Town of Winthrop : Record of Deaths 1925-1927, Part 213

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 213

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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-30.1|

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County. Suffolk

The Conununwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

State

man

(City or town)

Registered No.

City or Town

Winther

No.

100@ mans Red

St.

.Ward

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

2FULL NAME

Charles Willian Pennington

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

Ward,

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

months

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

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

5 a If married, widowed or divorced

HUSBAND of

mable. A. Penning's

6 AGE

Years

Months

Days IF LESS than 1 day, ........ hrs. Gr ........ min.

IF STILLBORN, enter that fact here

Tempogia

(duration) ________ yrs.

=mos ..

CONTRIBUTORY

(Secondary)

Several(duration)_

_yrs.

17 Where was disease contracted

if not at place of death

Did an operation precede death

200

For what

Date of operation

200

Was there an autopsy

What test confirmed diagnosis

Turite & Salmon

M. D.

(Signed)

(Address)

623 Theday St

July 2 192× weretied

Date

18 PLACE OF BURIAL, CREMATION, OR REMOVAL DATE OF BURIAL

(Cemetery)

(City or town)

14 Filed Jelly 7/27

(Month) (Day) (Year)

REGISTRAR

19 UNDERTAKER

C.R. Bowen

ADDRESS

Waitz

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

8 Pm: & Childress

Official rosition

Seattle Office 7/2/27 Permit No.

1271

1924

15 DATE OF DEATH

(Day)

(Year)

16 I HEREBY CERTIFY , That I attended deceased from June 28, 1927, 10 1927

that i last saw

win alive on

192}

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

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

530

7 OCCUPATION OF DECEASED

(a) Trade, profession, er

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

(State or country)

9 NAME OF

FATHER

John . Fol Penning/en

1 O BIRTHPLACE OF

FATHER (City).

Parlement

(State or country)

1 1 MAIDEN NAME

OF MOTHER

adalme E. HoryE

12 BIRTHPLACE OF MOTHER (City) (State or country) 11.1

Informant

(Address)

East

PARENTS

200.000. 9-26. NO. 6373

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

100 E coute 124

(a) Residence. No.

(Usua! place of abode)

Length of residence in city of town where death occurred 30 years

months

days.

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

years

Date of Issue

climent

mos

ds.

MEDICAL CERTIFICATE OF DEATH

July 1, 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, 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, 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 (6) 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 onty (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 discase. 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 indefinitc); 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 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 disease can be ascertaincd 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, 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 physiclan 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 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 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 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 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 ob- tained early 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 eertify 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.

M R-301

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

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH Suffolk

Winthrop BOSTON

(City or town)

Registered No.

City or Town

Boston Winthrop No. 21 Pleasant Park Road St., _Ward

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

Austin E. McCormack

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

(a) Residence. No ..

(Usual place of abode)

21 Pleasant Park 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

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Month)

(Day)

(Year)

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

Born Kirby

Anastacia E. McCorma

Years

Months

Days

If LESS than

1 day, __ hrs.

OT _.__ min.

If STILLBORN, enter that fact hera

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Printer

8 BIRTHPLACE (City)

(State or country)

Boston,

Lass.

(duration)

_yrs

mos. _ds

17 Where was disease contracted

if not at place of death?

FOR THECost

Did an operation precede death?

Date of

Fel 1927

10 BIRTHPLACE OF

FATHER (City)

Prince Edward Island

(State or country)

Canada

11 MAIDEN NAME

OF MOTHER

Catherine (unknown

12 BIRTHPLACE OF

MOTHER (City)

Prince Edward Island.

(State or country)

Canada

Data

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION DR REMOVAL

DATE OF BURIAL

Holy Cross.

Malden July 4, 1927

(Ceinetery)

(City or town)

19 UNDERTAKER

ADDRESS

Muchasd C'Me Past Boston

20 | HEREBY CERTIFY that a satisfactory stan-

BEFORE the burial or trensit permit was issued Um D. Childress

Official position agent-

Date of issue of permit July 4 th 2)

Pormit NO 1273

16 1906 to I HEREBY CERTIFY, That I attended deceased from Seit 1927 -

that I last saw h~

alive on

June 30

.192)

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

10 A

The CAUSE OF DEATH was as follows:

Caras

1 stomach

(duration)

yrs.

.mos. ds.

CONTRIBUTORY.

(SECONDARY)

John McCormack

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

(Signed) Romer gately

M. D.

(Address)

1927

Informant Mary McCormack

(Address) 21 Pleasant Park Road

14 Filed Ulan 7/27 (Month (Day) (Year)

REGISTRAR

State

Massachusetts

2 FULL NAME 200,000 9-25 NO. 2662 - 3. 3 SEX Male 6 AGE 62 9 NAME OF FATHER PARENTS 13 EN. 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 (b) Name ol amployer

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Widowed

2 1927

aly

July 2. 1927. 1

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 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," "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, 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 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.

Boston

East

Dr. Gatley, Bennington Street.

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 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.

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.

--- 11

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)

State Ing all side Park ( or ambulan ) St.

Registered No. ...........

Ward

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

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

.Ward.

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

How long In U. S., If of torelgn birth?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

If less than

1 day, ..... hrs.

or ..... min.

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

1927

(Day)

(Year

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

Material Causes: Presumably Cardio vascular distare

Ghid Suddenly while playy

hau-hall)

(See reverse side for description for unknown person)

17 Where was injury sustained

if not at place, of death ?.

, M.O.

(Signed)

(Address)

Medical Examiner for ....

Date

(Month)

2 (Day)

1927. (Year)

18 PLACE OF BURIAL, CREMATION, or REMOVAL

(Address)

37 Dolphin Ave; Winthrop Mass Camb

Camb.

'Cemetery)

(City or town)

DATE OF BURIAL

7/5/27

(Month) (Day) (Year)

19 UNDERTAKER

Josoph H. Ricker

ADDRESS

Camb.

20 13

um 10. Childress

issued by

Official DOB

Health Officer

21 Date of

issue

of July 2 nd 27

Permit No ... 1272

1 PLACE OF DEATH

County

Salt

Whichup:

City or Town.

2 FULL NAME

(a) Residence ..

(Usual place of abode)

Length of residence In city or town where death occurred

years

3 SEX

4 COLOR OR RACE

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Wary E Jessop

6 AGE

Years

Months

Days

63-65

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Retired

(b) Name of employer

8 BIRTHPLACE (City)

Charlestown

(State or country)

Wass

9 NAME OF

FATHER

John J. Jesson

10 BIRTHPLACE OF

FATHER (City)

Boston.

11 MAIDEN NAME

OF MOTHER

Ann Heenan

12 BIRTHPLACE OF

MOTHER (City)

Charlestown

(State or country)

T'ass.

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

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

PARENTS

Fled

47/27

(Month)

(Day) (Year)

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

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Town of Winthrop : Record of Deaths 1925-1927, Part 213

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

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