Town of Winthrop : Record of Deaths 1928-1930, Part 126

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 126

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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

Chelsea

(City or town)

687

Registered No.

(Place of death)

Registered No.

(Place of residedce.

St.,

.Ward

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

(a) Residence.

State

(Usual place of abode)

City or Town

Winthrop

No.

463 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

months

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

Name of

Louise E. Gallagher

6 AGE

Years

Months 2

Days

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

If STILLBORN. enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

Gate Tender

particular kind of work

(b) Name of employeBoston, Revere Beach & Lynn

R.R.

8 BIRTHPLACE (city or town)

Co.Galway

(State or country)

Ireland

9 NAME OF

FATHER

Martin O'Connor

PARENTS

10 BIRTHPLACE OF

FATHER (city or town)

(State or country)

Ireland

11 MAIDEN NAME

OF MOTHER

Nathalie Perkins

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

Ireland

13 Hospital Records

Informant

(Address) Soldiers' Home Hosp. Chelsea

Filed

Dec. 3, 129

Fil 16023, 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

December

1, 1929

(Month)

(Day)

(Year)

I HEREBY CERTIFY,

That I attended deceased from

April

Dec.

that I last saw him

alive on

Dec. 1,

19.

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

5.30

A. m.

The CAUSE OF DEATH wa . as follows: (State fully)

Cardio-renal Disease

(duration)

yrs.

mos.

de.

CONTRIBUTORY

(SECONDARY)

(duration)

yr's.

mos

17 Where was disease contracted

if not at place of death.

Did an operation precede death.

For what

Date of operation

none

Was there an autopsy

What test confirmed diagnosis

(Signed)

M.G. Odian

(Address)

Soldiers' Home Hosp.

Date

Dec. 1, 1929

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Calvary

Boston

(Cemetery)

(City or town)

19 UNDERTAKER

John F. O'Maley

DATE OF BURIAL

Dec. 3,

. 19

ADDRESS Winthrop

1 PLACE OF DEATH

County

Suffolk

State

Mass.

City or town

Chelsea

No.

Soldiers' Home Hosp.

2 FULL NAME

Patrick J. O'Connor

Mass.

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

§ HUSBAND

2 (or) WIFE

, M. D.

Dec. 1.1929.

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

Medical Examiner's Certificate of Death

Boston (City or town)

1 PLACE OF DEATH

(ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)

County

Suffolk

State

Registered No. 10732

(Place of death)

( Place of residence)

City or Town

Boston

No.

BOSTON OR WINTHROP

St ..

Ward

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

2 FULL NAME

RALPH ... E .... EVANS

43 LOCUST ST.

St.

Ward.

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

Length of residence In city or town where death occurred

years

months

days

How long in U. S., If of toreign birth?

years

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (aprite the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

BEATRICE

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

LAWYER

(b) Name of employer

8 BIRTHPLACE (city or town)

SWEDEN

(State or country)

MAINE

9 NAME OF FATHER

CHARLES M.

PARENTS

10 BIRTHPLACE OF FATHER (city or town) (State or country) SWEDEN, MAINE

11 MAIDEN NAME OF MOTHER

NETTIE R. CROUSE

12 BIRTHPLACE OF MOTHER (city or town)

(State or country)

BRIDGEWATER, N. S.

Informant

BEATRICE EVANS

(Address)

13 LOCUST ST. WINTHROP

Filed ..

DEC 7, 19 29ENUMSlenen

Registrar of city or town where death occurred

Filed 17. 19 ,19 29

Registrar of city or town where deceased resided

NATURAL CAUSES -- RHEUMATIC FEVER

(ACUTE) DIED IN AMBULANCE FROM

... HIS-HOME TO MASS. GENERAL HOSPITAL

(See reverse side for additional space)

17 Where was injury sustained

if not at place of death ?

(Signed)

GEORGE BURGESS MAGRATH

(Address)

BOSTON

Medical Examiner for

SUFFOLK

Date

DEC ..... 3. ... 1929

(Month)

(Day)

(Year)

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

WINTHROP, WINTHROP

DATE OF BURIAL T2-5-29 (Month) (Day) (Year)

19 UNDERTAKER

F. E. BROWN

ADDRESS

20 Burial permit issued by

Official position

21 Date of issue

EB0 454

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH.

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof

Grant are as follows :

6 AGE

Years

Months 1

(a) Residence. No.

(Usual place of abode)

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

WINTHROP MASS

Registered No.

10732

M.D.

Dec. 2. 1929.

301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

theray.

BOSTON

1 PLACE OF DEATH

County

Suffolk

State

Massachusetts

Registered No

City or Town

Boston Winthrop

No.

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

2 FULL NAME

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

(a) Residence.

No.

29 Jats, BE

.. 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

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED,

or DIVORCED (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 AGE

Years

Months

Days

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

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

(State or country)

9 NAME OF

FATHER

PARENTS

Informant

( Address)

27 Jake 72.

14 Acc- 17 29

Filed (Month) (Day)' (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

December 4 1929

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from

January 5, 1928, to

dec. 4

19 29

that I last saw him alive on Dec. 4 19 2%

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

6:10 0 .m. Broncho- pneumonia

(duration)

yrs.

mos ..

ds.

(Secondary)

(duration)

.. yrs ...

.......

mos.

ds.

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

Did an operation precede death.

For what.

Date of operation

nine

une

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

(Signed) Jacob

Ubrania M.D.

M. D.

(Address) 362 Slunley Street, Winthrop

Date December 5/29.

Mais

18 PLACE OF BURIAL, CREMATION; OR REMOVAL

DATE OF BURIAL

M. Hope

(Cemetery)

(City or town)

19 UNDERTAKER

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.

Un-W. Childrens Official

position

agent

Date of issue Of permit 12/5/29

Permit No.

165 6

STANDARD CERTIFICATE OF DEATH

(City or town)

St.,

.Ward

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

CONTRIBUTORY

Quanition

Ismechron.

10 BIRTHPLACE OF

FATHER (City)

(State or country)

11 MAIDEN NAME

OF MOTHER

Sicher. trawy

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Brookline. that's.

200M 7-'28 No. 2787-c

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," "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. 88, 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.

R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

...

(City or towny

Registered No. St.,

Ward

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

2 FULL NAME

12 jefferson

St., .Ward,

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

Length of residence in city or town where death occurred __ yrs.

mos.

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

mos.

dayı.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX female

4 COLOR OR RACE

White

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

5a If married, widowed, 47 divorwed

HUSBAND OF

(or) WIFE of

Samuel

Sales

6 AGE

Years 76

Montha 5

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

at Home

andone

8 BIRTHPLACE (City)

(State or country)

Cupland

9 NAME OF

FATHER

Henry Chaffelle

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

11 MAIDEN NAME

OF MOTHER

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

13 Mus. R. S. Cummings

Informant (Address) /60 Engenie and Hammota. 4.4

Filed / Jan 17 20

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

De5, 1924-

(Month)

(Day)

( Year )

16 I HEREBY CERTIFY, That I attended deceased from.

Mar- 24, 19201, to Alle 5

1927.

that I last saw

alive on ...

Que. 5,

19.

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

(duration)

.. yrs ....

.mos.

de.

CONTRIBUTORY

(Secondary)

2 yra

(duration)

............. m08.

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. Ar Villard Com

(Signed)

M. D.

(Address)

Date/ vie. 0,1429-

18 PLACE OF BURIAL, CREMAT'ON, OR REMOVAL

Forest Lawn. Buffalo n.Y

(Cemetery)

(City or town)

DATE OF BURIAL 12/ 8/29

19 UNDERTAKER C. R. Benun

ADDRESS wortht

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

iol realtà oficer position

Date of issue _of permit 12/6/29

Permit Ne 1657

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

200M 7-'28 No. 2787-c

1 PLACE OF DEATH

County

State Muss

City or Town

Whichnot

No 12 Jefferson

Lignes. Mamanna

Moty Sakes

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

(a) Residence.

No.

(Usual place of abode)

anderen

2,00

€ / m.

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 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," "Ileart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all discases 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

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Town of Winthrop : Record of Deaths 1928-1930, Part 126

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

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