Town of Winthrop : Record of Deaths 1928-1930, Part 128

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 128

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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." "," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition,"

etc. ), "Dropsy,Mas ", "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.

7-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

State Massachusetts

Registered No.

City or Town

Fort Warren

Dostou No

ford Warren-

St ... Ward

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

2FULL NAME James A. Ward.

Sergeant Headquarters, Battery,9th C.A.

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

(a) Residence. No.

(Usual place of abode)

Fort Herren, Kass.,

(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 foreign birth? years months

days.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Single.

5a If married, widowed or divorced

HUSBAND of

(or) WIFE of

Sangle.

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

Soldier.

(b) Name of employer

U. S. Army.

8 BIRTHPLACE (City)

(State or country)

New York City,

New York.

9 NAME OF FATHER

10 BIRTHPLACE OF

FATHER (City)

(State or country)

1 1 MAIDEN NAME OF MOTHER

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

Informant

Rand of Fat Waren

(Address)

14 Filed Vec17.20

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Dec.

(Month)

(Đây)

{Year)

16 I HEREBY CERTIFY , That i attended deceased from

19 -, to 19

that I last saw h_ alive on 19

and that death occurred, on the date stated above, at. 11.41

7 eel over stair railun I was as follows : state ful landed on head, in Gall 1. Fracture, simple co ... inuted anterior fossa, involving orbital plate, fronta) bone And lesser wing of sphenoid, skull right.

(duration) ____ yrs.

mos.

ds.

CONTRIBUTORY

Hemorrhage subdual traumatic

(Secondary) severe, following rupture of middle cerebral artery, rightton)ducyto above injury. 1 7 Where was disease contracted if not at place of death

Did an operation precede death.

lio.

For what

Date of operation

Was there an autopsy

Yosv

What test confirmed diagnosis

(Signed)

Capt. M. C.,, M. D.

(Address)

Fort Banks, Kase.,

Date

December 9 1929.

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

tostadas

R. Y.

(Cemetery)

(City or town)

DATE OF BURIAL

12/11/19

19 UNDERTAKER

CR Wenn

ADDRESS

20 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued V.A. Childress Official position

Date of issue

Health Officer 12/11/29

Permit No.

it 1664

200.000. 9-26. NO. 6373

- 3 SEX ----- Male. 6 AGE PARENTS 13 plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. 50 Exact, statement of OCCUPATION is. very important. See instructions and extracts from the laws on back of certificate.

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County Suffolk Under Fait Bankas Winthrop

Bostori (City or town)

St.,

Ward

1929

White

.......... V.

(Approved by U. S. Census and American Public Health Association)

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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, etc. But in many cases, especially 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 examples: (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 return "Laborer," "Fore- man," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer-Coal mine, etc. Women at home, who are engaged in the duties of the household onty (not paid Housekeepers who receive a definite salary), may be entered as House- wife, Housework, 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 occupa- tion 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 Causing Death (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, 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 "Asthenia," "Anemia" (merely symp- tomatic), "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 peritonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)

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 causo of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, menin- gitis, miscarriage, 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 deceased, furnish for registra- tion a standard certificate of death, stating to the best of his knowl- edge 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 duration 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 therefroth 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 exhume 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 containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate 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 sufficient reasons, his certificate cannot be ob- tained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certi- ficate 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 statement and certificate, shalt forthwith counter- sign it and transmit 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 oniy such persons as are supposed to have died by violence .- Gen. Laws, Chap. 38, Sec. 6.

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

I R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Menthol

1 PLACE OF DEATH

County

Suffolk

State ...

No. 164 Kevin Rd

City or Town

Himy Burgess.

(If death occurred in a hospital or institution, give its NAME instead of street and number) 20 oreuts

(a) Residence.

No.

164 River Rd

St.,

............. Ward,

(Usual place of abode)

Length of residence in city or town where death occurred yr.

mos.

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

yTe.

mos.

dayı,

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

male

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED,

or DIVORCED (write the word)

manuel

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Eileen

en anden mccarthy none

Roberts

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

attorney

(b) Name of employer

at Law. Self

8 BIRTHPLACE (City)

(State or country)

Parslow

9 NAME OF

FATHER

Hillary W. Robsite.

PARENTS

11 MAIDEN NAME OF MOTHER Elizatsch-illeott. Roberts

12 BIRTHPLACE OF

MOTHER (City)

St- John . n. N.

(State or country)

Informant (Address)

WixE) Elleen. M. Roberts

1164 River-Road Winthrok

14 Filed De 19 %

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from Mar 18

19.7 ........

.. , to

December 8, 1924.

that I last saw him alive on

December

. 1929.

2.15 Am.

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

(apapery)

(duration)

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

High Blood Pressure

CONTRIBUTORY

(Secondary)

(duration)

...... yrs ..

....... mos ............. ds.

17 Where was disease contracted

if not at place of death

Did an operation precede death

200

For what.

Date of operation

200

Was there an autopsy

What test confirmed diagnosis.

Cincial Signs

(Signed)

N. L. C Brien. I.d.

, M. D.

(Address)

78 l'extinction Care

Date

18 PLACE-OF-BURIAL, CREMATION, OR REMOVAL

DATE OF BURIAL 12/10/29

(Cemetery)

(City or town)

19 UNDERTAKER

Char R. Benson

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!

Job. Couldree Oficio Healthe Officer

Date of issue Ht/12/9/21

Pormit No. 1660

CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact Statement Of DUVOTAZIONI is very important. See instructions and extracts from the laws on back of certificate.

200M 7-28 No. 2787-c .

(City or town)

Registered No. 170

St .. Ward

2 FULL NAME

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

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

1929

10 BIRTHPLACE OF

FATHER (City)

(State or country)

P.E.S. 5/ml

Somerget

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 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.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the Role 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 128

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

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