Town of Winthrop : Record of Deaths 1928-1930, Part 10

Author: Winthrop (Mass.)
Publication date: 1928
Publisher:
Number of Pages: 1296


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 10


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


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH County


State


Registered No. 2


St ..


____ Ward


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


2FULL NAME


440 Wilshire


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 ØR RACE


érinté


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


5a If married, widowed ar divorced


HUSBAND of


(or) WIF


Charles to. Woodward


6 AGE


Years


Months


3.


Day:


IF LESS than i č:y ......... hrs. c ......... min.


IF STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


(b) Name of employer


cet Home


Jamaica Plain


8 BIRTHPLACE (City) (State or country)


icaro.


9 NAME OF


FATHER


Quarles N. Maccubou


10 BIRTHPLACE OF


FATHER (City)


/ altimon


(State or country)


1 1 MAIDEN NAME OF MOTHER


Gachelle Car


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


13 Harold Co. Woodward


(Address)


50 transport Vel ite


14 0716 241280 (Month) (Day) (Year) REGISTRAR


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


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


21/1125


(Month)


(Day)


(Year)


16


I HEREBY CERTIFY, That I attended deceased from


192.), to the 21


28


19


12/20


that I last saw h_A_


alive on


19


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


2 A


m.


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


(duration)


_yrs


ds.


mcs ..


CONTRIBUTORY


(Secondary)


Quilitos mellitus


(duration).


_yrs.


mos ..


ds.


17 Where was disease contracted


if not at place of death


Did an operation precede death.


For what.


Date of operation


Que 1927


Was there an autopsy


What test confirmed diagnosis


(Signed)


, M. D.


(Address)


Date


2-22-28


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL


(Cemetery)


(City or town)


19 UNDERTAKER


ADDRESS


Official position agent


Date of Issue Of permit 2/22/28 NO. 1366 Permit


plied. 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. 9-26. NO. 6373


(City of town) 20


City or Town


No.


Wine & Woodward


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


Ka) Residence. No.


(Usual place of abode)


Length of residence in city of town where death occurred 2years


months


Female


PARENTS


Feb- 21. 1928 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) 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 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 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 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 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, 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 body 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 Merk, as the case may be, a satisfactory written statement containing ure 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 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 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. 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 require .- Chap. 114, Sec. 45, G. L., as amended.


Medical examiners shall make examination upon the view of the dead bodies of oniy 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.


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 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.


R-301 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


BOSTON (City or town)


Suffolk


State Massachusetts


Registered No.


City or Town


Boston


No.


330 Shipley


St .. Ward


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


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


(a) Residence. No.


(Usual place of abode)


330 Shirley


St.,


Ward.


Winthrop Masa.


Length of residence in city or town where death occurred


years


months


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


(If non-resident give city of town and state) months days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


(Month)


23. 1918


(Day) (Year)


16 I HEREBY CERTIFY, That I attended deceased from Echmay 22, 1928, to Bey. 23, 1928, that I last saw h CL alive on Int. 23 - 28,


and that death occurred, on the date stated above, at 24


_. m.


The CAUSE OF DEATH was as follows: Zolas Pneumonia


AD (duration) _yrs .. .... mos. ds. CONTRIBUTORY Inmir ébrancy hi Reporter (SECONDARY) untam (duration) _yrs .. .mos ._____ ds


17 Where was disease contracted if not at place of death?


Did an operation precede death?


Date of


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


(Signed)


M. D.


(Address) y


Date


(Month) (Day) (Year)


18 PLACE OF BURIAL, CREMAȚION OR REMOVAL


DATE OF BURIAL


(Cemetery)


(City or town)


19 UNDERTAKER


ADDRESS


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


Official tid dealle officer


Date of issue of permit 2/23/28 Permit NO 1370


County 200,000 9-25 NO. 2662 - 3. 3 SEX 9 NAME OF FATHER PARENTS 13 instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (b) Name of employer


7-2011.


Informant


Carmine Colorier


(Address)


330 chives 2.


14 Filed Ja 8 28


(Month) (Day) (Year) REGISTRAR


Italy


11 MAIDEN NAME


OF MOTHER


Maria Minchielle


12 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


If STILLBORN, enter that fact hore


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


Domestic


8 BIRTHPLACE (City)


(State or country)


Italy


Crescenzo Hanet


10 BIRTHPLACE OF


FATHER (City)


(State or country)


Months


Days


X


If LESS than 1 day, _hrs. or __ min.


6 AGE


Years


77


4 COLOR OR RACE


21.


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Hidow


5a If married, widowed or divorced


HUSBAND of


(or) WIFE of


1 PLACE OF DEATH


2 FULL NAME


nunziata


Feb. 28, 1928


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH


(Approved by U. S. Cesous 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), 89 ds .; Bronchopneumonia (secondary), 10 da. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convul- sions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia,". "Weakness," etc., when & definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.


State cause for which surgical operation was undertaken.


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


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


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


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


A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registra- tion a standard certificate of death, stating to the best of his knowl- edge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ....- Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall bury a human body. . . until he has received a permit from the board of health or its agent. .. or. . from the clerk of the town where the person died ;. . . No such permit shall be issued until there shall have been delivered to such board, agent or clerk. .. a satisfactory written statement con- taining the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by 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.


R-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


State Mass


(City or town)


Registered No.


City or Town


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


2 FULL NAME


51 Harbor View ast,-


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


4 COLOR OR RACE


Ifute


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.


16 I HEREBY CERTIFY, That I attended deceased from -


19


., to


19


that I last saw h.


alive on


19


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


m.


The CAUSE OF DEATH was as follows:


Stile tour


6% months.


(duration)


_yrs ..


_mos ..


.ds.


CONTRIBUTORY (SECONDARY)


(duration)


_yrs.


mos. ds


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


@ Paku , M. D.


(Address)


Writtenof hear


Date


(Month)


25


1928.


(Day)


(Year)


13 ·Father Clifford From


Informant


(Address)


Winthrop Well and


(Cemetery)


(City or town)/


DATE OF BURIAL July 27/28


ADDRESS


19 UNDERTAKER


Walter J. White Waterline


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


Official position


Health officer


Date of issue 2/27/25 Permit NO 1371


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


instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH


PARENTS


10 BIRTHPLACE OF


FATHER (City)


I'M Vaterbury


(State or country)


11 MAIDEN NAME


OF MOTHER


Beatrice Bavili


Waterbury


12 BIRTHPLACE OF


MOTHER (City)


(State or country)


Coton


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


(Month)


24


1928 (Year)


(Day)


If STILLBORN, enter that fact here


Still Born


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


(b) Name of employer


Winstrol


8 BIRTHPLACE (City)


(State or country)


Miars.


9 NAME OF


FATHER


Clifford homme


No. Winthrop CommunityHunt


Baby Loomis


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


(a) Residence. No.


(Usual place of abode)


14


Filed


Mar. 8/28


(Month) (Day) (Year)


REGISTRAR


18 PLACE OF BURIAL, CREMATION OR REMOVAL


Wintheoffer-Whichuf


1 PLACE OF DEATH


County


Suffolk


Viel 241928 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. Aa 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 yra.). 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 da .; 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.




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.