Town of Winthrop : Record of Deaths 1925-1927, Part 81

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 81

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15 DATE OF DEATH

Dec.

1920

(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: Mature Causes : Character. in determinate, presumably Cardiovascular disease.

lied Suddink. )

(See reverse side for description for unknown person)

17 Where was injury sustained

if not at place of death ? ..

(Signed)

M.D.

(Address)

Suffith

Medical Examiner for ... >

Cale. Dec- 25

19200

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION, or REMOVAL Wruthup (Cemetery)

DATE OF BURIAL Manches Des 27 -25.

(City or town)

(Month) {Day) (Yenr)

19 UNDERTAKER

Frank @ Boun

ADDRESS

East Bratr

20 Burial permit issued by. albert S. Sunti Official position ... x

a. p.a

Seeing.

21 Date of issue Dec. 26, 1925 No. Permit

1001

1 PLACE OF DEATH

County

Suffolk

City of Town Whathuy

20 illiam

2 FULL NAME

(Usual place of abode)

Length of residence In city or town where death occurred

years

months

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

male

4 COLOR OR RACE

While

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married. widowed, or divorced

maryE.

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

Days

IF STILLBORN, enter that fact here

La Inaurance

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

(State or country)

9 NAME OF

FATHER

10 BIRTHPLACE OF

Kingstimepl

FATHER (City)

(State or country)

11 MAIDEN NAME

Un Alehaffer

OF MOTHER

PARENTS

12 BIRTHPLACE OF

MOTHER (City)

providence

(State or country)

many &

Davis

Informant

(Address)

Tue, 24/25

(Month) (Day) (Year)

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

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

8 BIRTHPLACE (City)

South Kingsfine

If less than

1 day ...... hrs.

or ..... min.

William &. Davis

REGISTRAR

14,646

days

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

years

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 olas- 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 thercof a certificate as herein- after provided. If there is no attending physiclan, or If, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or Is insufficient, a physl- 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 physiclan. 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 regis- trar may require .- General Laws, Chap 114, Seo. 45 as amended.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as aro sup- posed to have dled by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same. . . . General Laios, 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, Seo. 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 chemi- 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 production 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 railway 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)

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

auc.

1,1125

ORM R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City or town)

Registered No.

St.,

Ward

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

2 FULL NAME

Effic. May Sürgral. "

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

(a) Residence. No.

(Usual place of abode)

626 Pleasant

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

4 COLOR OR RACE

5 SINGLE, MARRIED, WIODWED, DR

DIVORCED (write the word)

Marek

5a If married, widowed or divoreed

HUSBAND of

(or) WIFE of

Edward. E. Sangenx

6 AGE

Years

Months

Days

If LESS than

1 day ...._ hrs.

or ___ min.

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(0) Trade, profession, or

particular kind of work

(b) Name of employer:

8 BIRTHPLACE (City)

(State or country)

( Muss

9 NAME OF

FATHER

Charles. E Toy

10 BIRTHPLACE OF

FATHER (City)

Buschicke

(State or country)

MAIDEN NAME

OF MOTHER

Olive. M. Huncon

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

72cl

Informant

Edwara. L. Sargent

(Address)

FiledY (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

DEC.

1925

(Year)

(Month)

(Day)

I HEREBY CERTIFY, That I attended deceased from

DIC.

1921, to

Dec. 22,1025

that I last saw h Lt alive on

DIC, 26, 125

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

25 am.

The CAUSE OF DEATH was as follows:

Myocarditis.

PrEloNephrTh

RIN

ENcal Stone

(duration) 15. _yrs. mos .. .ds.

CONTRIBUTORY. 1

Pulmonary Edema, Cachap

Hemoulage

(duration)

.yrs .____ mos.

.ds

17 Where was disease contracted

if not at place of death?

Did an operation precede death ?.

Date of

Was there an autopsy?

What test confirmed diagnosis?

(Signed)

S.t. Burnett

(Address)

M. D.

520 Commonsallt Az

Datı

Dec. 27 1925 Dosta

(Month)

(Year)

18 PLACE OF BURIAL, CREMATION DR REMOVAL

Winthrop Jimb/

DATE OF BURIAL 12 29 25

(Cemetery)

(City or town)

19 UNDERTAKER

Chas. R. Benneson

ADDRESS

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

Official position_ Secretary

Date of issue of permit 12/29/25

Pormit NO.

9-200,000

I PLACE OF DEATH

County

Winclinop

City or Town

No.

State 626 Placeauf Den

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.

PARENTS

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 he 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 he taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has heen 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 he 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 he 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 he 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 helief the name of the deceased, his supposed age, the disease of which he died, defined as required hy 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 hody. . . 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 he 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 violences 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 hodies of only such persons as are supposed to have died hy 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 he, 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 unre- lated to any form of injury, have died without recent medical at- tendance 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 poisons), thermal, or electrical agents, and deaths following ahortion, 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.

ORM R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop.

(City or towny

Registered No.

City or Town

Baby murphy

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

Ward.

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

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Female

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 thao

1 day, __ hrs.

or __ min.

If STILLBORN, enter that fact here * Stillborn

7 OCCUPATION OF DECEASED

(m) Trade, profession, or

particular kind of work

(b) Name of employer

(duration)

-yrs ..

mos .. ds.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs.

mos. .ds

17 Where was disease contracted

if not at place of death?

Did an operation precede death?

Was there an autopsy?

What test confirmed diagnosis ?.

(Signed)

(Address)

Dato Com 29

1925

(Month)

(Day)

(Year)

Informant

( Address)

2) Cristal for enz

Filed (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

192)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

Que29

19 20, to

that I last saw h

alive on

19 .

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

The CAUSE OF DEATH was as follows.

8 BIRTHPLACE (City)

(State or country)

mass

PARENTS

10 BIRTHPLACE OF

FATHER (City)

(State or country)

Italifax

11 MAIDEN NAME

OF MOTHER

Mary Drieque

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Exeter 71.79.

18 PLACE OF BURIAL, CREMATION OR REMOVAL

Dr. Michaels Boston

DATE OF BURIAL DEC 31, 1425

(Cemetery)

(City or town)

19 UNDERTAKER

un T- I Makey

ADDRESS

Win

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

Werk & o mitte

Official position.

secretary

Pormit Date of ISSUO of permit 12 391 25 NO. 1023

1 PLACE OF DEATH

County

Suffolk

State mass

No. 27.

Cristal Care for st. Ward

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

2 FULL NAME

27 Crystal Code sive

(a) Residence. No.

(Usual place of abode)

Length of residence in city or town where death occurred

years

months

days.

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

years

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. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See

1 3-200,000

9 NAME OF

FATHER

Date of.

M. D.

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, writs 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 acceptsd 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, stc., Carcinoma, Sarcoma, etc., of .......... (name origin; "Cancer" is lass 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 nesd 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.

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 ssction 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. ª

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Town of Winthrop : Record of Deaths 1925-1927, Part 81

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

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