Town of Winthrop : Record of Deaths 1925-1927, Part 249

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 249

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Carpenter.

Russia

8 BIRTHPLACE (City) (State or country)

9 NAME OF

FATHER

Till Solberg

10 BIRTHPLACE OF FATHER (City) (State or country)

Quarta

1 1 MAIDEN NAME OF MOTHER "Can not be learend )

1 2 BIRTHPLACE OF MOTHER (City) (State or country)

Russia

13 Fanny Informant

(Address)

14 Filed Dec 17/7 (Momh) (Day) (Yesf)

DEC &5 1927 REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY , That I attended deceased from

19 _. , to 19

that I last saw h

alive on

and that death occurred, on the date stated above, at The CAUSE OF DEATH was as follows: (State fully) .

.m.

(duration).

_. yrs

mos. ds.

CONTRIBUTORY

(Secondary)

(duration).

.yrs.

mos. ds.

Where was disease contracted

if not at place of death

Did an operation precede death For what

Date of operation

Was there an autopsy tf under one year, was infant Breast Fed ? What test confirmed diagnosis

(Signed) , M. D.

(Address)

Date

18 PLACE OF BURNAL, CREMATION, OR REMOVAL

DATE OF BURIAL anche Joland Montvale 1 2/13/27 (Cemetery) (City 'or toun)

19 UMBERTASER Chenles / Porquels

DRESS 73 Village It

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

Officiel position

Le of JEC 13 Permite 1657 of permit

80-'21-2011

2 00.000. 9-26. NO. 6373

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-

City or Town

Boston

2FULL NAME

Harris Yolellery

23 Wave Uve

(a) Residence. No. (Usual place of abode) Length of residence in city or town where death occurred years months . days.

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

PARENTS

Moleberg 23 Have ave Winthrop

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 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) 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, Laborer-Coal mine, etc. Women at home, who are engaged in the duties of the household onty (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 Discase Causing Death (the primary affection with respect to time and causation), using always the same accepted term for the same discasc. 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, 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 symp- tomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all discases 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- mittce 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- gitls, 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 belicf 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 body in a town, or remove thercfrom 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 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 carly 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 certi- 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 appcar 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. The person to whom the permit is so given and the physician certifying the cause of death shall thercafter 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 .- 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 shall in all cases certify to the town clerk or registrar in the place where the deceased dicd 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.

No undertaker or other person shall bury a human body or the ashes thereof which have been brought 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 funcral 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.

STATE BOARD OF HEALTH OF FLORIDA

52786

County

BUREAU OF VITAL STATISTICS

Permit No.

Precinct. (Write name, not number) or

Inc. Town acksonville:

Full name

Davies

Goldberg

55; : Sex ..

Age .. na .......

Color

Disease causing Death

Lavar Parfum

Date of death via

10/9/99

Removal to

Undertaker

Moulton tilyle

Address

Jacksonville, Fla.

A Certificate of Death having been filed in my office in accordance with the Laws of Florida, I hereby authorize the removal and burial of the body of said deceased person as stated above.

Dated.

12/10 19.2.7 Registrar's Signature .,

Burial Permits must be delivered by the undertaker to the sexton or other persons in charge of the Burial ground or cem- etery where burial takes place. When the body is to be shipped to a distant point, requiring the service of a common carrier, in addition to the Removal Permit, the body must be accompanied by a Transit Label as required by the State Board of Health. For full particulars see Rules and Regulations governing the transportation of dead bodies. Sexton's Signature.

. Date of Interment .. 19

This permit must be indorsed by the sexton and returned to the Local Registrar of his district within ten days. If there is no sexton or person in charge of burial ground, the undertaker or person acting as such, shall sign same as sexton, giving date of interment. Write across face of permit the words, "No person in charge," and return to' Local Registrar of the dis- trict in which interment is made within ten days.

Removal and Burial Permit

Reg. Dist. No ... 13-01

INSTRUCTIONS TO PASSENGER ACCOMPANYING REMAINS

This Burial and Removal Permit must be filled out by the Local Registrar of the registration district in which the death occurred from information stated on the Death Certificate, over his signature.

The transportation company's agent or baggagemaster must detach this portion of the permit and hand it to the person authorized to accompany the remains.

If the body is shipped by express, the express agent must detach this portion of the Transit Permit and attach it to the Waybill, as it must accompany the remains to its destination. The receiving agent to turn over this Permit to the receiving undertaker, or person to whom the body is delivered.

The passenger accompanying the remains must deliver this Permit to the undertaker or person having charge of the burial of the body,

This Permit authorizes the burial of the body of the deceased named on the reverse side of this Permit at any place in the State of Florida.

Dec. 9. 19 27.

M R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

(City or town)

Registered No.

St.,

Ward

2 FULL NAME

Aloysius

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

(a) Residence. N

(Usual place of abode)

Length of residenca in city or town whera death occurred

years

months

.St.

Ward.

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

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIEO, WIOOWED, OR

DIVORCEO (write the word)

Single

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

Days

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.

None

(b) Name ol employer

Boston

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

aymond

(Signed)

M. 0.

(Address Writing Board of Health.

Date

1,3

1927

(Month)"

(Day)

(Year)

18 PLACE Of BURIAL, CREMATION OR REMOVAL

Butvary Roxbury

(Cemetery)

(City or town)

DATE OF BURIAL

Decle1922

ADDRESS

Flled (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

1927

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

.. to

, 19

that I last saw h

alive on

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

6 %.

The CAUSE OF DEATH was as follows:

natural Causes.

Chemin Vilular Heart Daway

(duration)

_yrs.

mos.

____ _ ds.

9 NAME OF

FATHER

James mc Donoracle

10 BIRTHPLACE OF

FATHER (City)

(State or country)

PARENTS

11 MAIDEN NAME

OF MOTHER

mart. Watch

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

St Johns

Ne fr

Informant.

( Address) 25 Hermandet Winchcom

Dec 15.27

19 UNDERTAKER

H. He Franell Revere

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

Oste ol

Officlal positiony Health Officer ,permit 12/13/27 NO. Pormit 1336

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK- THIS IS A PERMANENT RECORD. Every item of information

should be carefully supplied. 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 and extracts from the laws on back of certificate.

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

OFFICE OF THE SECRETARY

DIVISION OF VITAL STATISTICS

I PLACE OF DEATH

County

State

Winthrop

City or Town

No.

125 Hemma

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

125 Herman

8 BIRTHPLACE (City)

(State or country)

Personal veertigatin

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.

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.

FORM R-301

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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Wirtuo (City or town)

Registered ND.

City or Town

No.

111

2FULL NAME

Julia T. Nolan

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

(a) Residence. No.

(Usua! place of abode)

111 Giorno come.

St.

Ward,

Length of residence in city or town where death occurred

years

months

days.

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

60 years

months

days.

PERSONAL AND STATISTICAL PARTICULARS 3 SEX

1 4 COLDR OR RACE

white

5 SINGLE, MARRIED, WIDOWED, DR

DIVORCED (write the word)

5a lí married. widowed or diverced HUGOANO of (9+) WIFE of Thomas not un

6 AGE

Years

Months

IF LESS than

1 day ......... hrs.

cr ....... min.

IF STILLBORN, enter that fact here

7 DCCUPATIDN DF DECEASED

(2) Trade, profession, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City) (State or country) Ireland

9 NAME DF FATHER

Joseph. little

1 O BIRTHPLACE OF

FATHER (City)

(State or country)

Friland

1 1 MAIDEN NAME DF MOTHER

Budget Mc Donall

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

Fretand

13 Muchas.H. Waldron Informant

(Address)

14 Tel: 21/27 Filed (Month) (Day) / (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

1927

(Day)

(Year)

I HEREBY CERTIFY , That ! attended deceased from

1927, to DEG 17

1927

that ! last saw h En alive on.

DEC 16

1927

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

The CAUSE OF DEATH was as follows: (State fully)

10.30 am.

arterio sclerosi

(duration).

_yrs.

.mos. .de.

CONTRIBUTORY

(Secondary)

(duration).

mos

ds.

1 7 Where was disease contracted

If not at place of death.

Did an operation precede death

200

For what

Date of operation

Was there an autopsy

200

What test confirmed diagnosis

(Signed)

John S. Treasury

, M. D.

(Address) 3 Hower St Brecon

Date

DEC. 18,1927

1-8 PLACE OF BURIAL, CREMATION OR REMOVAL

Holywood

Brookline

(Ceméttry)

(City or town)

DATE OF BURIAL 26.20 1927

1 9. UNDERTAKER

Charles

(P. Denneon Winthrop

ADDRESS

Official hatte officer

Date of Issue 12/11/21 Permit in.

1337

MARVIN RESERVED FOR BINDING

200.000. 9-26. NO. 6373 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- N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information should be carefully sup- PARENTS

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

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Town of Winthrop : Record of Deaths 1925-1927, Part 249

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

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