Town of Winthrop : Record of Deaths 1925-1927, Part 136

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 136

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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

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 AGE

Years

Months

Days

If LESS than

1 day, ____ hrs.

or -... min.

W STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of werk

(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?

Date of

Was there an autopsy?

Whit test confirmed diagnosis?

(Signed)

GEORGE A. MAC IVER

, M. D.

12 BIRTHPLACE OF

MOTHER (city or town)

NEW YORK CITY

(Address)

Date

JULY 31

1926

Informant

FATHER

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

WINTHROP (WINTHROP

(Cemetery)

(City or town)

DATE OF BURIAL

8-2

, 19 26

Filed

AUG. 4 ,1926

Registrar of city or town where death occurred

Filed

un . I, 1926

Registrar of city or town where deceased resided

-50,000

AGE should be stated EXACTLY. Exact statement of OCCUPATION is very important. See instructions on back of certificate.

PARENTS

9 NAME OF

FATHER

WALTER H.

10 BIRTHPLACE OF

FATHER (city or town)

ROANOKE

(State or country) VA.

11 MAIDEN NAME

OF MOTHER

MAUD LEE

(State or country)

N. Y.

15 DATE OF DEATH

JULY 31

(Month)

(Day)

1926

(Year)

16 I HEREBY CERTIFY, That I attended deceased from JULY 30 19 26 , to JULY 31 19 26

that I last saw h.

alive on

JULY 31

19.26

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

The CAUSE OF DEATH was as follows: STATUS LYMPHOTOCUS

8 BIRTHPLACE (city or town)

MEDFORD

(State or country) MASS,

PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified.

Registered No.

7247

(Address)

45 LOCUST ST, WINTHROP

19 UNDERTAKER FRANK E. BROWN

ADDRESS

(Approved by U. S. Census and American Public Health Association)

Statement of occupatlon .- 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, Composi- tor, 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 state- ment; 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 state- ment. 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 defi- nite salary), may be entered as Housewife, Housework, or Athome, 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 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 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. 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 statemsat 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, eryslpelas, meningitis, miscar- riage, necrosis, peritonitis, phlebltis, pyemia, septicemia, tetanus.

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 undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a stand- ard eertificate 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, defincd as required by section one, where same was contracted, the du- ration 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 satis- factory 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 physiclan, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or Is insuffi- clent, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon ap- plication make the certificate required of the attending physi- cian. 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 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 vio- lence .- 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; 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 eertify 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 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 poison), 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.

0 2

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

(City or town)

1 PLACE OF DEATH

County

Norfolk

State

Registered No.

(Place of residence)

City or town

St.,

Ward

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

2 FULL NAME George Carson Brown

(a) Residence. State Highland Precisosouthrop Mask 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

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

EL August

1926

(Year)

(Month)

(Day)

16 I HEREBY CERTIFY, That I attended deceased from July 30 1926, to August 3, 19 26

that I last saw her alive on

August 3

, 1926

6 AGE

Years

Months 11

Days

If LESS than

1 day, ____ hrs.

M STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Retired Merchant

(duration)

yTs.

mos. 5 ds.

CONTRIBUTORY

(SECONDARY)

(duration) 5 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?

(State or country)

11 MAIDEN NAME

OF MOTHER

Not known

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

NI Not known

Address Bedlam Heights, Mas Date Auquel , 1926

13 Life Cammata Browar

Onma

Informapt

(Adres)[highlander Winthrop Mare

14 Filed Hughit, $ 6 Earth Dayaut

Registrar of ally or boy's where death occurred Filed 4/ 171, 1926

19 UNDERTAKER

Saltar Arhite

DATE OF BURIAL

18 PLACE OF BURIAL CREMATION, OR REMOVAL

Mr. Wollaston raincy

KCemetery)

(City or town)

WD Efung 7. 1926

ADDRESS

0,000

AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH In plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back of certificate.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR OR RACE

White Married

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

(b) Name of employer Small Store

8 BIRTHPLACE (city or towa) Lehouset Boxton (State or country) Masa

PARENTS

9 NAME OF

Charles Brown

10 BIRTHPLACE OF

FATHER (city or town)

ofot known

What test confirmed diagnosis? (Signed Killian Mitchell . M. D.

Registrar of city of town where deceased resided

Registered No.

(Place of death)

Mars

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

St.

and that death occurred, on the dated stated above, at 11P. m. The CAUSE OF DEATH was as follows: Broncho Pneumonia

(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, Composi- tor, 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 state- ment; 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 state- ment. 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 defi- nite salary), may be entered as Housewife, Housework, or Athome, 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 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 None.

Statement of cause of death .- Name; first, the nisEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. 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.

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 undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a stand- ard 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 du- ration 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 satis- factory 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 purpose, or is insuffi- cient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon ap- plication make the certificate required of the attending physi- cian. 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 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 vio- lence .- 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 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.

M R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

(City ør town)

County

State

Mars

Registered No ..

St. Ward

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

2 FULL NAME

2 Matter Rand St.

Ward.

Length of residence in city or town where death occurred

years

months

days.

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

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Venida

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCEO (write the word)

Wichen

E. Kennedy

6 AGE

Years

Months

Days

If LESS than 1 day ..._ hrs. Of_ _ min.

If STILLBORN, anter that fact here

MEDICAL CERTIFICATE OF DEATH

august

3241921

(Year)

I HEREBY CERTIFY, That I attended deceased from

1924, to Que 3, 1926

that I last saw her

alive on

aug 3

1926

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

3.15 Am.

The CAUSE OF DEATH was as follows:

myoradites chanie mephites

parecchipinatur

(duration)

1 yrs.

_mos.

ds.

CONT

Carenina, maling ly with

(duration)

_yrs.

.mos.

17 Where was disease contracted

if not at place of death ?.

Did an operation precede death ?.

200

Date of

Was there an autopsy?

200

What test confirmed diagnosis?

Lab.

(Signed)

(Address)

Withup man

31926

Dato

(Month)

(Day)

(Year)

13 Ellen. In. Graf.

Informant

(Address)

2 Maple 1200 de Wichtig

14 Filed June 16/26

(MonthY (Day) (Year)

REGISTRAR

19 UNDERTAKER

Chu. R /Binmusa

ADDRESS

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

Vietiane D Childress 9.3.9.

position.

Official Health Office Dato of issue ces of permit aug. 4. 1926 NO. Permit 1117

200,000 9-25 NO. 2662 3.

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.

PARENTS

9 NAME OF

FATHER

Charles. Susan

10 BIRTHPLACE OF

FATHER (City)

(State or country)

M1.7.

11 MAIDEN NAME

OF MOTHER

Mary Port

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Tomates to

18 PLACE OF BURIAL, CREMATION OR REMOVAL

(Cemetery)

(City or town)

DATE OF BURIAL 8/6/2€

I PLACE OF DEATH,

No.

2 Makk Road

City or Town

Margaret. Tane Comedy

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

(a) Residence. No.

(Usual place of abode)

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

yBers

/Sa If married, widowed er divorced

HUODANS of

(or) Wife of

Edward.

7 OCCUPATION OF DECEASED

(a) Trada, profession, or

particular kind of work

150me

(b) Nama of employer

8 BIRTHPLACE (City)

(State or country)

15 DATE OF DEATH

(Month)

(Day)

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

M. 0.

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

(Approved by U. S. Census and American Public Health Association)

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Fore- man," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer -- Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as House- wife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupa- tion at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death .-- Nar , first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sarcoma,

etc., of .. .. . ..... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia,". "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.

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Town of Winthrop : Record of Deaths 1925-1927, Part 136

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

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