Town of Winthrop : Record of Deaths 1928-1930, Part 108

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 108

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that I last saw h

alive on

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

1 (Rear End Collision Jautomobi

· (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

For what

Date of operation

Was there an autopsy If under one year, was infant Breast Fed?

What test confirmed diagnosis

(Signed)

, M. D.

(Address)

Date

18 PLACE OF BURIAL, CREMATION, OR REMOVAL, Well, Genre

DATE OF BURIAL AUG 6 1929

(Cemetery)

(City or town)?

19 UNDERTAKER ManuelStoretely

Permit .No.

6 AGE 24 Years AGE should be stated EXACTLY. PHYSICIANS should state 8 BIRTHPLACE (City) (State or country) 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) 13 Informant ( Address) . 14 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. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK- THIS IS A PERMANENT RECORD. Every item of (b) Name of employer

STANDARD CERTIFICATE OF DEATH

(City or town)

117

2 FULL NAME

Rose Liber

26 Wave Way Owe

(a) Residence.

No ..

(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 ?

Mr. Liberman 26 Wave Way Que AUG 8 without

Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Asa'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., F'armer 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- " "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, atter 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 sufhi- 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.

ways write with ink.

CONNECTICUT STATE DEPARTMENT OF HEALTH TRANSIT PERMIT

No.

PERMIT OF LOCAL REGISTRAR

To remove a dead body for burial beyond the limits of the town in which death occurred, a transit permit

must be obtained from the local Registrar

Clase Lieber man

Aug 5 1989

me of Deceased

e, years

months

days.

Race or Color

automobile

use of Death (1) Fractured skull

Mer and collision ?

ending Physician Ralph N. Crane Julical

Address

examine

ce of Death. Darin Com

Embalmer

Jahres

No. 727

dertaker Thomas & Pritchard

Address Stanford Cium

The body has been prepared for removal and shipment in accordance with Rule. of the Rules and Regulations of the STATE PARTMENT OF HEALTH.

The Certificate of Death and the undertaker's statement that all proper measures have been taken to render the body harmless shipping, having been filed and recorded, PERMISSION IS HEREBY GRANTED FOR REMOVAL OF THE ABOVE NAMED DY,

Danke Com

TO Everett Maso

expres

Date of Shipment

Aug5-1929

at harhammond

Aug 5 1929

Registrar of

Danke Cour

m S-9 7-27-10M

EXTRACTS

Finale

Date of Death

Mits

(2) stating mell al

aug. 5. 1929.

CONNECTICUT STATE DEPARTMENT OF HEALTH Bureau of Vital Statistics

COPY

Medical Certificate of Death

1. Full name of deceased.

Rose .... Lieberman

2. Primary cause of death

Fractured Skull as

a result of rear

Duration

days

If death from violent cause state (1) means and nature of injury (2) whether accidental, suicidal or homicidal.

end collision f automobile striking truck at Darien Ct.

4. Secondary or contributory

August ... 5., .... 19.29

5. Duration

days

Remarks

viewed the deceased as Med. Exam

I certify that I attended the dec

XMaschilihess, and that the cause of death

was as above stated.

Signature

Ralph W. Crame M. D.

Med. Ex.

Capacity in which he signs

Dated.

August 5th

1929

Address ... Stamford .... Conn.

Undertaker's Certificate

1. Full name of deceased

Rose Lieberman

2. Place of death-Town

Darien

No.Post Road

Street,

Ward

If death occurred in hospital or institution, give its name instead of street and number.

3. Number of families in house.

4. Residence at time of death.

Winthrop

Mass.

5. Occupation

Stenographer

Town

State or Country

6. Condition (state whether single, married, divorced or widowed).

Single

7. If wife or widow, give name of husband

8. Date of death-year

1929

month

August

day

9. Date of birth-year

1905

month unknown

day unknown

10. Age in years

months

days

11. Sex ..

Female

12. Color

White

13. Birthplace-Town

Winthrop

State or Country

Mass.

14. Father's name in full

Max Liberman

15. Father's birthplace-Town

State or Country .... Russia

16. Mother's maiden name

Bertha Snider

Russia

Registrar.

I certify that this is a true copy of the certificate received for record.

anna 5. Com

Attest,

isst.

This Certificate received for record on the. ....... 5. day of August 19 29

J. A. F. MacCammond

Registrar. Place of Burial. Cemetery.

This copy of Certificate received for record at

this ........ day of 19

Registrar.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Rutland

City or town)

Registered No.

127

( Place of death)

Registered No.

(Place of residence)

St.,

Ward

2 FULL NAME

Ida Stevenson

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

(a) Residence.

State

Mass.

City or Town

Winthrop

No.

115 Toring Roadst.

(Usual place of abode)

Length of residence in city or town where death occurred

years 5

months : days.

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

years

months

day

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Female

4 COLOR OR RACE

bite

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

5a If married, widowed, or divorced

Name of & HUSBAND

2 (or) WIFE

Chester W.Stevenson

6 AGE

Years

Months 8

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

Housewife

(b) Name of employer

8 BIRTHPLACE (city or town)

Salem,

(State or country)

Mass.

9 NAME OF

FATHER

Malcolm J.McBride

10 BIRTHPLACE OF

FATHER (city or town)

Grove City,

(State or country)

Pa.

11 MAIDEN NAME

OF MOTHER

Bridget Ofalley

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

Iroland

Informant

From Sanatorium Records

(Address)

Filed \Llo.9

1920 Louis Mr. Stauff

Registrar of city or town where death occurred

19-

1 Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Aumust

(Month)

(Day)

(Year)

That I attended deceased from

I HEREBY CERTIFY,

Fcb. 15

19220, to.

August 8

that I last saw her

alive on

August S

19 29

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

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

6 :15 p.

Pulmonary tuberculosis

(duration)

mos

12 ds.

CONTRIBUTORY

(SECONDARY)

17 Where was disease contracted

if not at place of death

(duration)

yrs ..

mos.

ds.

Did an operation precede death

For what.

Date of operation

Was there an autopsy

What test confirmed diagnosis.

Xray & laboratory

(Signed)

William R. Davidson

M. D.

Date Mig. 8, 1929

18 PLACE OF BURIAL, CREMATION, OR REMOVAL Oak Grove, Vedford, Mass.

(Cemetery)

(City or town)

19 UNDERTAKER 1.E.Long & Son

DATE OF BURIAL

[I]. 11, 19 :? "

ADDRESS

Cambridge

No. 4312

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.

1 PLACE OF DEATH

County

worcester

State

Nass.

City or town

Rutland

No .-

Rutland State Sanatorium

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

1970

yrs.

PARENTS

(Address)

Rutland, Nass.

ung. 8.1927

ORM R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachuset's

STANDARD CERTIFICATE OF DEATH

BOSTON

1 PLACE OF DEATH County

Suffolk-

State Massachusetts Colorado

(City or town)

City or Town

Boston Mag V Bratran

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

2 FULL NAME

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

(a) Residence.

(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

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

8/13/29

( Month )

( Day) (Year)

16 I HEREBY CERTIFY, That I attended deceased from. 19 to

that I last saw h

alive on

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.

DECEASED Stenographer

(b) Name of employer

8 BIRTHPLACE (City) (State or country)

mass.

9 NAME OF FATHER

Max Bostorm

PARENTS

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

11 MAIDEN NAME OF MOTHER

Sweden Olan Fundotill

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

Leveden

Date

18 PLACE OF BURIAL, CREMATION, OR' REMOVAL

DATE OF BURIAL 18.24

( Cemetery ) ( City or town)

19 UNDERTAKER (S). Bennison

ADDRESS

14 Filed -) ...........

AUG 1 7 1929

REGISTRAR

(Month) , (Day) (Year)

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 position

Date of issue . of permit

Permit No. 3281

0-2011.

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

200M 7-'28 No. 2787-c

13 Martin Bostrom Informant ( Address) 1 Brother

"What test confirmed diagnosis

(Signed)

, M. D.

(Address)

(duration) Zamanqual Interestin Muuration) .. .. yrs. .. ¿s. .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 If under one year, was infant Breast Fed?

and that death occurred, on the date stated above, at The CAUSE OF DEATH was as follows: (Stafe-fully)) „m. Pulmonary later culosis

CONTRIBUTORYS (Secondary)

3 SEX Female Schuite Jungle

4 COLOR OR RACE

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

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

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

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

Registered No ... SprayWard

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

aug. 13.1929.

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.

(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,"" "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.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the wole 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.

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Town of Winthrop : Record of Deaths 1928-1930, Part 108

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

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