Town of Winthrop : Record of Deaths 1925-1927, Part 206

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 206

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Official position

Date of

Health Office 5/19/27

Parmit NO 1257

23-200.000

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

lect

1926, to

nicy 18

that I last saw h

alive on

may 18

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

.m.

The CAUSE OF DEATH was as follows:

Lacessione of Stomach,

(duration)

-yrs.

.mos.

ds.

CONTRIBUTORY

(SECONDARY)

(duration)

... yrs ..

.mos.

17 Where was disease contracted

if not at place of death ?.

FOR WHAT?

Did an operation precede death?

Date of

Was there an autopsy ?. If under one year, was infant Breast Fed? What test confirmed diagnosis ?.

(Signed) Faire, us/ illy M. D.

(Address)

you, teas and &''

Date

(Month)

(Day)

(Year)

18 PLACE OF BURIAL CREMATION DR REMOVAL

Winthrop

(City or lown)

DATE OF BURIAL May 21;27

(Cemetery)

19 UNDERTAKER

C. a. Rollins.

ADDRESS

8. Baston

-YM

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.

5 19

Diabetes Inellitus

9 NAME OF

FATHER

Samuel B. Gilbert

I PLACE OF DEATH

County

Winthrop

Bustorf

may

18.1927

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, eo that the relative healthfulness of various pursuite 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 firet line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, etc. But in many casee, especially in industrial employmente, 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 examplee: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may

form part of the second etatement. Never return "Laborer," "Fore- man," "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 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, ae 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 persone 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 alwaye 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" ie 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, euch 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. Alwaye qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

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

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 pereon or of any member of the family of the deceased, furnish for registra- tion a standard certificate of death, etating 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 eame 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. 1

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 pereon 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 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.

. .. 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 lawe 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 dieeaee unrelated to any form of injury.

(2) Board of Health Physicians will certify to such deaths only as those of pereons who, though disabled by recognized disease unre- lated to any form of injury, have died without recent medical at- tendance or whoee physician ie 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 reeulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but aleo deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of pereone found dead.

RM R-301

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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Vinthrop

(City or town)

Registered No.

City or Town

Winthrop

No. Winthrop Community Hospital St. Ward

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

2FULL NAME

Margaret E. Callahan

(If U. S. War Veteran, specify WAR)

(a) Residence. No.

166 Bowdoin St.

St.

Ward,

(Usual place of abode)

(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

4. COLOR OR RACE

Female

White

5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word) Married

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

Henry

6 AGE

Years

Months

IF LESS than 1 day. ...... hrs. cr ........ min.

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

Housewife

8 BIRTHPLACE (City)_

(State or country)

Ireland

9 NAME OF

FATHER

James Rice

1 O BIRTHPLACE OF FATHER (City) (State or country) Ireland

1 1 MAIDEN NAME

OF MOTHER

Celia Burns

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

Informant Henry Callahan

(Address) 166 Bowdoin St.

Filed 7/10/23/37

(Month) (Day) (Year)

REGISTRAR

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

W.D. Chiliens 9.0.9.

Official position.

n Healthe office ) Date of

6/20/27

Permit ils.

1258

15 DATE OF DEATH

(Month)

(Day)

(Year)

I HEREBY CERTIFY , That I attended deceased from

1927, to

Tway 19

, 1927

that I last saw her alive on

way 19

19Z>

.m.

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

The CAUSE OF DEATH was as follows: (State fully)

Endocarditis

(duration). _. yrs. .mos. de.

CONTRIBUTORY

Choletichrusio

(Secondary)

(duration). mos. ds.

1 7 Where was disease contracted

if not at place of deatlı

Did an operation precede death

_For what chotelichinino

Date of operation

5/11/24

Was there an autopsy t

What test confirmed diagnosis

(Signed)

M. D.

(Address)

1200

Date

5/17/27

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Holy Cross

Walden

(Cemetery)

(City or town)

DATE OF BURIAL May 21 1927

1 Ø UNDERTAKER

John J. Omaley

ADDRESS Winthrop

Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information should be carefully sup- PARENTS

200.000. 9-26. NO. 6373

State

fass

MEDICAL CERTIFICATE OF DEATH

may 19. 1927 REVISED UNITED STATESSTANDARD 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, 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," "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 ony (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 Scrvant, 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 Discase Causing Death (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemie 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 ncoplasms); Measles; Whooping cough; Chronic valvular heart discase; 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 symp- tomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite discase 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- mittce 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, menin- gitis, 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 dicd, defined as required 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 or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, 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 its agent aforesaid 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, agent or clerk, as the case may be, 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 eerti- 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 ob- tained carly enough for the purpose, 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. If the death certi- ficate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. 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 require .- Chap. 114, Sec. 45, G. L., as amended.

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.

No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46, G. L., as amended.

R-305

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

State Infirmary tewksbury, LESS. (City or Town)

1 PLACE OF DEATH

County iddlesex

State.

Dass.

Registered No.

(Place of death)

(Place of residence)

City or Town

Tewksbury,

No.

itate Infirmary

St.,

Ward

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

2 FULL NAME

Isabelle Jones

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

St.,

Ward.

Minthron

( 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

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED OR

DIVORCED (write the word)

Ilidowed

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

John Jones

6 DATE OF BIRTH (Month)

(Day)

(Year)

7 AGE

Years

Months

Days

If LESS than 1 day ....... hrs.

or ...... min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Housework

9 BIRTHPLACE (city or town). Cape Treton

(State or country)

Nova Scotia

10 NAME OF FATHER John "Schellan

11 BIRTHPLACE OF FATHER (city or town)

Not learne

(State or country) Scotland

12 MAIDEN NAME OF MOTHER

Catherine "

backend

13 BIRTHPLACE OF MOTHER (city or town) of leamed. (State or country) Scotland

Informant

Ilo piela Records

Filed

HET 22/9 27

Filed Curé 13, 1927

Registrar of city or town where death occurred

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH.

May 21,

(Month)

(Day)

(Year)

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

the right humerus caused by an accidental fall from her bed

(See reverse side for additional space)

18 Where was injury sustained

if not at place of death?

State - firmary

(Signed)

mgrshall L. Alling

. M.D.

(Address Lowell, Lass.

Medical Examiner for.

5th Middlesex District

Dale

223

1927

(Month)

(Day)

(Ycar)

-19 PLACE OF BURIAL, CREMATION, OR REMOVAL

lit. . Hope

sos ton

DATE OF BURIAL

way 24/27

(Month) (Day) (Year)

20 UNDERTAKER

J. .. watman & von3

ADDRESS

boston

21 Burial permitTATE ANFI.

issued by .

Official

position

22 Date of

issue

May 22, 1927

3 SEX Female 82 PARENTS 14 (Address) 15 See reverse side for extracts from the laws of the Commonwealth and instructions. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Is very important. should be carefully supplied. Age should be stated EXACTLY. MEDICAL EXAMINERS should state CAUSE OF N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK -THIS IS A PERMANENT RECORD. Every item of Information (b) Name of employer

MEDICAL EXAMINER'S CERTIFICATE OF DEATH (ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTERS 24 AND 29)

Registered No.

199

(a) Residence. No. State Infirmary

(Usual place of abode)

1927

EXTRACTS

FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician 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 belief the name of the deceased, his supposed age, the disease of which he died (defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician and the date of his death. . . . - Revised Laws Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.

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 city or town in which the person dicd; . . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . & satisfactory written statement containing the facts required by law to be returned and recorded, which . . . shall be accompanied 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 purpose, or ie insuffi- cient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . . . The person to whom the permit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary infor- mation 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. - Revised Laws, Chap. 78, Sec. 38.

Medical examinere shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died. his name and residence, if known. otherwise

a description of such person ag full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons aa are sup- posed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.

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Town of Winthrop : Record of Deaths 1925-1927, Part 206

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

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