Town of Winthrop : Record of Deaths 1928-1930, Part 122

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 122

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(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 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.

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

ALFRED T. GARBUTT

(a) Residence.

State

MASS.

City or Town

TNTHRYOpthe United States, give rank organization, etc.)

No.

233

MAIN

St.

(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

Name of

S HUSBAND

? (or) WIFE

HELEN GENTLE

6 AGE

Years

Months

Days

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

If STILLBORN, enter that fart here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

PRINTER

(b) Name of employer

8 BIRTHPLACE (city or town)

(State or country)

ENGLAND

9 NAME OF

FATHER

ISAAC

10 BIRTHPLACE OF

FATHER (city or town)

(State or country)

ENGLAND

11 MAIDEN NAME

OF MOTHER

UNKNOWN

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

Informant

NORMAN W. GARBUTT

(Address)

232 MAIN ST. WINTHROP

Filed

OCT 28 ,19 29

ErMSlenen

Filed

Lo CC, 1929

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

OCT 25. 1929

(Month)

(Day)

(Year)

I HEREBY CERTIFY,

That I attended deceased from

OCT 16

OCT 25

that I last saw h

alive on

OCT 25

, 19.29

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

8 A

The CAUSE OF DEATH was as follows:

(State fully)

CARCINOMA OF SIGMOID AND OPERATION

THERFORE.

(duration).

yrs ..

mog

de.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs.

mos .- ds.

17 Where was disease contracted

if not at place of death

Did an operation precede death

YES

For what

ABOVE

Date of operation

OCT 22. 1929

Was there an autopsy

What test confirmed diagnosis

CLINICAL

(Signed)

C. A. POWELL

(Address)

Date

OCT 23, 1929

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

WINTHROP

(Cemetery)

(City or town)

19 UNDERTAKER

C. R. BENNISON

DATE OF BURIAL 10-28 29 , 19

ADDRESS

may be properly classified. Exact statement of OCCUPATION is very important. PARENTS

. 4312

Registered No.

9531

(Place of death) 155

City or town

Boston

No.

MASS. HOMEOPATHIC HOSPITAL

CHRONIC MYOCARDITIS

, M. D.

Registrar of city or town where death occurred

Oct. 25.1929.

may be properly classified. Exact statement of OCCUPATION is very important. PARENTS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

S HUSBAND

Name of ? (or) WIFE

AGAVNEY

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

RUG DEALER

(b) Name of employer

8 BIRTHPLACE (city or town)

(State or country)

TURKEY

9 NAME OF

FATHER

UNKNOWN

10 BIRTHPLACE OF

FATHER (city or town)

(State or country)

TURKEY

11 MAIDEN NAME

OF MOTHER

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

TURKEY

Informant

TAKON SOGOMONIAN

(Address)

9 VENNER RD. ARLINGTON

Filed

NOV 1, 19 20.10.M Hlenen

Filed

nov. 8. 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.

OCT 28, 1929

(Month)

(Day)

(Year)

I HEREBY CERTIFY,

MAY 26

19.29

OCT 28

that I last saw h

alive on

OCT 27

., 19

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

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

HEART (CORONARY THROMBOSIS)

(duration)

.mos

8 de.

CONTRIBUTORY

(SECONDARY)

(duration)

yTS ..

mos ..

.da.

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)

A. D. MAC LENNAN

M. D.

(Address)

Date

OCT 28, 1929

18 PLACE OF BURIAL, CREMATION, OR REMOVAL FOREST HILLS BOSTON

DATE OF BURIAL

10-30

(Cemetery)

(City or town)

, 19

19 UNDERTAKER

J. S. WATERMAN & SONS

. 4312

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Boston

(City or tovat

1 PLACE OF DEATH

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

ARAKEL

SOGOMONTAN

MASS.

City or Town

WINTHROP

No.

(If in the Army or Navy of the United States,

90 SHORE DRIVE

.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

Registered No .-

9685

(Place of death)

156

County

Boston

City or town

No.

ELIOT HOSPITAL

organizationetc.)

3 SEX

51 7

yrs.

That I attended deceased from

4 A

ADDRESS

11.5 52741212121 *出≥111421 1 1 6 品! ! Oct. 28.1929

R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop. (City or town)

1 PLACE OF DEATH

County

Suffolk

State Massachusetts Registered No.

City or Town

Winthrop

No. 76 Crest Ave

St.

Ward

2 FULL NAME

FarMie A.

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

(a) Residence.

No.

76 Crest Avenue

(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 temale

4 COLOR OR RACE

White

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

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Wallace M. Pendle

6 AGE

Years 66

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

At home.

(b) Name of employer

Concord

8 BIRTHPLACE (City) (State or country) New Hampshire.

9 NAME OF

FATHER

Edward Hillsgrove.

Concord.

10 BIRTHPLACE OF

FATHER (City)

(State or country)

New Hampshire.

11 MAIDEN NAME OF MOTHER Susan F. Hain maiden nam

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

Unable to obtain.

13 Wallace H. Pendle.

Informant

(Address)

76 Crest Avenue Winthrop

Filed (Month) (Day) (Year)

REGISTRAR

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

Win wo hildment .. position UH.

HO.

Date of issue of permit nor 1.29

DATE OF BURIAL November 2. 1929

(Cemetery)

(City or town)

19 UNDERTAKER Charles R. Bennison

Did an operation precede death For what.

Date of operation

Was there an autopsy.

What test confirmed diagnosis

(Signed)

M. D.

(Address)

Whit

Date

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

200M 7-'28 No. 2787-c

is very important. See instructions and extracts from the laws of back of certificate. PARENTS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Gut

3 1

1.20%

(Month)

(Day) (Year)

16 I HEREBY CERTIFY, That I attended deceased from.

that I Just saw h.C ....... alive on. 19

and that death occurred, on the date stated above, at 1) A The CAUSE OF DEATH was as follows: (State fully)

CONTRIBUTORY (Secondary)

(duration) .. yrs.

mos.

ds.

17 Where was disease contracted if not at place of death

(duration)

.yrs.

mos.

ds.

Blossom Hill. Concord, N.H

ADDRESS Winthrop Mass

Permit No. 1648

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

St., Ward,

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

unable to ob.

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 .; Bronchopneumonia (secondary), 10 da. 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.

EXTRACTS

FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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- inent and certificate, shall forthwith countersign it and trans- init 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.

-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

(City or town)

1 PLACE OF DEATH

County

Suffolk

State

Muss

Registered No.

St.,

Ward

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

2 FULL NAME

20 Winichina

(If 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.

dayı.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

White

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

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Clara. ED unico Covrex

6 AGE

Years

Months 5

Days

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work.

(b) Name of employer

Jorden Dexier 83001m

8 BIRTHPLACE (City)

nahand-

(State or country)

9 NAME OF

FATHER

Jumuer. Com

PARENTS

10 BIRTHPLACE OF

FATHER (City)

Wiefleur

(State or country) Cape Cod

11 MAIDEN NAME OF MOTHER Jerusha F. Brown

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Vreflech mass

200M 7-'28 No. 2787-c

Informant

(Address)

Mrs. Ciana. E. Cování

-12.21

Filed (Month) (Day) (Year)/

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

www.

1929.

(Month)

(Day)

(Year)

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

that I Jast saw h.k .......... alive on

1927

5:30 P.

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

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

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

Probably augina tetris.

CONTRIBUTORY

(Secondary)

(duration)

.yrs ...........

.mos.

ds.

17 Where was disease contracted if not at place of death

Did an operation precede death

100

For what.

Date of operation

Was there an autopsy 200

What test confirmed diagnosis.

Pasmal Investigation

(Signed)

(Address)

Winthough Brand of Health.

Date www. 5 1929.

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

(Cemetery)

(City or town)

19 UNDERTAKER Chas Ri verversen

DATE OF BURIAL 11/8/29

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 ..

Official .. position

Date of issue of permit

Permit No ..

It 649

City or Town Sam . Fizerman,

No.

St.,

.....

Ward,

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

(duration)

.. yrs.

.mos.

da.

M. D.

............

5.1924.

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.

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Town of Winthrop : Record of Deaths 1928-1930, Part 122

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

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