Town of Winthrop : Record of Deaths 1925-1927, Part 172

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 172

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ED Student

Waterbury

8 BIRTHPLACE (City)

(State or country)

Confu.

9 NAME OF

FATHER

Alberto 9.

10 BIRTHPLACE OF

FATHER (City)

(State or country)

France.

11 MAIDEN NAME

OF MOTHER

Annie Regan

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

telando

13 Alfred av. martel

( Address)

15 Olurgis SO

Filed

(Month) (Day) (Year) REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

lamay 20

(Month)

(Day)

1927

(Year)

HEREBY CERTIFY, That I attended deceased from

January 2

, 1927

Summary 21, 1927,

January 20, 1927

That I last saw h

alive on

12:3093

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

The CAUSE OF DEATH was as follows:

Tuberculosis

pneumonia.

(ducation)

.ds.

acute miting

CONTRIBUTORY.

(SECONDARY)

trabancialis

17 Where was disease contracted

if not at place of death ?.

Did an operation precede death?

h: 00

Date of

Was there an autopsy?

non

What test cor

(Signed)

insula labrada

Oat

(Month)

(Day)

year)

18 PLACE OF BURIAL, CREMATION OR REMOVAL

(Cemeter))

(City or town)

DATE OF BURIAL

1/22/27.

ADDRESS

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

Official position

Health Ofice

Data of

91/ 21/27

Pormit

1182

2 FULL NAME 6 AGE PARENTS Informant 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

200,000 9-25 NO. 2662 3.

City or Town.

Alfred D. martel

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

(a) Residence. No.

(Usual place of abode)

4 COLOR OR RACE

19 UNDERTAKER

Holm & O' maly.

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

til

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 employ ments, 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 .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite) ; Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sarcoma, etc., of . ..... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia,". "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

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

Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.

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. 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 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.

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

Luffolke

State

maso

Registered No.

City or Town

Winthrop

No.

18. Atlantic

St., Ward

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

2 FULL NAME

Augustus Peterson

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

(a) Residence. No.

(Usual place of abode)

18 attarilie

St.

Ward.

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

Length of residance in city or town where death occurred

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

male White

4 COLOR OR RACE

SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Single

Sa If married, widowed or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

Days

If LESS than

1 day, __ hrs.

er __ min.

If STILLBORN, enter that lact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Tailor

(b) Nama el employer

(duration)

_yrs.

mos.

ds.

CONTRIBUTORY.

(SECONDARY)

(duration)

.yrs ..

.. mos.

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)

(Addr ass)

1927

Data

0 (Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION OP REMOVAL

DATE OF BURIAL

Ducturp Winthro an 23,1927

(Cemetery)

(City or town)

19 UNDERTAKER

ADDRESS

Filed

(Month)

(Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

Jan

1927

(Year)

16 I HEREBY CERTIFY, That I attended deceased from

17 to Amaro

that I last saw h

alive on

Jan 19

19.22

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

3.300

The CAUSE OF DEATH was as follows;

Pestris

8 BIRTHPLACE (City)

(State or country)

Sweden

9 NAME OF

FATHER

nela

PARENTS

10 BIRTHPLACE OF

FATHER (City)

(State or country)

Smeden

MAIDEN NAME

OF MOTHER

nellie Pierson

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Smeden

Mies Emma & Peterson

(Address)

Informant

18 atlantic St.

1= == 127

20 | HEREBY CERTIFY that o satisfactory stan- dard certificate of death was liled with me BEFORE the burial or transit permit was issued William W. Childress.

Official

position

agli

Date of ISSUS of permit Jan. 22 nd

Permit NO 1183

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

instructions and extracts from the laws on back of certificate.

1 M. D.

(Day)

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irre- spective of age. For many occupations a single word or term on the first line will he sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Lahorer," "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 he entered as House- wife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should he taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has 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 he indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sarcoma, etc., of . . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not he stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia,". "Weakness," etc., when a definite disease can he ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

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

Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registra- tion a standard certificate of death, stating to the best of his knowl- edge and helief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ....- Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury a human hody. .. until he has received a permit from the hoard of health or its agent. .. or ... from the clerk of the town where the person died ;. . . No such permit shall be issued until there shall have been delivered to such board, agent or clerk. .. a satisfactory written statement con- taining the facts required by law to be returned and recorded, which shall he accompanied, in case of an original interment, hy 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. 45.

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

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

RULES OF PRACTICE

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

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given 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 hy recognized disease unre- lated to any form of injury, have died without recent medical at- tendance or whose physician is ahsent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

R-303

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)

City or town)

1 PLACE OF DEATH

County

Suffolk

State

Registered No. ....

St.,

....

.. Ward

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

M. Simmons

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

(a) Residence. No Unthu, 2,3 Locali"

(Usual place of abode)

Length of residence In city or town where death occurred

years

.St.,

Ward.

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

months days How long in U. S., It of toreign birth? years

months days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

( Month)

(Day)

19 25

(Year)

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

Waterent Causes: Cardio-

Vascular disease-

(See reverse side for description for unknown person)

17 Where was injury sustained

if not at place of death ?

(Signed)

M. O.

Sufick

Date

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION, or REMOVAL

woodlawn

(Cemetery)

(City or town)

19 UNDERTAKER

DATE OF BURIAL 1. 26-27- (Month) (Day) (Year) ADDRESS Wunschog

20 Burlal permit

issued by

Huit Children

Official Domition Ah rithe ffibest, ide

21 Date of

1/26/27

Permit No .. .. 1184

2 FULL NAME 3 SEX Veniale 6 AGE · State or country) FATHER (City) PARENTS 13 (Address) 14 DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of Death. See reverse side for extracts from the laws relative to the return of certificates of death. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B. - WRITE PLAINLY, WIIR UNTAMINUT DUAVR INITIIO IN A FARMIANONI ALUVIVU. SIVy 12 UL (State or country)

4 COLOR OR RACE

White

5 SINGLE, MARRIEO, WIDOWED, OR

DIVORCED (write the word)

credor

5a If married, widowed, or divorced HUSBAND of (or) WIFE of

William B. Summons

Years 76

Months

Days

If less than 1 day ...... hrs. or ..... min.

IF STILLBORN, enter that fact hera

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

at Home

8 BIRTHPLACE (City)

Sant Bulon-

9 NAME OF

FATHER

Charles, Summons

10 BIRTHPLACE OF

East Bulon-

11 MAIDEN NAME

OF MOTHER

Quan. E. Scary

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Medical Examiner for. Jan

244 1927

Informant

has 12 d'en

Filed

28/27

(Month)

(Day) (Year)

REGISTRAR

15,486

No. 213

Lunch

City or Town ...

Lucy

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has at- tended during his last illness, at the request of an under- taker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he dled (defined so that it can be clas- sified under the international classification of causes of death), where same was contracted, the duration of hls last illness, when last seen alive by the physician or officer and the date of his death. . . .- General Laws, Chapter 16, Section 9.

No undertaker or other person shall bury or other- wise dispose of a human body in a town, or remove there- from a human body which has not been buried, until he has received a permit from the board of health . . . , or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, or from one cemetery to another, until he has received a permit from the board of health . .. or from the clerk of the town where the body is buried. No such permit shall be Issued until there shall have been dellvered to such board, . . . or clerk .... a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied . . . by a satisfac- tory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as herein- after 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 physiclan. If death Is caused by vlolence, the medical examiner shall make such certificate. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The per- son to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary Information which can be obtained as to the deceased, or as to the man- ner or cause of the death, which the clerk or regls- trar may require .- General Laws, Chap 114, Sec. 45 @8 amended.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are sup- posed to have died by Violence. If a medical examiner nas notice that there is within hls county the body of such & person, he shall forthwith go to the place where the body lies and take charge of the same. . . . General 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 1.018, Chap. 88, Seo. 7.

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Town of Winthrop : Record of Deaths 1925-1927, Part 172

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

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