Town of Winthrop : Record of Deaths 1925-1927, Part 30

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 30

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560 Shirly.

.St.

Ward.

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

(Month)

18 PLACE OF BURIAL, CREMATION DR REMOVAL

wirthump

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 Pianter, 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- cdge and belief the name of the deceased, bis 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.

State of Rhode Island.

CHAPTER 121, GENERAL LAWS, 1909. OF THE REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES

SLc. 20. The clerk or registrar of each town and city shall on the first day of each and every month make a certified copy of all births, marriages and deaths recorded in the books of said town or city during the previous month, whenever the parents of the child born, or the bride or the groom, or the deceased person, were resident in any other town or city in this State or in any other state at the time of said birth, marriage or death; and shall transmit such certified copies to tbe clerk or registrar of the town, city or state in which such parents of the child born, the bride or the groom, or the deceased, were resident at the time of said birth, marriage or death, stating in case of a birth, the name of the street and number of the house, if any, where such parents resided, the place of birth of such parents and the maiden name of the mother, whenever the same can be ascertained; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording births, marriages and deaths. Such Certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the state hoard of health.

COPY OF THE RECORD OF A DEATH.

recorded in the books of the .... City .of. .... Cranston

(Town or City.)

during the month of. June 19.2.5. ....

1. Date of Death May .... 4, 1925

2. Name in FULL

Mary ... Wilhemina .. Welsh

Date of Birth. Aug .23, 18.59 .. Age ... 6.5 .... yrs .. 6. .mos ... 11 .... dys

4. Place of Death CityxoxKou ... Cranston

5. St. or Road & No.1.49 Shaw Ave

6. Usual Residence. 891 Shirley ... St. Winthrop ... Mass

7. Sex. Female Color White

( Single, Married,

9. Widowed or Di- ( vorced Widow

10. Name of Husbandxxxxxx George .. Welsh

11. Occupation of decedent

12. Place of Birth ... Stillarton .. NovaScotia

13. Father's Name ....... James Macdonald

14. Mother's Name. Margaret Macdonald

15. Parents' Birthplace Fa .... Nova Scotia Mo .... Nova Scotia.

16. Where to be buried .... Pocasset Cemetery

17. Cause of Death .. Chronic ... Myocarditis .. . Cardio .... Vascular ... Renal Insufficiency

Name of Physician . Theo .... C ..... Hascal.1

Name of Informant

Mrs ... Frank ... Schellinger ... Daughter.

Name of Undertaker

Frank E. Remington

I certify that the foregoing is a true copy

Attest, Lunde Smith 1

June 3,

19 25

City .... Clerk. (Town or City.)

June 9,19 25

may 4, 1925

RM R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

State 16 ans

Registered No.

City or Town

Winthrop

No.

156

River Rd

St .. . Ward

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

2 FULL NAME

Nora Gertrude Buruz

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

(a) Residence.

No ..

156 River Rd

St.,

Ward.

(Usual place of abode)

(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

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

May

سى

1923

(MonthY

( Day)

(Year)

I HEREBY CERTIFY , That I attended deceased from

May 5

125 to May 5, 1920,

that I last saw le ........... alive on

Way

19.2.0.

and that death occurred, on the date stated above, at 0: 13am

The GAUSE OF DEATH was as follows :

Central hen

morrhage

(duration)

..... .... yrs ..

mos.

ds.

CONTRIBUTORY

(SECONDARY)

(duration)

.yrs ...

mos.

ds,

Did an operation precede death ?

Was there an autopsy ?

What test confirmed diagnosis ?

Clinical

562 Jusley Street

May 5, 19 lutherpilhas

(Month)

18 PLACE OF BURIAL CREMATION, OR REMOVAL

Holy Cross ', 'anden

(Cemetery)

(City or town)

DATE OF BURIAL May 8 1925

ADDRESS

19 UNDERTAKER John H. Lacy

Official position ...

Date of issue of permit 5 6,25

Permit

100,000. 3567.

Informant

Helen Punkham Daught

(Address) 156 River Rd Innature Al Ce

Filed 221pues62 925

(Month) (Day) ( Year)

REGISTRAR

20 1 HEREBY CERTIFY that a satisfactory stan- dard certifcale of death was Gled with me BEFORE the burial or trans'! permit was issued 4.1. Daniele ex :8

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

demale

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Lance H. Burue

Months

Days

58 3

If LESS than 1 day ........ brs. or ........ min.

If STILLBORN, enter that fact bere

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

At Collector

Besten Elevated

East of water

8 BIRTHPLACE (City)

(State or country

9 NAME OF

FATHER

Daniel Crowley

10 BIRTHPLACE OF

FATHER (City)

(State or country )

Ireland

11 MAIDEN NAME

OF MOTHER

Ellen O' Brien

12 BIRTHPLACE OF

MOTHER (City)

(State or country )

greland

Date

17 Where was disease contracted

if not at place of death ?.

. Date of .

County. 3 SEX 6 AGE PARENTS 13 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. 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 (b) Name of employer

The Commonwealth of Massachusetts

(City or town)/

No. .

4 COLOR OR RACE

Muito

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

LApproved 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, irrespective of age. Fer many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, 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 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," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupatiens 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 (rctired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ... .. (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

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

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

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

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

A physician or registered hospital medical officer shall ferthwith, 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 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 died, defined as re- quired by sectien 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 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 licu 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 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 physician. If death is caused by violence, the medical examiner shall make such certi- ficate. ... The person to whom the permit is so given and the physi- cian certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Gen. Laws, Chap. 114, Sec. 45.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by 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; other- wise a description as full as may be, with the cause and manner of death. - Gen. Laws, Chap. 38, Sec. 7.

RULES OF PRACTICE

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

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health Physicians will 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 sup- posably 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 abertion, 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 persens found dead.

ORM R-301

2 FULL NAME

3 SEX

male

8 BIRTHPLACE (City)

(State or country)

PARENTS

Informant

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

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

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)

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married.

Sa If married, widowed ør divorced

HUSBAND of

(om) WIFE of

Alice Skye Smith.

6 AGE

Years

Months

Days

# LESS than 1 day,_hrs. of __ min.

I STILLBORN, cater that fact here

7 OCCUPATION OF DECEASED

(a) Trada, profession, or

particular kind of work

(b) Name of employer Bos. Terminal Refrigerative

Ottumwa

Có.

lowa

9 NAME OF

FATHER

George W. Smith.

10 BIRTHPLACE OF

FATHER (City)

Unable to obtain

Illinois.

11 MAIDEN NAME

OF MOTHER

martha Stokes.

12 BIRTHPLACE OF

MOTHER (City).

Unable to obtain-

(State or country)

L'auras-

13 alice, J. Smith (wi)E)

(Address)

17 Wwethiop St.

Filed 22001 22 1921

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH.

may

1975

(Month)

(Year)

(Day)

I HEREBY CERTIFY, That I attended deceased from

1925-

may 7

,19 ZJ.

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

1925

that I last saw h

alive on

9 p. m.

The CAUSE OF DEATH was as follows:

Mutual atenorio

(duration)

mos. ds.

CONTRIBUTORY.

Quete quitute

(SECONDARY)

(duration)

yrs.

mos

17 Where was disease contracted

if not at place of death?

Did an operation precede death?

200 Date of

Was there an autopsy?

200

What test confirmed diagnosis ?. -

(Signed)

(Address).

Without man

Data

May 91 1925

(Year)

18 PLACE OF BURIAL, CREMATION DR REMOVAL

(Month)

(Day)

Northrop

DATE OF BURIAL

May 10, 1925

(Cemetery)

(City or town)

ADDRESS

19 UNDERTAKER

Charles P. Brunison - Nuitho

20 | HEREBY CERTIFY that a satisfactorystas- dard cartilicato al death was liled with one BEFORE the burial or traosd permit was issued.

4 2 .00000

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop

1 PLACE OF DEATH

County

Suffolk

State Maso.

Registered

(City or town) No.

City or Town.

Arinthrop

No 17 Winthrop

St. _Ward

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

Charles Martin Smith.

harles

17 Drinthrop

St.,

Ward.

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

(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

months days

PERSONAL AND STATISTICAL PARTICULARS

Mehamstra

Official Agent

Date ol ISSUE of permit it May 9. 1925 NO. 907

Titts alle offices

M. D.

MARGIN RESERVED FOR BINDING

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

may 7. 1925 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

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Town of Winthrop : Record of Deaths 1925-1927, Part 30

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

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