Town of Winthrop : Record of Deaths 1928-1930, Part 129

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 129

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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.

I R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

1 PLACE OF DEATH /11.uk

County

State

Registered No.

City or Town

No. 62 Please

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

2 FULL NAME

(a) Residence.

No.

162 Pleasant

St.

Ward,

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

( 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 ØR RACE

While

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

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

6 AGE

Years 20

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

amore Warnock

PARENTS

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

11 MAIDEN NAME OF MOTHER

Martha Warnock

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

200M 7-'28 No. 2787-c

Informant ( Address)

12. 29

Filed. ........... (Month) (Day) (Year)

REGISTRAR

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

N.D. Children5

position

Heads Office

DATE OF BURIAL

(Cemetery )

Cambrid [City or town)

19 UNDERTAKER Ci

ADDRESS

Dermit 2/9/29 No

Permit 1661

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

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Day)

1929

(Year)

16 I HEREBY CERTIFY, That I attended deceased from

.. , 19 29. to ser 8 19 24.

that I lact saw It ............ alive on 19 29

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

(duration)

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

- mos.

.ds.

Cerebral hamburga

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

200

Was there an autopsy

What test confirmed diagnosis.

Clinical

(Signed)

M. D.

(Address)

123 UnciationST.

Date

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

250 0

Norton

STANDARD CERTIFICATE OF DEATH

(City or town)

St., Ward

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

alle Date of issue

dopourJojus

Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Ass'n.)

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, es- pecially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As ex- amples : (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never re- turn "Laborer," "Foreman," "Manager," "Dealer," etc., with- out more precise specification, as Day laborer, Farm laborer, Laborer-Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, House- work, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus : Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death .- Name, first, the Disease Caus- ing Death (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never report "Typhoid pneumonia") ; Lobar pneumonia; Bronchopneumonia ("Pneu- monia," unqualified, is indefinite) ; Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of

(name origin; "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example : Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthe- nia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc. ), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peri- tonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Associa- tion.)

Bronchopneumonia: If primary cause,

write the word "primary"; if secondary, give primary cause.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the de- ceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the 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.

PINOUS

IR-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Winthrop. (City or town) \

1 PLACE OF DEATH

County

Suffolk

Sta

Massachusetts

Registered No.

City OF Town

Winthrop

No. 311 Prospect Ave St,

Ward

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

2 FULL NAME

Joseph Francis Donohue

(a) Residence.

No.

31 Prospect Ave

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 ?

yrs.

mos.

dayı.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED,

or DIVORCED (write the word)

Married.

5a If married, widowed, or divorced

HUSBAND of

for) WIFE of

Susan Ball

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

Retired.

(b) Name of employer

8 BIRTHPLACE (City)

Boston.

(State or country)

Massachusetts.

9 NAME OF

FATHER

Unable to obtain.

PARENTS

11 MAIDEN NAME

OF MOTHER

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

13 Sarah L. Ball.

Informant

(Address)

31 Prospect Are.

14 Dec 17, 2g

Filed (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

December 9 1929

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from.

December y 1929,

December 9

1929

that I last saw

hun alive on

December 9, 1929.

9:05 a:

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

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

Central hemorrhage

(duration)

ds.

CONTRIBUTORY

(Secondary){

) Replication

.. yrs.

mos.

ds.

17 Where was disease contracted

if not at place of death

Did an operation precede death

For what.

Date of operation

Inne

Was there an autopsy

What test confirmed diagnosis ..

(Signed)

Jacob Schram Mi 0

M.D.

(Address)

Date

Dec. 9/29

Mais

18 PLACE OF BURIAL, CREMATION, OR REMOVAL Winthrop

Winthrop.

DATE OF BURIAL Pzc. 12. 1924

(Cemetery)

(City or town)

(19 UNDERTAKER harles P. Bennison usou

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

U.S. Children Oficio

position

Heatice Officer

Date of issue ... of permit 12/10/29

Permit No. 166.2

CAUSE OF DEATH in plain terms, so that it may be properly classified. Badet platcielly of Oudes ALIval is very important. See instructions and extracts from the laws on back of certificate.

200M 7-'28 No. 2787-c

(Usual place of abode)

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

Clinic Interstitial

.yra ..........

10 BIRTHPLACE OF

FATHER (City)

(State or country)

clinical + datastory

a pinoys Dy peuddns Kung

Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Ass'n.)

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 : Mcasles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthe- nia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma." "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peri- tonitis," etc.

State cause for which surgical operation was undertaken.

( Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Associa- tion. )

Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.

EXTRACTS

FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .- Gen. Laws, Chap. 38, Sec. 6.

.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known : otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Boston

1 PLACE OF DEATH

County

Suffolk

State

Registered No.

(Place of residence!

St.,

Ward

2 FULL NAME

MASS.

City or Town

WINTHROP

-No.

169 RIVER RD

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

S HUSBAND

Name of ? (or) WIFE

MARY- Landy

G AGE

Years

Months

Days

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

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

FURNITURE DEALER

8 BIRTHPLACE (city or town)

(State or country)

RUSSIA

9 NAME OF

FATHER

SOLOMON CANNER

10 BIRTHPLACE OF

FATHER (city or town)

(State or country)

RUSSIA

11 MAIDEN NAME

OF MOTHER

MARY FINE

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

RUSSIA

Informant

CARL CANNER

210 BABCOCK ST. BROOKLINE

(Address)

Filed

DEC 14, 19 29ENUMSlenen

Filed

Dec. 17, 129.

Registrar of city or town where death occurred

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

DEC 11

1929

(Month) (Day)

(Year)

I HEREBY CERTIFY,

NOV 30

That I attended deceased from

DEC HI

that I last saw h

alive on

DEC 11

1929

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

6 P

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

BRONCHO PNEUMONIA

(duration)

yIS ..

mos.

ds.

CONTRIBUTORY

PULMONARY EDEMA

(SECONDARY)

(duration)

yrs.

mos.

17 Where was disease contracted

if not at place of death

Did an operation precede death

For what

Date of operation

Was there an autopsy

What test confirmed diagnosis.

PHYSICAL EXAMINATION

(Signed)

-G. MENARD

, B. D.

(Address)

Date

DEC 11, 1929

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

OHEL JACOB. WOBURN

(Cemetery)

(City or town)

DATE OF BURIAL

12-12

, 19

19 UNDERTAKER

J. H. LEVINE

ADDRESS

may be properly classified. Exact Statement of OCCUPATION IS very important. PARENTS

812

Registered No .- City093'1

( Place of death) 182

City or town

Boston

No.

N. E. BAPTIST HOSPITAL

BENJAMIN S. CANNERcurred in a hospital or institution, give its NAME instead of street and number)

(a) Residence.

State

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

yee

11.1929,

------...

......

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

(City or town)

Registered No.

106

(Place of death) 789 8

Registered No.

(Place of residence

St., Ward

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

(If in the Army or Navy of the United States, give rank, organization, etc.3

City or Town Wanthet _No. Hant Banks, St.

(a) Residence.

State

(Usual place of abode)

Length of residence in city or town where death occurred

years 11 months O

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)

Single

5a If married, widowed, or divorced

§ HUSBAND

Name of ? (or) WIFE

6 AGE

Years

Months 0

Days 8

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.

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Town of Winthrop : Record of Deaths 1928-1930, Part 129

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

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