Town of Winthrop : Record of Deaths 1928-1930, Part 106

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 106

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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, 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.

.... 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

STANDARD CERTIFICATE OF DEATH

State @Mass

(City or town)

Registered No.

112

City or Town Bernice Deldion

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

(a) Residence.

No.

94. Circuit Rd

(If/0) S War Veteran, specify WAR)

(Usual place of abode)

Length of residence in city or town where death occurred 20 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) Manid

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

Flora Nevers Sevill

6 AGE

Years

- 59 -

Months

Days

-6 -1- 21-

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. (b) Name of employer Telacroft Organ Lo Doingwell

Organ Salesman

8 BIRTHPLACE (City)

(State or country) quebec Ontario

9 NAME OF FATHER

Prin P. Venill

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

My Plement

11 MAIDEN NAME OF MOTHER

Flora Baldwin

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

Dufine Quebec

Quebec

200M 7-'28 No. 2787-c

13 Wife.

Informant

( Address)

94 lement Rd Winthrop Man

131.29

Filed (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

1929.

4qnth)

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from

, 19 ., to

nem

that I last saw hh alive on

July

, 19

3:300 .... . m.

natural Causes Cadably angina pectoris

(duration) 2 yrs. T .. mos. ds.

CONTRIBUTORY (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

What test confirmed diagnosis/

(Signed) Haymond B Parken , M. D.

(Address)

Written Broad Attacks

Date

July

22 1929

18 PLACE OF BURIAL, CREMAȚION, OR REMOVAL Winthrop Len (Cemetery) (City or town)

DATE OF BURIAL July 24/29 1

ADDRESS

19 UNDERTAKER

Walter J. Muito Withwhi".

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

Official positionex

Date of issue of permit.

7/23/21

Permit 16/5 .. No .....

information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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

LIVELY ILCALL UL

1 PLACE OF DEATH Suffolk

County

OUVinthrop

No.

94. Giraud Rd

St.,

2 -

Ward

2 FULL NAME

St., 2 Ward,

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

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

PARENTS

Pittsburg

Personal muestraget

July

21.1929. 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.

(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 "Asthe- nia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma. . "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.

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, 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 leceased, 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.

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.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Boston : City or town} 7172

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

WALTER H. PURDY

MASS.

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

No. 53 PARK

ave St.

(a) Residence.

State

(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

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

DELLA Slocum

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.

(b) Name of employer

ENGINEER

8 BIRTHPLACE (city or town)

UPPER CLEMENTS

(State or country)

N. 8.

9 NAME OF

FATHER

STILLMAN PURDY

10 BIRTHPLACE OF

FATHER (city or town)

UPPER CLEMENTS

(State or country)

N. S.

11 MAIDEN NAME

OF MOTHER

CYNTHIA MAC KENNA

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

N. S.

13 WIFE

Informant

(Address)

53 PARK AVE. WINTHROP

Filed

JUL 26 , 19

GUM Ilenen

Filed

July 31, 1929

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 22, 1929

(Month)

(Day)

(Year)

I HEREBY CERTIFY,

That I attended deceased from

JUL 15

29to.

JUL 22

that I last saw h

I Malive on

JUL 22

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

1 A

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

DIABETES MELLITUS AND COMA

(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

For what

Date of operation

Was there an autopsy.

YES

What test confirmed diagnosis

AUTOP SY

(Signed)

E. M. SMITH

(Address)

Date JUL 23, 1929

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

WINTHROP CEM WINTHROP

(Cemetery) (City or town)

19 UNDERTAKER

J. S. WATERMAN & SONS

DATE OF BURIAL 7-25 , 19

ADDRESS

No. 4312

Registered No.

(F nice of death)

183

City or town

Boston

No.

BOSTON CITY HOSPITAL

City or Town

WINTHROP

fully 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.

PARENTS

N. D.

July 22, 1929.

FORM R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Mass

(City or town)

-City or Town Winthrop

No.

State 911 Shirley It

Registered No.

St.,

Ward

(If death pcgurred in a hospital or institution, give its/NAME instead of street and number) Charles Brigham Comee

(a) Residence.

No ..

911 Shirley " )

St.

Ward,

(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

4 COLOR OR RACE

White

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

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

Othel C. Toute-

Months 4

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.

ED Manager Kurage Restaurante Cambridge

8 BIRTHPLACE (City)

(State or country)

Male

William P. Come

Gardner

Mass

alice Henry

Fairfield Vermont

13 Wife

Informant ( Address) 911 Thulyst Winthink

11 July 31. 29

Filed (Month) (Dạy) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

July 25 1929. ( Year)

( Month)

(Day)

16 I HEREBY CERTIFY, That I attended deceased from. July 2 1929, to July 25

1929.

that I last saw him alive on July 25 , 19 -7.

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

2:10 p. m.

Coronary thrombosis.

.mos ....

ds.

CONTRIBUTORY

(Secondary)

Pericarditis .yrs ...

Aduration)

.yrs ..

Pectoris .mos .. . ds.

17 Where was disease contracted if not at place of death no

Did an operation precede death

For what.

Date of operation

Was there an autopsy clinical

What test confirmed diagnosis.

(Signed)

Yacob

(Addr 6562 Alleley H, Cowithup, July 26/1429 Date

18 PLACE OF BURIAL, CREMATION, OR REMOYAL. DATE OF BURIAL LauralHill fermeture Tretchburg

( Cemetery) 1City or town il are 7/29-29

19 UNDERTAKER

Walter . J. Vi

ADDRESS

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

Um D. Children Official Mposition

legent

Date of issue . of permit 7/29/29

Permit .No .. 16/17

200M 7-'28 No. 2787-c

2 FULL NAME 3 SEX Male 6 AGE Years 52 9 NAME OF FATHER 10 BIRTHPLACE OF FATHER (City) (State or country) 11 MAIDEN NAME OF MOTHER 12 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) 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 is very important. See instructions and extracts from the laws on back of certificate. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (b) Name of employer

1 PLACE OF DEATH

County

Suffolk

(If Ų.]S. War Veteran, specify WAR)

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

Chaplin

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

(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 .; Bronchopneumania (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthe- nia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma. = "Convulsions," "Debility" ("Congenital," "Senile," etc. ), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," By "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 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.

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Town of Winthrop : Record of Deaths 1928-1930, Part 106

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

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