Town of Winthrop : Record of Deaths 1928-1930, Part 132

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 132

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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 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.

M 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 mass

Registered No 123

St.,

Ward

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

Lilla & Lance

(If U S. War Veteran, specify WAR)

No. 45 Circuit Road

Ward,

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

Length of residence in city or town where death occurred

17yrs.

tmos.

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

yrs.

mos. days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX Female Sq Lite

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

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

Charles & Lance

6 AGE

Years

Months

Days

JF 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)

mass

9 NAME OF FATHER

Washington Dill

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

Mitellklar

Derais

11 MAIDEN NAME OF MOTHER Lervig & Clay

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

200M 7-'28 No. 2787-c

Informant ( Address) 137 flow of Roud When

14 JAN - 3 1930

Filed (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

Dic

26 1929

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY, That I attended deceased from. IN 11, 1929 to Dvc 26

that I last saw hee

alive on

Sc 26

and that death occurred, on the date stated above, at. 11

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

angina Pectoris

(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 120

What test confirmed diagnosis

(Signed)

Raymond B Parker

M. D.

(Address)

Winthrop mars

Date

1929

PLACE OF BURIAL, CREMATION, OR REMOVAL 18

DATE OF BURIAL

(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

V.A. Childr og ia Health Officer

Date of iąsue 12/26/29

Permit .No .. 1667

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.

City or Town

No. Win Come Atas

2 FULL NAME

(a) Residence.

(Usual place of abode)/

4 COLOR OR RACE

angina CE

Charlestrivi

PARENTS

Personal. Observación

Dec 29, 1429

26. 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.

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. 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.

...

A R-301

1 3 SEX Male HUSBAND of (or) WIFE of 7 AGE 56 OCCUPATION 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 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. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. D .- WRITE PLAINLY, WITH UNFADING BLACK INA -- THIS IS A PERMANENT RECORD. Every item of (State or country) 200M-11-'29. ' No. 7180-a

PLACE OF DEATH

Suffolk (County)

Winthrop (City or Town)

No. Winthrop Community Hospital

Ward

give its NAME instead of street and number)

2 FULL NAME

James Darrell Foster

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(a)

Residence. No ..

100 tremont

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?

JTs.

mos. days.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

Die

(Month)

(Day)

19 29 (Year)

19 I HEREBY CERTIFY, That I attended deceased from

Der

I last saw ho ....... alive on

. 1929, death is said

to have occurred on the date stated above, at.

11 P. m.

The principal cause of death and related causes of importance in order of onset were as follows:

Dateofonset

14 mg

Contributory causes of importance not related to principal cause:

Name of operation

Date of

What test confirmed diagnosis?

Was there an autopsy ?.........

20 Was disease or injury in any way related to occupation of deceased? If so, specify.

(Signed)

, M. D.

(Address).

Date'

420

19 -7

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Winthrop

DATE OF BURIAL

December 31.

19 29.

22 NAME OF

UNDERTAKER

Charles R. Bennison

ADDRESS

Winthrop. Mass

Received and filed

JAN - 3 mm?

A TRUE COPY, ATTEST:

(Registrar)

(Official Designation)

(Date of Issue of Permit)

(write the word)

Married

5a If married, widowed, or divorced Lola Forbes

Gardner

(Give maiden name of wife in full)

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

Years

Month

Days

If less than 1 day

Hours

Minutes

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.

Owner of

9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.

Winthrop Garage

10 Date deceased last worked at

this occupation (month and

year) November. 1929

11 Total time (years)

spent in this

occupation

12 BIRTHPLACE (City)

Halifax

(State or country)

Nova Scotia.

13 NAME OF

FATHER

Unable to obtain.

14 BIRTHPLACE OF

FATHER (City) .

. .

17 hola F. G. Foster.

Infer

(Address)

100 Fremont St.

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: N. c.D. Childress

Signature of Agent of Board of Health or other)

Health Officer

12/31/29

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

Winthrop (City er town making return)

Registered No (If death occurred in a hospital or institution,

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

(If nonresident, give city or town and state)

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(Cemetery)

(Gity or town)

Revised United States Standard Certificate of Death

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.

To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation ..

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store, "

"" factory. ". "mill." etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotion mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

Statement of cause of death .- Cause of death means the disease, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contri- butory causes of importance not related to principal cause, name other important diseases or injuries.

Example

The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis

Date of onset

1915

Chronic interstitial nephritis

1931

Cerebral hemorrhage

July 5, 1927

Contributory causes of importance not related to principal cause : Fracture of arm

Automobile accident

May 3, 1927

In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.

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 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 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 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 exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, 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 satis- factory 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 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 sufficient reasons, his certificate cannot be obtained 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 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 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 only 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 ceme- tery or burial ground in which the interment is made .. . Chap. 114. Sec. 46, G. L., as amended.

State cause for which surgical operation was undertaken.

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.

M R-301

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County Suffolk

State

Mass

Registered No

St.

Ward

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

2 FULL NAME Elias A. Malone

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

(a) Residence.

Lincoln St

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.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

Male

white

5 SINGLE, MARRIED, WIDOWED,

or DIVORCED (write the word)

Married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE

Helena M, Peers

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, orCommission Merchant particular kind of work. (b) Name of employer

8 BIRTHPLACE (City)

(State or country)

Nova Scotia

PARENTS

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

11 MAIDEN NAME

OF MOTHER

Debora

Chetwynd

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

200M 7-'28 No. 2787-c

Informant Mrs. H.M. Malone

( Address)

9 Lincoln St.

Filed (Month Alpan Great)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

12/28

(Month)

(Day)

19mg

(Year)

16 1I HEREBY CERTIFY, That I attended deceased from

Den 28

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)

un father

(duration)

3 yrs. 6 mos.

. 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.

Juntala

Date of operation

1427

Was there an autopsy.

What test confirmed diagnosis.

(Signed)

M. D.

(Address)

Date

11/28/24

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Woodlawn

Everett

DATE OF BURIAL 12/30/29

(Cemetery)

(City or town)

ADDRESS 19 UNDERTAKER John & O Ialy Minthoh

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

W.A. Childrossial /health Officers

Date of

permit 12/30/24

Permit No .... 1669

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.

(City or town);

City or Town.Winthrop

No 9 Lincoln St

(Usual place of abode)

1.30%

.m.

9 NAME OF

FATHER

Henry

Lec, 28. 1929

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

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Town of Winthrop : Record of Deaths 1928-1930, Part 132

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

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