Town of Winthrop : Record of Deaths 1928-1930, Part 136

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 136

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(Address)

Carrie E. Carpenter.

180 Somerset Ave.

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

ignature of Agenda of Board of Health or other)

Health officer

1/15/01

(Official Designation (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

January

1930.

(Month)

19.

I HEREBY CERTIFY

o 29, to Summary 12 1930

Hemmary 12, 19 30, death is said

to have occurred on the date stated above, a

06:45JR.

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

Dateofonset

Clironic Interstitial Leplentes 1928

Contributory causes of importance not related to principal cause: Senility.

Name of operation

none

Zio

20 Was disease or injury in any way related to occupation of deceased?

If so, specify

Jacobo always h. W.

(Signed)

, M. D.

Date June 13 19.30.

21 PLACE OF BURIAL,

CREMATION OR REMOVAL forest Hill

fitchburg Mass (City er-town)

DATE OF BURIAL

January 15

19.3.0.

22 NAME OF

UNDERTAKER

Charles R. Bennison

ADDRESS

Winthrop, Mass.

Received and filed

Jan. 24

19 30

A TRUE COPY, ATTEST: (Registrar)

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

200M-11-'29. No. 7180-a

No.

Winthrop (City or Town) 180 Somerset Ave

St.

Ward

(If U. S.

War Veteran,

specify WAR)

(Day) (Year) That I attended deceased from Jily 6

Vlast saw her alive on

If less than 1 day

OCCUPATION.

Chesterfield.

: Date of

What test confirmed diagnosis? Clinical X was there an autopsy?

(Cemetery)

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, cotton 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 merchanis 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 contr :- 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

1921

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.

.... 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 ceme- tery or burial ground in which the interment is made .. . Chop. 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.

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

200M-11-'29. No. 7180-a

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wax. S. Children

Health office

(Signature of Agent of Board of Health or other)

1/5/80

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

(Year)

DEATH

tam

13, 95

(Day)

(Month)

19 I HEREBY CERTIFY, That i attended deceased from June Giv 14 1926, to A/d. 18, ., 19. 30.

1 last saw

b. Or alive on

, 1920 death is said to have occurred on the date stated above, at /0-30 Pm. 1

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

Dateofonset

Interio-acuraand

Frank, 26

Contributory causes of importance not related to principal cause:

Ener 1229

Name of operation bine-

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)

(Address)

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

(Cemetery)

& Weymouth

(City- town)

DATE OF BURIAL

January

19.3.00.

22 NAME OF

UNDERTAKER

ADDRESS

Charles I Berusou

Truthrop

mars.

Received and filed

1930

A TRUE COPY, ATTEST: (Registrar)

5a If married, widowed, or divorced HUSBAND of

(or) WIFE of

George

(Give maiden name of wife in full)

Luissel

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

AGE

Years

Months

Days

If less than 1 day

Hours

Minutes

OCCUPATION

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

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

10 Date deceased last worked at

11 Total time (years)

spent in this

occupation

this occupation (month and

year)

way out

12 BIRTHPLACE (City)

(State or country)

13 NAME OF

FATHER

Johnathan Robbins

14 BIRTHPLACE OF

FATHER (City) .

(State or country)

man

15 MAIDEN NAME

OF MOTHER

Paloma - L'eau

16 BIRTHPLACE OF

MOTHER (City)

(State or country)

Informant

(Address)

332 Plecat St Wuste

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

(City or town making return)

Registered No. 10

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

Ruth, Emily Numele

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

(a)

Residence.

No.

332 /Gerade

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)

2 FULL NAME

PLACE OF DEATH

(County)

(City or Towny

No. 332

(Robbin)

Ward

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

(If nonresident, give city or town and state)

.. , M. D.

,90

301

Revised United States Standard Certificate of Death

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, cotton 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

1015

Chronic interstitial nephritis

1921

Cerebral hemorrhage

July 5, 1927

Contributory causes of importance not related to principal cause :

Fracture of arm

Automobile accident

May 3, 1927

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall 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 .- Chop. 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.

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.

-301

PLACE OF DEATH

Suffolk (County)

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,

give its NAME instead of street and number)

2 FULL NAME

Ellen (Stewart) Mac Kenzie

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

(a)

Residence. No.

91 Hermon

.St., ..........

, Ward,

(Usual place of abode)

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

days.

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

yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

female

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

Widow.

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

(Give maiden name of wife in full)

John Mac Menzle

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

AGE

Years

Months

.Days

If less than 1 day Hours Minutes

OCCUPATION|

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.

10 Date deceased last worked at

this occupation (month and

year)

11 Total time (years) spent in this occupation.

12 BIRTHPLACE (City)

(State or country)

Cape Breton, Nova Scotia.

13 NAME OF

FATHER

Archibald Stewart.

14 BIRTHPLACE OF

FATHER (City) ..

Edinborough,

Scotland.

15 MAIDEN NAME

OF MOTHER

Annie Nicholson.

16 BIRTHPLACE OF

MOTHER (City)

Glasgow

(State or country)

Scotland.

17 MRS : ANNIE CAMPBELL

Informant (Address)

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Man. D. Childress (Signature of, Agent &f Board of Health or other) Heabilo oficir 1/18/30

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

Jan

15-

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

pam

1930, to

Jan 15

193.0

I last saw h.A .__ alive on 14, 193 0, death is said to have occurred on the date stated above, at 5 140Ce m. The principal cause of death and related causes of importance in order of onset were as follows: Rente myocarditis

Dateofonset 1/12/30

Contributory causes of importance not related to principal cause:

Laguffe - Bronchitisciente

1/3/30

Name of operation

Date of

Was there an autopsy?

What test confirmed diagnosis?

Chcial.

20 Was disease or injury in any way related to occupation of deceased?

If so, specify

TP w hay ton

. M. D.

(Address )

winthrop

Date 1/ 16

19:30

21 PLACE OF BURIAL,

Winthrop, Winthrop.

GREMATION OR REMOVAL

DATE OF BURIAL

January 18

19:30

(Cemetery)

(City of town)

22 NAME OF

UNDERTAKER

Charles P. Bennison

ADDRESS

Winthrop

Mass .

Received and filed

19 30

A TRUE COPY, ATTEST: (Registrar)

200M-11-'29. No. 7180-a

Winthrop

(City of Town)

91 Herman St.

No.

St .,

Ward

(If U. S.

War Veteran,

specify WAR)

(If nonresident, give city or town and state)

1929

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

St Peters.

(State or country)

(Signed)

Revised United States Standard Certificate of Death

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, cotton 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.

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Town of Winthrop : Record of Deaths 1928-1930, Part 136

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

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