Town of Winthrop : Record of Deaths 1928-1930, Part 104

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 104

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FORM R-301 DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

Winthrop

BOSTON

1 PLACE OF DEATH

Suffolk

State Massachusetts

Registered No.

St., Ward

With death occurred in a hospital or institution, give its NAME instead of street and number) Udolph Sice el

(a) Residence.

No.

Cutter

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

St., Ward, Winthrop

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

Length of residence in city or town where death occurred 2 yrs. mos. days. How long in U. S., if of foreign birth ?(ors. mos. days.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE while

5 SINGLE, MARRIED, WIDOWED, or DIVORCED- {write the word) married

5a If married, widowred, er divorced HUSBAND of (or) WIFE of

Months

Days

IN LESS than

1 dạy.

.hrs.

or.

........ min

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work. Retired

(b) Name of employer

(State or country) Russia

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

abraham Siegel

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

13 Informant (Address) 36 Cutler 12.5

Filed 8 19. 000

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH July 10 1929

( Month)

(Day)

Year)

16 I HEREBY CERTIFY, That I attended deseased from. March 15, 1928 to July 9

that I last saw h.

alive on .. July 9 19

7 a m.

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

CONTRIBUTORY

(Secondary)

acute cardiac dilatati Cardia Cion) asthma. ds.

17 Where was disease contracted if not at place of death

Did an operation precede death No For what

Date of operation no

Was there an autopsy year ,

What test confirmed diagnosis

Signed)

(Address)

Date

18 PLACE OF BURIAL,/CANTON

Glace

DATE OF BURIAL FelwoburnJuly 121914 (CityVor town)

( Cemetery)

19 UNDERTAKER

ADDRESS Boston

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

W.S. Childreng

Official Hearthe officer

Date of issue of permit

7/10/29 Permit No.

16/1

0-20M.

County 2 FULL NAME 3 SEX Mall 6 AGE 67 9 NAME OF FATHER 11 MAIDEN NAME OF MOTHER PARENTS 14 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. N. B .- WRITE PLAINLI, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 8 BIRTHPLACE (City)

STANDARD CERTIFICATE OF DEATH

(City or town)

106

City or Town

Boston

No. 36 Cutler

(Usual place of abode)

Sadofely

200M 7-'28 No. 2787-c

Sarah ComoFly

thandical + laboratory Jacob alaugh. W. M. D. 562 Shirley St, Unthay July 10, 1929

July 1 0.1929.

Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Ass'n.)

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. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, es- pecially 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 ex- amples : (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 re- turn "Laborer," "Foreman," "Manager," "Dealer," etc., with- out 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 Housewife, House- work, 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 occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death .- Name, first, the Disease Caus- ing Death (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never report "Typhoid pneumonia") ; Lobar pneumonia; Bronchopneumonia ("Pneu- monia," unqualified, is indefinite) ; Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of.

," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," Iarasmus," "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 peri- tonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Associa- tion.)

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, mis- carriage, 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, aiter 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 de- ceased, 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 required by section one, where same was contracted, the dura- tion 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 ex- hume 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 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 suffi- cient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a mem- ber of the board of health, or employed by it or by the select- men for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by vio- lence, the medical examiner shall make such certificate. If the death certificate 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 state- ment and certificate, shall forthwith countersign .it and trans- mit 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 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.

No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the common- wealth 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.

FORM R-301

DIVISION OF VITAL STATISTICS The Commonwealth of Massachusetts Chelsea natifles STANDARD CERTIFICATE OF DEATH

Sincetheof

1 PLACE OF DEATH full County

State

Hase

(City or town)

10?

City or Town

No. 87 Upland Road

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

2 FULL NAME

Lamil H. Sullivan

(a) Residence.

No ..

90 letark ane leblanc

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

mos.

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

yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, or DIVORCED (write the word) Manud

5a. If married, widowed, or divorced HUSBAND of (OT) WIFE Of Kellie Lenger

6 AGE

Years

Months

Days

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work

Real estate

(b) Name of employer

Chelsea

8 BIRTHPLACE (City)

(State or country)

Krass

PARENTS

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

11 MAIDEN NAME

OF MOTHER

Mary Helst

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

13 Aus Nellie Sullivan Informant ) 9r telark au lehelera

14 Filed 2018 MAY (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Et July

1929

(Year)

(Month)

(Day)

16 I HEREBY CERTIFY, That I attended deceased from Sefir

1928, to

Lucas 12 0, 1929

that I last saw h lie alive on

1 July 12

1929.

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

Hermano Glucemia

(duration) 2 yrs ..

.mos. ds.

CONTRIBUTORY

Chr. Dianteira

(Secondary)

(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

Was there an autopsy

20000

What test confirmed diagnosis. Blood gram.

(Signed)

eplace, M. D.

(Address)

458 12nad way Chelder

Date Lucy 15-29-

18 PLACE OF BURIAL, CREMATION, OR REMOVAL Holyluca Malden (Cemetery) (City or town)

DATE OF BURIAL July 1>

19 UNDERTAKER

ADDRESS

John H. Halk Chelsea

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

I.S. Childress 4.8

Oficial Health Officer

Date of issue of permit. 7/12/29

Permit No .. 1012

9 NAME OF

FATHER

John Sullivan

200M 7-'28 No. 2787-c

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

Registered No.

Ward

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

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

4.456

IF LESS than 1 day . ....... hrs. or. ........... min. 2

Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Ass'n.)

Statement of cause of death .- Name, first, the Disease Caus- ing Death (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples : Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never report "Typhoid pneumonia") ; Lobar pneumonia; Bronchopneumonia ("Pneu- monia," 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, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example : Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 da. Never report mere symptoms or terminal conditions, such as "Asthe- nia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Convulsions," "Debility" ("Congenital," "Senile," etc. ), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition." "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 peri- tonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Associa- tion.)

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 de- ceased, 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 required by section one, where same was contracted, the dura- tion 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 ex- hume 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 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 suffi- cient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a mem- ber of the board of health, or employed by it or by the select- men for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by vio- lence, the medical examiner shall make such certificate. If the death certificate 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 state- ment and certificate, shall forthwith countersign it and trans- mit 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 only such persons as are supposed to have died by violence .- Gen. Laws, Chap. 38, Sec. 6.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Boston

(City or town)

1 PLACE OF DEATH

County

Suffolk

State

Registered No.

(Place of residence}

St.,

Ward

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

2 FULL NAME

JEREMIAH GREEN

(If in the Army or Navy of the United States, give ropk, organization pte.)

(a) Residence.

State

(Usual place of abode)

MASS

-City or Town

No.

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

& HUSBAND

Name of ? (or) WIFE

EMELINE U.

EMMALINE Beckett

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

RETIRED

(b) Name of employer

8 BIRTHPLACE (city or town)

(State or country)

IRELAND

9 NAME OF

FATHER

JOHN

PARENTS

10 BIRTHPLACE OF

FATHER (city or town)

(State or country)

IRELAND

11 MAIDEN NAME

OF MOTHER

ANN HARRINGTON

12 BIRTHPLACE OF

MOTHER (city or town).

(State or country)

IRELAND

13 Informant

EMMALINE GREEN

(Address)

9OHIGHLAND AVE. WINTHROP

Filed

JUL 23, 19

UM Seinen

Fil July -6, 19.

Registrar of city or town where death occurred

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

JUL 19. 1929

(Month)

(Day)

(Year)

I HEREBY CERTIFY,

29 to.

JUL 19

MAY 4

alive on

JUL 19

, 19.

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

7 P

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

CHRONIC MYOCARDITIS

(duration)

mos.

da.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs ..

mos

4 de.

17 Where was disease contracted

if not at place of death.

Did an operation precede death

For what

Date of operation

Was there an autopsy

What test confirmed diagnosis.

CLINICAL

(Signed)

L. H. WRIGHT

.M. D.

(Address)

Date JUL 19. 1929

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

CAMB. CEM. CAMB.

(Cemetery)

(City or town)

19 UNDERTAKER J. F. O'MALEY

DATE OF BURIAL

7-22

, 19

ADDRESS

L'o. 4312

Tuny Suppleu. 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.

Registered No.

7003

(Place of death)

City or town

Boston

No.

PETER BENT BRIGHAM HOSPITAL

WINTHROP

St.

Length of residence in city or town where death occurred

years

months

days.

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

years

That I attended deceased from

that I last saw h

BRONCHO PNEUMONIA

July 19, 1929.

RM R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County

Suffolk

State.lass

(City or town) 119

City or Town

Winthrop

No ..

24 Hawthorne Ave

St.,

Ward

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

2 FULL NAME

John J. Donovan

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

(a) Residence.

No ....

24 Hawthorne Ave

St., ................ Ward,

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

Length of residence in city or town where death occurred

yrs.

tmos.

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

yrs.

mos.

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED,

or DIVORCED (write the word).

Widowed

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Agnes B. Burns

G AGE

Years

Months

Days

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

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

particular kind of work.

Plumbing Supplies

(b) Name of employer

8 BIRTHPLACE (City)

(State or country)

Boston Mass

9 NAME OF

FATHER

Daniel P. Donovan

PARENTS

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

11 MAIDEN NAME

OF MOTHER

Cannot be Learned

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

13 David J. Donovan Informant 24 Hawthorne Ave

18 PLACE OF BURIAL, CREMATION, OR REMOVAL HoIghdod Brookline

(Cemetery)

(City or town)

DATE OF BURIAL

7/22/29.

14 July 21,29

REGISTRAR

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Town of Winthrop : Record of Deaths 1928-1930, Part 104

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

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