Town of Winthrop : Record of Deaths 1925-1927, Part 95

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 95

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(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

1 PLACE OF DEATH

County

Suffolk

State

Masa,

(City or town)

Registered No.

City or Town

Winthrop

No.

224 Bowdoin St

St.,

Ward

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

2 FULL NAME

Grephs Lillian Cordes

(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

St.,

Ward.

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

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH.

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

1926

Der 24

1925, to_

Fely 26.

that I last saw h.

alive on

Foly 25

1926

and that death occurred, on the date stated above, at 940

A_m. The CAUSE OF DEATH was as follows: Cardio Renal Disease

More (duration)

CONTRIBUTORY

Martino sclerosis

(duration)

yrs.

mos ..

17 Where was disease contracted

if not at place of death?

Date of.

Did an operation precede death?

Was there an autopsy?

What test confirmed diagnosis ?.

clinical

(Signed)

M. D.

(Address)

123 Willup ST

Date

Poly 27, 1926 Quetu

(Month)

(Day)

(Year)

Informa

Mra Martha Cordes

( Address)

224 Bowdoin St Winthrop

Filed

100/4/26

(Month) (Day) (Year)

REGISTRAR

18 PLACE OF BURIAL, CREMATION OR REMOVAL

Winthrop Winthrop

(Cemetery)

(City or town

DATE OF BURIAL Feb. 28/26

19 UNDERTAKER

Long+ Margeson

maas

ADDRESS

Winthrop

20 | HEREBY CERTIFY that o satisfactory stan- dard certificate of death was hiled with me BEFORE the burial er tronsit permit was issued

Gilbert S. Scritte

Official position See'y

Date of issue df per mit 2/27/26

· NO. Parmi 033

3 SEX

4 COLOR OR RACE

White

y Male

'Sa If married, widowed or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

# STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(*) Trada, profession, or

particular kind of work

8 BIRTHPLACE (City)

Iruso

(State or country)

Mass.

10 BIRTHPLACE OF

FATHER (City)

Iruso

(State or country)

Mass,

PARENTS

in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See

(b) Name of employer

BRBYL RR

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

Martha Cordes

Days

If LESS than 1 day, _._ hrs. or __ min.

Ticket agent

9 NAME OF

FATHER

William D. Cordes

11 MAIDEN NAME

OF MOTHER

Sally Rich

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

maso,

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.

23-200,000

9 . 3.Q.

-yrs .__ mos. ads.

26. 1926

224 Bowdoin

months

26, 1926 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

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

Statement of occupation .- Precise etatement of occupation ie very important, eo 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 firet 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 etatement; it ehould 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 etatement. Never return "Laborer," "Fore- man," "Manager," "Dealer," etc., without more precise specification, ae 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, ae At school or At home. Care should be taken to report specifically the occupations of pereons engaged in domestic service for wages, ae 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 illnese. 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 miecarriege, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cauee 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 ehall 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 eatisfactory 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 eupposed 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 euch 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 whoee physician ie absent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deathe supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including reeulting eepticemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but aleo 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.

ORM R-301

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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

State Max

(City or town)

Registered No.

City or Town

No.

201 woo duren args

Ward

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

2 FULL NAME

Baby Rozell

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

Ward.

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

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

Days

If LESS than

1 day, __ hrs.

or ..._ min.

I STILLBORN, entor that fact hora

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

(State or country)

9 NAME OF

FATHER

Charles. O. Roz ell

10 BIRTHPLACE OF

FATHER (City)

(State or country)

11 MAIDEN NAME

OF MOTHER

Fanny, A. Hanley

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Informant

( Address)

203 2000 desde and Winter

Filed

72.000.1/26

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

1926

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

1926, to

1922

news

that I Last saw him

alive on

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

The CAUSE OF DEATH was as follows:

Stillhow

(duration)

.yrs.

mos.

ds.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs.

mos.

17 Where was disease contracted

if not at place of death?

Did an operation precede death ?.

Date of

Was there an autopsy?

What test confirmed diagnosis ?.

(Signed

Rquand

B Parken

M. D.

(Address)

Wattot han

1920

Date

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION DR REMOVAL

DATE OF BURIAL

(Cemetery)

(City or town)

19 UNDERTAKER

ADDRESS

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

Albert S. Smith

Official position

Secretary

Date of issue of permit 2/27 26

Pormit ND. 1032

PARENTS

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

23-200,000

(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

Tel. 27.1926

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 smployments, 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 worksd on may form part of the second statement. Never return "Laborer," "Fore- man," "Manager," "Dealer," etc., without more preciss 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 bs 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 definits 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, Btc., of .. (name origin; "Cancer" is less dsfinite; 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 (dissase causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Nsver 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

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 suppossd 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 certificats of the attending physician, if any, as required by law, or in lieu thereof a certificats 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.

M R-303

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

Medical Examiner's Certificate of Death (ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)

(City or town)

1 PLACE OF DEATH

County

Suffolk

City or Town Willing

Charles Richard

State

Registered No.

No. 400 Kultury

St.,

Ward

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

2 FULL NAME

(a) Residence. No Withinp 400 Wruchuto

(Usual place of abode)

Length of residence In city or town where death occurred

years

months

days

St.,

.. Ward.

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

How long In U. S., If of toreign birth?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

٠ليه

1926

(Month)

(Day)

(Year)

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, eoter that tact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

Winthrop.

mães.

Charles Buups.

10 BIRTHPLACE OF

FATHER (City)

(State or country)

Vermont.

albany

11 MAIDEN NAME

OF MOTHER

Mary J. Hawking

Pensacola

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

+ la.

Cate

Medical Examiner fer

March 10

1926

(Month)

(Day)

(Year)

18 PLACE OF BURML, CREMATION, or REMOVAL

Wurtheop

(Cemetery)

(City or town)

DATE OF BURIAL Nurthanh Mar. 11, 1926

(Month) (Day) {Year)

ADDRESS

Filed

(Month) (Day) (Year)

REGISTRAR

20 Burial permit Issued by Albert J. Smithy

Official position.»

Secretary 21 Date of isque 3/11/26

Permit

No .. ..

1038

Connexions associated with intra cranial infun cause by an accidental fall.

(See reverse side for description for unknown person)

17 Where was injury sustained

If not at place of death ?

(Signed)

George Burgers Magath

M.D.

(Address)

Suffolk

Informant

Charles Bureps, (father

(Address) 450 Withauch St

14 11 17/26

10 UNDERTAKER

Charles R. Bununson

14,811

3 SEX Male 9 NAME OF FATHER PARENTS 13 information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of Death. See reverse side for extracts from the laws relative to the return of certificates of death. N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Single .

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

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

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

A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has at- tended during his last illness, at the request of an under- taker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died (defined so that it can be clas- sified under the international classification of causes of death), 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. . . .- General Laws, Chapter 46, Section 9.

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Town of Winthrop : Record of Deaths 1925-1927, Part 95

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

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