Town of Winthrop : Record of Deaths 1922-1924, Part 221

Author: Winthrop (Mass.)
Publication date: 1922
Publisher:
Number of Pages: 1202

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 221

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The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

BOSTON

(City or town)

1 PLACE OF DEATH

County

Suffolk

State

Massachusetts

Registered No.

St., Ward

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

2 FULL NAME

Baby Renner

(Stillhow)

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

Ward.

C. Pocten.

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

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

Days

If LESS than

1 day, ____ hrs.

or ___ min.

If STILLBORN, enter that fact bere Stillborn.

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

Wherecheap

(State or country)

Mais

CONTRIBUTORY

(SECONDARY)

(duration)

_. yrs.

mos. ds

Did an operation precede death ?.

A Date of

Was there an autopsy?

What test confirmed diagnosis ?.

(Signed)

(Address)

Date

13 Mahaut En Revue Nov 28 19 mg (Year)

Month)

(Day)

Informant

Nicolis Pernec

18 PLACE OF BURIAL, CREMATION OR REMOVAL

If. Michael Boatone

DATE OF BURIAL now. 30, 1924

(Address)

56 Baywood, die E.15.

(Cemetery)

(City or town)

ADDRESS

Bretone

107.1. Bene Nil.

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

HleDanish

Official position Azallti officer

Date of issue of permit Nov 29

NO.

Permit 833

Dec. 3/24

Filed

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

4, to

20020

that I last saw her alive on 19 zip

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

12 50 m.

The CAUSE OF DEATH was as follows:

Stiller

(duration)

yrs. mos. .ds.

9 NAME OF

FATHER

Disciples

PARENTS

10 BIRTHPLACE OF

FATHER (City)

Cambridge

(State or country)

mass

11 MAIDEN NAME

OF MOTHER

ulice time requiere

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

n.4.

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

200,000

City or Town

No ..

5-6 Baywood, Eine St.

(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

19 UNDERTAKER Vifichiauf J. Por cella.

M. D.

17 Where was disease contracted

if not at place of death?

YUR, WHAT i

VOV. 26.1924

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 he 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.

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 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 he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- Gen. Laws, Chap. 114, Sec. 45.

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

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

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unre- lated to any form of injury, have died without recent medical at- tendance or whose physician is 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 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.

R - 301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County ......

Manthrow

City or Town.

State mari.

(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

Emilie Black

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

(a) Residence. No ...

(Usual place of abode)

42 Lavois Que

St.,

Ward.

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

Length of residence in city or town wbere death occurred

years

months

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

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Females

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED ( write the word)

Widowed

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

James

6 AGE

Years

Months

Days

If LESS than

1 day, ....... hrs.

or . ... min.

If STILLBORN, eater that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

At home

(b) Name of employer

8 BIRTHPLACE (City)

(State or country

Ireland

PARENTS

11 MAIDEN NAME

OF MOTHER

Elizabeth Llyod

12 BIRTHPLACE OF

MOTHER (City)

(State or country) !

VEland.

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

200.

( Day)

1924

( Year)

I HEREBY CERTIFY, That I attended deceased from

1924, to

that I last saw

halive on

, 19.2 %.

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

8 m. The CAUSE OF DEATH was as follows :

.. (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 ?

. Date of

Was there an autopsy ?

What test confirmed diagnosis ?

(Signed)

1 un

, M.D.

(Address)

Date

424

(Month)

(Day)

( Year)

Informant

Emily @ Stewitt

(Address)

Sheldon Et.

14 Dec, 3, 24

Filed.

(Month) (Day) (Year)

REGISTRAR

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

H.C. Damell 4.5

Official position Health ficar em

12/1/24

No ..

894

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

,000. 3567.

18 PLACE OF BURIAL, CREMAȚION, OR REMOVAL

Wantto Hintenof

( Cemetery)

(City or town)

DATE OF BURIAL Dec 11924

19 UNDERTAKER

John :@haley

praxe

ADDRESS

Wantwith

Permit

Ervis Ors

9 NAME OF

FATHER

Andrew Larymore

10 BIRTHPLACE OF

FATHER (City)

(State or country )

Ireland

Y Ilov. 28, 1924 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

[Approved by U. S. Census aud 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, irrespective of age. For many occupations a single word or term on the first line will be sufficient, c. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry. and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entcred as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, ete. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATII, state occupation 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, writc 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. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ..... . (name origin; "Cancer" is less definite; avoid uso of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- eurrent) 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" (mcrely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," ctc.), "Dropsy,""Exhaustion,""Ileart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL 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 "pri- mary" ; 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 forthwith, after the death of a person whom he has attended during his lastillness, at the request of an undertakeror otherauthorized 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 deccased, his supposed age, the disease of which he died, defined as rc- quired 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 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 licu thereof a certificate as hereinafter provided. If thore is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- 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 physician. If death is caused by violence, the medicai examiner shall make such certi- ficate. .. . The person to whom the permit is so given and the physi- cian 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. - 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 tho place where the deccased died his name and residence, if known; other- wise 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 unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These inelude not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemieal (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.

M R-301 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS I PLACE OF DEATH County Suffolk

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

State Massachusetts

Registered No.

City or Town

Bosto

No.

27 Kautharne Que

St ...

Ward

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

2 FULL NAME

Michael W.O Connor

(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

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH.

Vov.

( Month)

(Day)

(Year)

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

Lucy

6 AGE

Years

L/F

Months

Days

If LESS than 1 day .__ hrs. or ..___ min.

If STILLBORN, enter that fact høre

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

Stram filter

particular kind of work

(b) Name of employer

(duration)

_yrs ..

mos. 10 ds.

CONTRIBUTORY

(SECONDARY)

(duration)

_yrs.

mos. ds

17 Where was disease contracted

if not at place of death?

FOR WHAT7

Did an operation precede death ?.

Date of

Was there an autopsy?

2011 Under One Year, Was Baby Breast Fed

What test confirmed diagnosis ?.

(Signed)

M. D.

(Address)

186 wanting Vanilleund man

28:424

(Year)

18 PLACE OF BURIAL, CREMATION OR REMOVAL

(Month) (Day) W Rox

DATE OF BURIAL

Nov.30-1924

(Cemetery)

(City or town)

19 UNDERTAKER

Deseth De Burke.

ADDRESS

75 chambers W

gestão

$23-20M

00.000

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

Official position_

Health officer

Date of issue of permit 11/29/24

Permit NO 8 32

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 I. D .- WRITE PLAINLY, WITH UNTADING DLAVN INA- THIS IS A PERMANENT RECORD. Every Item of information instructions and extracts from the laws on back of certificate.

PARENTS

10 BIRTHPLACE OF

FATHER (City)

(State or country)

Ireland

11 MAIDEN NAME

OF MOTHER

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Ireland

Date

Lucy O'Connor

Informant

(Address)

27Haw thome an Winthis

Dec. 3.24

Filed_

(Month) (Day) (Year)

REGISTRAR

16 I HEREBY CERTIFY, That I attended deceased from 11/ 25- 1924. , to 11/28 1924

that I last saw h alive on 11/27 19

and that death occurred, on the date stated above, at 6,40 0 m. The CAUSE OF DEATH was as follows: Broncho pneus

19:

3 SEX

Male

4 COLOR OR RACE

SINGLE, MARRIED, WIDOWED OR

DIVORCED (write the word)

carica

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

27 Hawthorne

Ward. Winthers

Winthrop -BOSTON (City or town)

8 BIRTHPLACE (City)

(State or country)

mass

9 NAME OF

FATHER Aummich OConnor

.201147

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 Pianter, 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.

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Town of Winthrop : Record of Deaths 1922-1924, Part 221

Author: Winthrop (Mass.) Publication date: 1922 Publisher: Number of Pages: 1202

Author: Winthrop (Mass.)
Publication date: 1922
Publisher:
Number of Pages: 1202