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 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 be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- 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.

... Hs 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 .- Gen. Laws, Chap. 38, Sec. 7.

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for the observancs 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 diseass unre- lated to any form of injury, have died without recent medical at- tendance or whose physician is absent from home when the certificate of death is needed.

STANDARD CERTIFICATE OF DEATH

DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS

1 PLACE OF DEATH

County

Suffolk

State

MASSACHUSETTS.

Registered No.

Township

Winthron

or ,Village

No.

tart Banks

St.,

Ward

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

2 FULL NAME

Charles Franklin Salisbury

(a) Residence. No.

Fort Banks, Mass.

St.

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

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED.

OR DIVORCED (write the word)

Married

5a If married, widowed, or divorced

HUSBAND of

XOXWIFEofx Mrs. Isabelle Salisbury.

6 DATE OF BIRTH (month, day, and year) July 11, 1871.

Years

Months

Days

If LESS than

1 day, ---- hrs.

or ---- mln.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

Soldier,

(b) General nature of Industry,

business, or establishment In

which employed (or employer)

U.S.ARMY

9 BIRTHPLACE (city or town)

Flora

(State or country)

Indiana.

10 NAME OF FATHER Matthews Salisbury,

11 BIRTHPLACE OF FATHER (city or town)

Flora

(State or country)

Indiana.

12 MAIDEN NAME OF MOTHER

Minerva Cline

13 BIRTHPLACE OF MOTHER (city or town)

Flora.

(State or country)

Indiana.

Informant

l'rs. Isabelle Salisbury

(Address)

Fort Banks, Vase

Winthrop, Winthrop,L'ass.

DATE OF BURIAL 4/2 20

ADDRESS

Filed 21/ 2-5, 1927

REGISTRAR

11-3184

MEDICAL CERTIFICATE OF DEATH

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

17,

1927.

19-

I HEREBY CERTIFY, That I attended deceased from

January 19

,to.April

.17

19.27,

that I last saw him.

-- alive on

April 17.

19.27.

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

9:40 Pm.

The CAUSE OF DEATH* was as follows:

Valvular heart disease; Mitral insufficiency chronic, severe.duration unknow.l'vocarditis chronic, Nephritis chronic interstitial. Unknown (duration) yrs. mos. ds. CONTRIBUTORY Cardiac dilatation acute severe. (SECONDARY)

(duration) ...... yrs. ...... mos.

20mg

18 Where was disease contracted

if not at place of death ?-

Unknown .

Did an operation precede death ?

Date of

Was there an autopsy?

TTO

What test confirmed diagnosis ?

Clinicse

TI. C.

V. F . Turner, Capt.

(Signed)

M. D.

4/18192 7(Address) Fort Ranks, liass.

* 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 space.)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

20 UNDERTAKER

CR Ben:

I Health Hout echelon

201 1124

City 3 SEX Male 7 AGE 56 PARENTS mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 15 N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of infor- TION is very important. See Instructions on back of certificate. CAUSE OF DEATH In plain terms, so that It may be properly classified. Exact statement of OCCUPA- particular kind of work

(Usual place of abode)

april

1721

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 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, 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial 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 household 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 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," unqualified, is indefi- nite); Tuberculosis of lungs, meninges, peritoneum, etc., Car- cinoma, Sarcoma, etc., of . (name origin; “Can- cer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The con- tributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal condi- tions, such as "Asthenia," " Anemia". (merely symptom-

atic), "Atrophy," "Collapse,"" "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inani- tion," " Marasmus," "Old age,"" "Shock," "Uremia,"' "Weakness," etc., when a definite disease can be ascer- tained as the cause. Always qualify all diseases result- ing from childbirth or miscarriage, as "PUERPERAL septi- cemia," "PUERPERAL peritonitis," etc. State cause 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 determine 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 (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.)

NOTE .- Individual offices may add to above list of undesirable terms and refuse to accept certificates containing them. Thus the form in use in New York City states: "Certificates will be returned for additional information which give any of the following diseases, without explana- tion, as the sole cause of death: Abortion, cellulitis, childbirth, convul- sions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus." But general adoption of the minimum list suggested will work vast improve- ment, and its scope can be extended at a later date.

11-3184

ADDITIONAL SPACE FOR FURTHER STATEMENTS

BY PHYSICIAN.

RM R-303

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

15,676

Medical Examiner's Certificate of Death

(City or town)

1 PLACE OF DEATH

County

Halk.

State

Registered No.

St.,

Ward

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

naus

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

.. Ward.

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

Length of residence In city or town where death occurred

years

months

days

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

19.1927

( 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. Hvid Suddenly )

(See reverse side for description for unknown person)

17 Where was Injury sustained

if not at place of death

(Sig )Large

(Address)

Burgas Magatt

$ ... M.D.

Date

(Month)

(Day)

Medical Examiner for ..

aful

201 1927.

(Year)

DATE OF BURIAL

18 PLACE OF BURIAL, CREMATION, or REMOVAL

(Month) (Day) WYear)'

Holy wood

Brookline april 22/27

(Cemeterf)

(City or town)

19 UNDERTAKER

W. J. Cassidy

ADDRESS

Boston

20 1 Him. L. Ciulderes Issued by

Official position

Health Prices issue .. 4/20/27

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Town of Winthrop : Record of Deaths 1925-1927, Part 198

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

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