Town of Winthrop : Record of Deaths 1925-1927, Part 212

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 212

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If STILLBORN, enter that fact bere

8 OCCUPATION OF DECEASED

Porter

(a) Trade, profession, or

particular kind of work ....

(b) Name of employer

Gilchrist Co. Boston

9 BIRTHPLACE (city or town).

Livermore Falls

(State or country)

Maine

10 NAME OF FATHER William Walton

PARENTS

11 BIRTHPLACE OF FATHER (city or town) Livermore Falls

(State or country) Maine

12 MAIDEN NAME OF MOTHER Mary Walton

13 BIRTHPLACE OF MOTHER (city or town Livermore Falls Winthrop Winthrop

(State or country) Maine

Informant

Agnes Chellis

(Address)

34 Wyola Road

Nantasket

15 Filed July 12 y 1927

Registrar of city or town where death occurred

Filed . My 14. 19 27

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

June 21, 1927

(Month)

(Day)

(Year)

17 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows : Natural Cause Probably organic heart disease Dropped dead on way to Boat

(See reverse side for additional space)

18 Where was injury sustained

if not at place of death?

(Sigmed) ... J. B. Peterson

., M.D.

(Address)Hingham Centre

Medical Examiner For.

5th Plymouth

Date June 21, 1927

(Month)

(Day)

( Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL

20 UNDERTAKER

C. R. Bennison

(Month) (Day) ( Year)

ADDRESS

Winthrop

21 Burial permit

issued by

F. P. Richardson

Offi

Clerk B of H.

position

22 Date of

issue

June 21, 1927

should be carefully supplied. Age should be stated EXACTLY. MEDICAL EXAMINERS should state CAUSE OF See reverse side for extraots from the laws of the Commonwealth and instructions. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Is very important.

(a) Residence. No.

(Usual place of abode)

Length of residence in city or towo where death occurred

years

months

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

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician 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 helief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his Inst illness, when last seen alive by the physician and the date of his death. . . . - Revised Laws Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.

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 city or town in which 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 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 purpose, or is insuffi- cient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selecimen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . . The person to whom the permit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary infor- mation 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. - Revised Laws, Chap. 78, Sec. 38.

Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if known. otherwise

a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are sup- posed to have come to their death hy violence. - Revised Laws, Chap. 24, Sec. 8.

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 trom 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 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.

COPIES OF RECORDS OF DEATHS OF NON-RESIDENT DECEDENTS

The clerk of each city and town shall forthwith make certi- fied copies of the records of all . . . deaths recorded during the previous month, if the . . . deceased [was a resident ] of any other city or town in this commonwealth or in any other state at the time of said . . . death, and transmit them to the clerk of the city or town of which such . . . deceased peren [way] resident at the time of the said .. . death ... and the clerk of a city or town in this commonwealth eo receiving such certified copies, or certified copies of ... deaths, from the clerk of a city or town without the commonwealth, shall record the same. - Remsed Laws, Chap. 29, Sec. 13, as amended by Acts of 1910. Chap. 93. Sec. 3.

DESCRIPTION (for unknown person).

June 21,1927.

RM R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

Winthrop

BOSTON (City or town)

1 PLACE OF DEATH

County

Winthrop

Suffolk

State _.

Massachusetts __ Registered No.

City or Town

Boston

No.

53. Waldemar

Ave.

-St.,

Ward

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

Mary B. Mc Carthy

2 FULL NAME

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

(a) Residence. No.

(Usual place of abode)

53 Waldemar Ave, St.

Ward.

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

Langth of residence in city of town where death occurred

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, MARRIEO, WIDOWED, OR

DIVORCEO (write the word)

Married

5a If married, widowed or divorced

~HUSBAND of

(or) WIFE of

William M. Mc Carthy

6 AGE 30 Years

Months

Days

If LESS than

1 day ..._ hrs.

of __ min.

If STILLBORN, enter that fact hera

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Housewife

8 BIRTHPLACE (City)

East Boston

(State or country)

Myass.

William , Anderson

10 BIRTHPLACE OF

FATHER (City)_

Boston

Mass.

11 MAIDEN NAME

OF MOTHER

Margaret E. Holey

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

4Mars.

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

6 -18

192 Z, to

6-28

that I last saw h.

alive on

6 - 28

, 1927

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

5- Am.

The CAUSE OF DEATH was as follows:

Toremin

(duration)

-yrs‹

mos.

.ds.

CONTRIBUTO

(SECONDARY)

(duration)

_yrs_

nos ..

_ds

17 Where was disease contracted

if not at place of death?

Did an operation precede death? die

Date of

Was there an autopsy?

If under one year, was infant Breast Fed ?

What test confirmed diagnosis?

(Signed)

M. D.

(Addsecs)_

Oato

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION OR REMOVAL

DATE OF BURIAL

Holy Cross Halden June 30, 1927

(Cemetery)

(City or town)

19' UNDERTAKER

David Le troley

ADDRESS 135 LandMI-

E. Boston

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

Hm. D. Childrens 4.8

Official

Health Officer

Date of Issua 6/28/27 Permit 1270

200,000 9-25 NO. 2662 - 3. 3 SEX Female 9 NAME OF FATHER 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

1-0-27-203 .

13 William M. 44elcarthy

( Address)

53 Waldemar Ave

July 7/27

/(Month) (Day) (Year) REGISTRAR

rulesofred. total memory

(Stafe or country)

STANDARD CERTIFICATE OF DEATH

June 28. 1927 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 nesded. 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, 88 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.

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 & 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 & 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.

RM R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop

(City or town)

Registered No ..

City or Town

Winthrop

No ._

Winthrop Commonly HofSt.

Ward

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

Grange

2 Highland aux,

St.,

Ward.

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

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Jeme

(Month)

(Day)

(Year)

| HEREBY CERTIFY, That Iattended deceased from

_, to

that I test saw her

alive on

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

m. The CAUSE OF DEATH was as follows:

ST is tom

(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?

(Signe

Play

M. D.

(Address)

Winthrop man

1927.

Date

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION DR REMOVAL

DATE OF BURIAL

(Cemetery)

(Cityfor town)

19 UNDERTAKER

Walter 1. Write. Whether

ADDRESS

Officlal Vilken Office permit. Date of

Permit 7/5 /27 NO. 1274

1 PLACE OF DEATH Suffolk.

County

2 FULL NAME

200,000 9-25 NO. 2662 - 3.

3 SEX

4 COLOR OR RACE

white

female

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

If STILLBORN, enter thet fact hore

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Nama of employer

(State or country)

mass,

PARENTS

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

Filed

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

(State or country)

conn,

5 SINGLE, MARRIED, WIDOWED, DR

DIVORCED (write the word)

Days

If LESS then

1 day,_hrs.

or __ min.

8 BIRTHPLACE (City)

Winthrop

9 NAME OF

FATHER

Gibson Craige

10 BIRTHPLACE OF

FATHER (City)

HartFord

11 MAIDEN NAME

OF MOTHER

Elizabeth Simpson

12 BIRTHPLACE OF

MOTHER (City)

Providence

(State or country)

13 Informant Father Gibeon Graig

(Address)

12 Highland Que Winthrop 100g

July 1/2>

Month) / (Day) (Year)

REGISTRAR

20 | MEREBY CERTIFY that o satisfactory staa- dar'd certificato of death was filed with me BEFORE the burial or trensit per mrt was issued Nm. D. Children

State

(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

1927

June 30, 1927

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 .- 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.

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

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.

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Town of Winthrop : Record of Deaths 1925-1927, Part 212

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

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