Town of Winthrop : Record of Deaths 1922-1924, Part 83

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 83


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121 | Part 122 | Part 123 | Part 124 | Part 125 | Part 126 | Part 127 | Part 128 | Part 129 | Part 130 | Part 131 | Part 132 | Part 133 | Part 134 | Part 135 | Part 136 | Part 137 | Part 138 | Part 139 | Part 140 | Part 141 | Part 142 | Part 143 | Part 144 | Part 145 | Part 146 | Part 147 | Part 148 | Part 149 | Part 150 | Part 151 | Part 152 | Part 153 | Part 154 | Part 155 | Part 156 | Part 157 | Part 158 | Part 159 | Part 160 | Part 161 | Part 162 | Part 163 | Part 164 | Part 165 | Part 166 | Part 167 | Part 168 | Part 169 | Part 170 | Part 171 | Part 172 | Part 173 | Part 174 | Part 175 | Part 176 | Part 177 | Part 178 | Part 179 | Part 180 | Part 181 | Part 182 | Part 183 | Part 184 | Part 185 | Part 186 | Part 187 | Part 188 | Part 189 | Part 190 | Part 191 | Part 192 | Part 193 | Part 194 | Part 195 | Part 196 | Part 197 | Part 198 | Part 199 | Part 200 | Part 201 | Part 202 | Part 203 | Part 204 | Part 205 | Part 206 | Part 207 | Part 208 | Part 209 | Part 210 | Part 211 | Part 212 | Part 213 | Part 214 | Part 215 | Part 216 | Part 217 | Part 218 | Part 219 | Part 220 | Part 221 | Part 222 | Part 223 | Part 224 | Part 225 | Part 226 | Part 227 | Part 228 | Part 229


State cause for which surgical operation was undertaken.


(Recommendations on statement of cause of death approved by Com- mitteo on Nomenclaturo of the American Medical Association.)


Bronchopneumonia: If primary cause, write the word "pri- mary" ; 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, miscar- riage, 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 forthwith, after the death of a person whom he has attended during his lastillness, at the request of an undertakeror other authorized person or of any member of tho 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 re- quired by section onc, 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, Scc. 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 dicd; . . . No such permit shall beissued until thereshall 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 thercof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or 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 medical 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 requirs. - 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 havs died by violence. - Gen. Laws, Chap. 88, Sec. 6.


. . . He shall in all cases certify to ths town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may bs, 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 thoss of persens 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 needsd.


(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only dsaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths follewing 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 thoss of persons found dead.


STANDARD CERTIFICATE OF DEATH


DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS


1 PLACE OF DEATH


County


٢٠٬٢٢٥٦٦٠


State


MASSACHUSETTS.


Registered No


30


Township


inthron,


or Village


or


St.,


Ward


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


2 FULL NAME


Balay


Tarmor


(a) Residence. No.


St.,


Ward.


(Usual place of abode)


Length of residence In city or town where death occurred


yrs.


mos.


ds.


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


yrs.


(If nonresident give city or town and State)


mos.


ds.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Llc.


4 COLOR OR RACE


5 SINGLE. MARRIED. WIDOWED.


OR DIVORCED (write the word)


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


---


6 DATE OF BIRTH (month, day, and year) : cb. 12, 1025.


7 AGE


Years


Months


Days


7


If LESS than 1 day, ---- hrs. or ---- mln.


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work -.


(b) General nature of industry,


business, or establishment In


which employed (or employer)


(c) Name of employer


(duration)


yrs.


mos. -


ds.


CONTRIBUTORY


(SECONDARY).


72


1.011012


(duration)


··· yrs. ...... mos. ...... ds.


18 Where was disease contracted


if not at place of death ?


Did an operation precede death ?


ITO,


Date of


Was there an autopsy?


What test confirmed diagnosis ?


(Signed)


M. D.


,19 (Address)


* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


Winthrop ameteres


DATE OF BURIAL


Fel-17. 1923


15 70=17 Filed


, 1923


11-3184


REGISTRAR


20 UNDERTAKER


E R Bennison.


ADDRESS Winthrop


& # 534


mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of infor- TION is very important. See instructions on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPA-


V. S. No. 98


14


Informant


or,Te.7


(Address)


13 BIRTHPLACE OF MOTHER (city or town) ... ""C " 1-


(State or country)


T.Y.


16 DATE OF DEATH (month, day, and year) - Ob . 14


19 20


17


I HEREBY CERTIFY, That I attended deceased from


23


23. 15


19.


7 .


19.40


to


0b.15


that I last saw h ...


alive on


19.


60


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


--- m.


The CAUSE OF DEATH* was as follows:


9 BIRTHPLACE (city or town)


inthron.


(State or country)


Lass .


10 NAME OF FATHER


Te.l A.Torner


11 BIRTHPLACE OF FATHER (city or town)


(State or country)


issouri


12 MAIDEN NAME OF MOTHER Anita


PARENTS


--


-


--


MEDICAL CERTIFICATE OF DEATH


1


,-


City


Jeb. 14. //XV


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]


Statement of occupation .- Precise statement of occupa- tion 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, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engincer, Civil engineer, 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 ma- terial 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 household only (not paid Housekeepers who receive a definite salary), may be entered 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, Housemuid, etc. Ifthe occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indi- cated 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 timo and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefi- nite); Tuberculosis of lungs, meninges, peritoneum, etc., Car- cinoma, Sarcoma, etc., of . .___ (name origin; “Can- cer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The con- tributory (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 condi- tions, such as " Asthenia," " Anemia" (merely symptom-


atic), "Atrophy,", "Collapse,"" "Coma," "Convulsions," "Debility"? ("Congenital,"" "Senile,"" etc.), "Dropsy,"? "Exhaustion," "Heart failure," "Hemorrhage,"? "Inani- tion," " Marasmus,"? "Old age,"? "Shock," "Uremia,"? "Weakness," etc., when a definite disease can be ascer- tained as the cause. Always qualify all diseases result- ing from childbirth or miscarriage, as "PUERPERAL septi- cemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train-accident; Revolver wound of head- homicide; Poisoned by carbolic acid-probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association,)


NOTE .- Individual offices may add to above list of undesirable terms and refuse to accept certificates containing them. Thus the form in use in New York City states: "Certificates will be returned for additional information which give any of the following diseases, without explana- tion, as the sole cause of death: Abortion, cellulitis, childbirth, convul- sions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis; pyemia, septicemia, tetanus." But general adoption of the minimum list suggested will work vast improve- ment, and its scope can be extended at a later date.


11-3184


ADDITIONAL SPACE FOR FURTHER STATEMENTS


BY PHYSICIAN.


M R- 301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


Winthrop (City or town)


1 PLACE OF DEATH


County.


Suffolk


State


Mass


Registered No.


3 1


St .. Ward


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


2 FULL NAME


Rebecca. Blanche. Smith.


(a) Residence.


No ..


112 Rivi Rock


St.,


Ward.


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


Length of residence in city or town where death occurred 1 3


years


months


days.


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


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


White


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED ( write the word)


Widow


5a If mied, widowed, or divorced


HUSBAND of


(or) WIFE of


of Jonathan. J. Smith


6 AGE


Years


85


Months


10


Days


29


If LESS than 1 day, ....... hrs. or ........ min.


If STILLBORN, enter that fact bere


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


at Home


8 BIRTHPLACE (City).


woburn


(State or country


Mass


9 NAME OF


FATHER


Samuel Gatés


10 BIRTHPLACE OF


FATHER (City)


(State or country)


England


11 MAIDEN NAME


OF MOTHER


Mary. Berganson


12 BIRTHPLACE OF


MOTHER (City)


(State or country)


Concilio


22.5,


13 William. H. Warren


(Address)


112 River Road Winthro


14 21/0, 61,23


Filed


(Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


Fely


21


1923


15 DATE OF DEATH


(Month)


16


I HEREBY CERTIFY, That I attended deceased from


Zelen 18


192.5 to


, 1923


that I last saw h & Lalive on


Jely 20


, 19.2.5


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


125 A m.


The CAUSE OF DEATH was as follows :


Le duración) e


yrs .... -.


mos. ds.


CONTRIBUTORY


(SECONDARY)


Sec (duration)


arteria - sclerosis


17 Where was disease contracted


.yrs ...... .


.. ds.


if not at place of death ?


Did an operation precede death ?


200


Date of


Was there an autopsy ?.


320


clinical


What test confirmed diagnosis ?


Queville E lotusone, M.D.


(Signed)


(Address).


Jelly


123 Hurtig Startup


21


6


Date


( Month)


(Day)


1923


( Year)


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL


2/23=1923


(Cemetery) Forest Hills (City of town)


19 UNDERTAKER


thes. R. Bennison


ADDRESS


Winnetwork This.


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


Official position Secretary


Date of issze of permit 2/23/23 No. 536


Permit


00,000.


3 SEX Female PARENTS Informant 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 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (b) Name of employer


City or Town


Winthrop


.No


112 River Road


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


(Usual place of abode)


(Day)


(Year)


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH


[Approved by U. S. Census and American Public Health Association]


Statement of occupation. - Precisc statement of occupation is very important, so that the relative healthfulness of various pursuits ean 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, e. g., Farmer or Planter. Physician, Compositor, Architect, Locomotive engineer, Civil engineer, 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," ete., without more precise specification, as Day laborcr, 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 entered 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 domestie 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 occupation at beginning of illness. If retired fromn 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. 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 use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) 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," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "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 "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.


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, miscar- riage, 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 forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertakeror other authorized person or of any memberof 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 re- 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 elerk of the town where the person died; . . . No such permit shall be issued until thereshall 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 lieu thereof a certificate as hercinafter provided. If there 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 medical 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 elerk or registrar in the place where the deceased 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 observanee 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 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.


M R-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


County


Suffolk


State,


Registered No.


-City er Town.


Winthrop


No.


78 Centre


St.,


3 Ward


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


fancy P.


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


(a) Residence. No.


(Usual place of abode)


Length of residence in city or town where death occurred


25


years


months


days.


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


years


months days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


Female White


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Widow


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


alexander


6 AGE


Years


86


Months


11


Days


17


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


(h) Name of employer


home


e


8 BIRTHPLACE (City)}


(State or country


Marcel


9 NAME OF


FATHER


Samuel allen


10 BIRTHPLACE OF


FATHER (City).


Shaftrighe.


11 MAIDEN NAME


OF MOTHER


(State or country ) Manuel abigial Pray


Shaperighe.


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


13


Informant ...


(Address) Withiran haso


14 Max 6.1923


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


albert S. Smitte


Official Sec


position.


Per. 9.0.9.


70%.


21


1723


(Day)


(Year)


16 I HEREBY CERTIFY, That I attended deceased from


19 23, to.


70 21


19


23


that I last saw har


... alive on


92.20


19 ......


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


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 ?.


no


Date of.


Was there an autopsy ?


What test confirmed diagnosis ?.


(Signed)


...


. M.D.


(Address) 3.


1723


(Month)


(Day)


(Year)


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL


(Cemetery)


(City or town)


1523


19 UNDERTAKER


ADDRESS


Permit


Date of issue of permit Tiel. 23, 1923 No. 537


00,000.


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 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH


The Commonwealth of Massachusetts


(City or town)


2 FULL NAME


78 Centre


St., ..


Ward.


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


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


(Month)


Strahlright


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, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositar, Architect, Lacomative engineer, Civilengineer, Stationary fireman, ete. 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) Catton mill; (a) Salesman, (b) Gracery; (a) Fareman, (b) Autamabile 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 labarer, Laborer - Caal 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 entered as Housewife, Hausework, or At home, and children, not gainfully employed, as At school or At hame. Care should be taken to report spc- cifically the occupations of persons engaged in domestic service for wages, as Servant, Caak, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, 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, write Nane.




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.