Town of Winthrop : Record of Deaths 1928-1930, Part 116

Author: Winthrop (Mass.)
Publication date: 1928
Publisher:
Number of Pages: 1296

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 116

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Statement of cause of death .- Name, first, the Disease Caus- ing 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 meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never report "Typhoid pneumonia") ; Lobar pneumonia; Bronchopneumonia ("Pneu- monia," unqualified, is indefinite) ; Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of.

(name origin ; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or 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 "Asthe- nia," "Anemia" (merely symptomatic), "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 ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peri- tonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Associa- tion.)

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 Role cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mis- carriage, 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 de- ceased, 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 as required by section one, where same was contracted, the dura- tion 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 ex- hume 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 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 suffi- cient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a mem- ber of the board of health, or employed by it or by the select- men for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by vio- lence, the medical examiner shall make such certificate. If the death certificate 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 state- ment and certificate, shall forthwith countersign it and trans- mit 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 common- wealth 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.

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

Medical Examiner's Certificate of Death

Boston (City or town)

County

Suffolk

State.

Registered No. 8557

Registered No

City or Town

Boston

BOSTON CITY HOSPITAL

(Place of residence)

St.,

Ward

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

2 FULL NAME

PETER J. CARLEN

68 HERMON

(If in the Army or Navy of the PRITHFROprive MASS !!!

(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 toreign birth?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

ANN

6 AGE

Years

Months

Days ..

If less than

1 day, ..... hrs.

or ...... min.

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

HELPER

(b) Name of employer

NAVY YARD

8 BIRTHPLACE (city or town)

BOSTON

(State or country)

MASS.

9 NAME OF FATHER JAMES Carlew

PARENTS

10 BIRTHPLACE OF FATHER (city or town)

(State or country)

ST. ALBANS. VT.

11 MAIDEN NAME OF MOTHER ALICE CURTIS

12 BIRTHPLACE OF MOTHER

(State or country)

(city or town)

BOSTON

MASS

Informant

ALICE CARLEN

(Address)

WINTHROP, MASS.

14 Filed SEP 20, 19 29ENUMSlenen

Registrar of city or town where death occurred

Filed

Sep. 25. 1929

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

SEPT 17, 1929

(Month)

(Day)

(Year)

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

FOLLOWING EXTRACTION OF TEETH

AUG 31.

CHR. MITRAL AND AORTIC

ENDOCARDITIS

(See reverse side for additional space)

17 Where was injury sustained

if not at place of death ?

(Signed)

TIMOTHY LEARY

M.D.

(Address)

BOSTON

Medical Examiner for

SUFFOLK

SEPT 17

1929

Dale

(Month)

(Day) (Year)

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

MT. BENEDICT. BOSTON

9-1 9-29

(Month) (Day) (Year)

19 UNDERTAKER J. D. KELLY

ADDRESS

20 Burial permit issued by

Official position

21 Date of issue

organization, etc.)

St.,

Ward.

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

1 PLACE OF DEATH

(ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)

erer " Sept. 1%. 1929

-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS I PLACE OF DEATH County Suffolk

STANDARD CERTIFICATE OF DEATH

BOSTON (City or town)

State_ Massachusetts. Registered No.

City or Town

No. 10

Kuf Side ave

St.,

Ward

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

2 FULL NAME

Frank F.

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

(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

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

PERSONAL AND STATISTICAL PARTICULARS

3 SEX male White

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

Widowed.

Sa If married, widowed or divorced HUSBAND of Lon WIFE of

Francis E Paulo

6 AGE

Years 89

Months 6

Days

If LESS than 1 day ._._ hrs. OF ...__ min.

If STILLBORN, enter that fact here

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Left

(Month)

2 2 1929 (Day) (Year)

16 I HEREBY CERTIFY, That I attended deceased from 1925, to Left LL, 1929

that i last saw h

alive on

Lift

20, 1929

and that death occurred, on the date stated above, at 11150 m.

The CAUSE OF DEATH was as follows:

Cardio Vascular Disease

(duration)

yrs ._. mos .=_ ds.

CONTRIBUTORY

Senility

17 Where was disease contracted

if not at place of death?

Did an operation precede death?

20 Date of

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

(Signed)

M. D.

123 Vanbuy 3+ Unavily (Address) Left (Month) (Day)

22 $ 1979 (Year)

13 Frank LTaylor InformantOM

(Address) 10 durvis

14 Sefal 23,29

Filed

( 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

MAX. Chil dress

Official

19 UNDERTAKER white bar

DATE OF BURIAL Sept 212

(Cemetery)

(City or town)

ADDRESS

Date of issue 9/23:59

Permit mit 1636

in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.

Machinist national Load Mfg bo-

(b) Name of employer

8 BIRTHPLACE (City)

(State or country)

Manchester (SECONDARY)

9 NAME OF

FATHER

Unknown

PARENTS

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

11 MAIDEN NAME OF MOTHER

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

18 PLACE OF BURIAL, CREMATION OR REMOVAL

NOM.

200,000 9 25 NO 2662 3

The Commonwealth of Massachusetts

Ward.

4 COLOR OR RACE

7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work.

_yrs ..

___ mos.

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 CAUBING 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 CAUBING 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 "Epidemio 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 da .; 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.

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 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. 46.

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.

(2) Board of Health Physicians will certify to such deaths only na 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.

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)

Winthrop

(City or town)

IPLACE OF DEATH

County

Suffolk

State

Registered No.

City or Town

Winthrop

St., ......... Ward

and number)

2FULL NAME

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

(a)Residence. No .... ]2 .... Cherry ... St

(Usual place of abode)

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

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

Frances Perry

6 AGE

Years

Months

Days

if less than

1 day ..... hrs.

or ..... min.

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Real .... Estate

(b) Name of employer

8 BIRTHPLACE (City)

(State or country)

Maine

9 NAME OF

FATHER

John

10 BIRTHPLACE OF

FATHER (City)

.... Cannot be learned

(State or country)

11 MAIDEN NAME

OF MOTHER

Grace Pillsbury

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Maine

13 Informant Mrs Frances Greene

(Address)

12 Cherry St.

Filed

(Month) (Day) (Year)/

REGISTRAR

(See reverse side for description for unknown person)

17 In what Cityfor town

was injury Justninco?

(Signed)

, M. D.

(Address)

Med punto 24 /929

Date.

(Month) (Day)

(Year)

18 PLACE OF BURIAL, CREMATION, or REMOVAL

DATE OF BURIAL

Winthrop (Cemetery) (City or town)

Winthrop. Sept. 26. 29 (Month) (Day) (Year)

19 UNDERTAKER

ADDRESS

20 Burial permití

issued by

W. A. Childress

/ health Offices Official position

21 Date of issue 9/24/29

Permit No. 1637

JUL9 (Year)

I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)

Coronary

Thuambos

15 DATE OF DEATH

(Month)

Leon 23

(Day)

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

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 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 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 re- quired by law to be returned and recorded, which shall be accom- panied, 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 can- not be obtained 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 cer- tificate. If the death certificate 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 countersign it and trans- mit 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.

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.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died 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. .. .- Gen- eral Laws, Chap. 38, Sec. 6.

. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.

The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.

A medical examiner has no right to delay filing the certificate referred to (death certificate) until judicial inquiries have been concluded and certified, .- Extract from Opinion of the Attorney General, July 29, 1926.

STATEMENT OF CAUSE OF DEATH

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Town of Winthrop : Record of Deaths 1928-1930, Part 116

Author: Winthrop (Mass.) Publication date: 1928 Publisher: Number of Pages: 1296

Author: Winthrop (Mass.)
Publication date: 1928
Publisher:
Number of Pages: 1296