Town of Winthrop : Record of Deaths 1925-1927, Part 220

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 220


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 | Part 230 | Part 231 | Part 232 | Part 233 | Part 234 | Part 235 | Part 236 | Part 237 | Part 238 | Part 239 | Part 240 | Part 241 | Part 242 | Part 243 | Part 244 | Part 245 | Part 246 | Part 247 | Part 248 | Part 249 | Part 250 | Part 251 | Part 252 | Part 253 | Part 254


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


1 PLACE OF DEATH


County.


Suffolk


State Mass


Registered No.


City or Town


Winthrop


No.


35 Thornton Park


-st Ward


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


2FULL NAME.


William


35Th


(a) Residence. (Usua! place of abode)


Length of residence in city or town where death occurred years


months


davs.


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


months


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4. COLOR OR RACE


male


White


5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word) married.


5a M Ir married, widowed cr divorced HUSBAND of (or) WIFE Luuma Louise austro/t / last saw/ h in


6 AGE


Years


Months


8


Days


25


IF LESS than 1 day ......... hrs. cr ........ min.


IF STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED (a) Trade, profession, of particular kind of work Forwantto (b) Name of employer


chinist


(duration). _yrs .. .mos.


.ds.


CONTRIBUTORY


(Secondary)


(duration).


_yrs.


.mos.


1 7 Where was disease contracted


if not at place of death.


Did an operation precede death


For what


Date of operation


Was there an autopsy


What test confirmed diagnosis


(Signed) Harry auf. LE . M. D.


(Address)


Date


18 PLACE OF BURIAL, CREMATION, OR REMOVAL Winthrop-Winthrop (Cemetery) (City or town)


DATE OF BURIAL


13


8. F. Bell


Informant (Address) 35 Tha


14 Filed


(Month) (Day) (Year)


RECISTRAR


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


W.D. Children


Official position


9.3.9.


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


(Month)


7


(Day)


27


(Year)


16


I HEREBY CERTIFY , That I attended deceased from


6X 1926


19


_, to


1927.


alive on 1927


m.


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


The CAUSE OF DEATH was as follows:


(State fully)


myocarditis


8 BIRTHPLACE (City)


(State or country)


unsurch


9 NAME CF


FATHER


nadlaws


PARENTS


1 O BIRTHPLACE OF FATHER (City)


(State or country)


England


1 1 MAIDEN NAME OF MOTHER


12 BIRTHPLACE OF MOTHER (City) (State or country) grel


nd


19 UNDERTAKER


ADDRESS


R. Be


Date of issue Asf permit Health Ofy 8/9/27 Permit NO. 1284


N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information should be carefully sup- Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified.


200.000. 9-26. NO. 6373


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


Winthrop (City or town)


adams


(! U. S. War Veteran, specify WAR)


St., Ward,


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


63


REVISED UNITED STATESSTANDARD 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 ean 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) Forcman, (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, Laborcr-Coal mine, ete. 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 domestie service for wages, as Servant, Cook, Housemaid, ete. 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 discase. Exam- ples: Cerebrospinal ferer (the only definite synonym is "Epidemie 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, ete., 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 intereurrent) 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 symp- tomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," cte., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from ebildbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.


State cause for which surgical operation was undertaken.


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


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


Certificates will be returned for additional information which give any of the following diseases, without explanation, as the soie cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, menin- gitis, 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 wae contracted, the duration of his last illness, when last scen alive by tbe physician or officer and the date of his death ..... Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which hae not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the elerk 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 bas received a permit from the board of health or its agent aforesaid or from the elerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or elerk, as the case may be, 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 hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be ob- tained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by tbe seleetmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, tbe medical examiner shall make such certificate. If the death eerti- fieate contains a recital, as required by seetion ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. Tbe 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 tbe manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.


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 sball 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 deatb .- Gen. Laws, Chap. 38, Sec. 7.


No undertaker or other person shall bury a human body or the ashes tbereof which have been brought into the commonwealth until be has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46, G. L., as amended.


RM R-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


Winthrop (City or town)


Suffolk.


State Massachusetts


Registered No.


City or Town


Winthrop


No. 6H Lincoln


St .. Ward


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


Cau


(If U. S. War Veteran, specify WAR)


St.


Ward


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


Length of residence in city or town where death occurred


years


months


days.


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


years


months"


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Male


4 COLOR OR RACE


White.


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Carried.


5a If married, widowed cr divorced


HUSBAND of


Georgia Punnella.


6 AGE Years


Months


56


ro


12


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


Car Suspector


Undetemel. (daration).


CONTRIBUTORY


(Secondary)


(duration). yrs .mos.


ds.


17 Where was disease contracted


if not at place of death


Boston city


.


Did an operation precede death


y en


For what


Date of operation


June 16-1927


7


Was there an autopsy


200


What test confirmed diagnosis


tracy x


(Signed)


M. D.


(Address) worthup man.


Date


8/9/27


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL


Holdereuro


(Cemetery)


(City or town)


19 UNDERTAKER


Charles R. Bennison Winthrop.


ADDRESS


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


W. N. Childress 9.10.9.


Official positien


Healthe Officer


Date of Issue of permit 8/9/27.


Permit flo.


1285


15 DATE OF DEATH


(Month)


8


(Day)


(Year)


16 I HEREBY CERTIFY , That I attended deceased from 1927, to Cinq. 8 1927


that I last saw ha


Lalive on.


7


19 27


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


The CAUSE OF DEATH was as follows:


(State fully)


1


P


m.


(b) Name of employer B.R. B. + P. P.P. Holderness.


8 BIRTHPLACE (City)


(State or country)


New Hampshire.


9 NAME OF


Cuoch Cousins.


FATHER


1 O BIRTHPLACE OF FATHER (City) Porter,


PARENTS


(State or country) Maine.


1 1 MAIDEN NAME OF MOTHER Lydia Cotton Cox.


12 BIRTHPLACE OF


MOTHER (City)


Holderness.


(State or country) NEW Hampshire


13


Vers Giorgia Tunnells.


Informant


(Addres


6HLuchSt


Consus


14 Filed 10-21/27 (Month) (Day) (Year) REGISTRAR


N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information should be carefully sup- Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified.


200.000. 9-26. NO. 6373


2FULL NAME


allah Cotton"


b+ Lincoln


(a) Residence. No.


(Usua! place of abode)


MEDICAL CERTIFICATE OF DEATH


1927


July 21


Care


pane


.mos. ds.


chmiel.


REVISED UNITED STATESSTANDARD CERTIFICATE OF DEATH


C (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, ete. 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, ete. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state oceupa- 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 affeetion with respect to time and causation), using always the same accepted term for the same discase. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemie 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, ete., 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 symp- tomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childhirth 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, menin- gitis, 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 or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, 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 its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the ease may be, 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- fieate 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 oh- tained early enough for the purpose, 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. If the death eerti- ficate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the elerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.


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.


No undertaker or other person shall bury a human hody or the ashes thereof which have been hrought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial ground in which the interment is made .- Chap. 114, Sec. 46, G. L., as amended.


0 2


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


(City or town)


1 PLACE OF DEATH


County


Suffolk


State


Massachusetts


Registered No.


7026


(Place of death)


City or town


Boston


No.


MASS, HOMEOPATHIC HOSPITAL


St., Ward


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


2 FULL NAME _MIRIAM D. LAMB


MASS.


City or Town WINTHROP


No.


46 HILLSIDE


St.


Length of residence in city ar town where death occurred


years


mouths


days .


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


years


months days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


1927


(Year)


16


I HEREBY CERTIFY,


That I attended deceased from


27


AUG. 14


to


19 27


MAY 5


19


that I last saw h_


E Ralive on


AUG. 14


.19 27


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


2,15 Am.


The CAUSE OF DEATH was as follows:


CHRONIC NEPHRITIS


GENERAL ARTERIO SCLEROSIS


(duration)


yrs.


mos.


ds.


CONTRIBUTORY


(SECONDARY)


(duration )


yrs.


mos.


ds.


(State or country)


MAINE


9 NAME OF


FATHER


WALTER MATHEWS


10 BIRTHPLACE OF


FATHER (city or town)


SEARSPORT


(State or country) MAINE


11 MAIDEN NAME


OF MOTHER


MARION MATHEWS (0.2)


12 BIRTHPLACE OF


MOTHER (city or town)


SEARSPORT


(Address)


Date


AUG. 14, 1927


13


Informant


FRED LAMB


(Address) 46 HILLSIDE AVE. WINTHROP


1


FILMUG.


17


,19 27 UM Seinen


Registrar of city or town where death occurred


Filed UMA 18, 19 27


Registrar of city or town where deceased resided


17 Where was disease contracted


if not at place of death?


Did an operation precede death?


YES


Date of.


5-7-27


Was there an autopsy ?.


YES


What test confirmed diagnosis?


AUTOPSY


(Signed)


C. A. POWELL


, M. D.


(State or country) MAINE


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


(WOODLAWN) EVERETT


DATE OF BURIAL


8-16


, 19 27


(Cemetery)


(City or town)


19 UNDERTAKER


C. H. FAUNCE


ADDRESS


50,000


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


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


4 COLOR OR RACE


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


WIDOWED


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


GEORGE F.


6 AGE Years


75


Months 1


Days


If LESS than


1 day, ____ brs.


2 1


M STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED


(a) Trade, profession, ar


particular kind of work.


NONE


(b) Name of employer


CHRONIC PYELITIS


8 BIRTHPLACE (city or town)


SEARSPORT


PARENTS


15 DATE OF DEATH


AUG. 14


(Month)


(Day)


3 SEX


F .


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


(a) Residence. State.


(Usual place of abode)


Registered No. (Place of residence)


BOSTON


DIAND STANDARD CERTIFICATE OF DEALI


(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.




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.