Town of Winthrop : Record of Deaths 1928-1930, Part 158

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 158

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PLACE OF DEATH

Julfolk (County) Of Winthrop

(City or Town) 306 Revere

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

(City or town making return)

Registered No.

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

2 FULL NAME

Henry Reid Henderson

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

specify WAR)

(a)

Residence. No ..

306 Revere S

St.,

Ward,

(Usual place of abode)

Length of residence in city or town where death occurred 30 yrs.

mos.

days .

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

yrs.

mos. days.

18 DATE OF

DEATH

april

16. 1930:

(Day)

(Month)

(Year)

19 /I HEREBY CERTIFY, That I attended deceased from February 15 1930, april 16 1930

I last saw him alive on april 95, 1930, death is said to have occurred on the date stated above, at 150m The principal cause of death and related causes of importance in order of onset were as follows: Cerebral tremoshagen

Datepfonget 1/10/29

Contributory causes of importance not related to principal cause: (internacionais

Garancia Interstitial heplantas.

Name of operation

none

... Date of What test confirmed diagnosis Imucil was there an autopsy? 20

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

If so, specify.

(Signed)

(Address 62 Shirley It Wrutlemp

Date 9/16/2019

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Winthrop - Winthrop

(Cemetery)

(City or towny

19307

, M. D.

No.

St.,

Ward

(If U. S. War Veteran,

(If nonresident, give city or town and state)

PERSONAL AND STATISTICAL PARTICULARS

aper

16. 19.30 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 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 discase, 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

1021

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 .- 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.

... 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.

200.000. 9-26. NO. 6373 -

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County Suffolk.

notifies

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

State Masschusetts

(City or town) Registered No. 74

St. Ward

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

2FULL NAME

Billings, Charles.

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

Ka) Residence. No.

303 Washington, St. Brighton, Mass ._ 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

years

months

days.

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

years

months

deys.

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 of

(or) WIFE of

6 AGE

Years

Months

Days

IF LESS than

1 day, ........ hrs.

or ........ min.

· IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

· particular kind of work

Retired Soldier

(b) Name of employer

U.S.Army.

·BIRTHPLACE (City)

Boston,

(State or country)

Massachusetts

PARENTS

10 BIRTHPLACE OF

FATHER (City)

York

(State or country)

Maine

1 1 MAIDEN NAME

OF MOTHER

Mathea Palmer :

.12 BIRTHPLACE OF

MOTHER (City)

Eaton Center

(State or country)

N.H.

13. Informant Howard Griffin

(Address)

22 Blynman Ave. Goucester,Mass.

Filed 006. 2830

(Month) (Day) (Year) .

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

April

193 0

(Month)

(Day)

(Year)

I HEREBY CERTIFY , That I attended deceased from

Apr. 2,1930

to Apr. 18,1930

that 1 last saw

alive on

April 18, 1930

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

1.52

The CAUSE OF DEATH was as follows: (State fully) Carcinoma, type undetermined. involving upper 1/3 of stomach and lower end of esophagus metastosis of lymph glands of lesser cur- vature of stomach and left lobe of liver. (duration). yrs. _mos .. _ds.

CONTRIBUTORY

(Secondary)

Stricture of esophagus.

(duration)_yrs.

mos

.ds.

1 7 Where was disease contracted

if not at place of death.

Unknown

Did an operation precede death yes

For whatExploratory lapo-

ratomy.

Date of operation

April 7,1930

Was there an autopsy

No.

What test confirmed diagnosis

(Signed)

W.K. Turner, Major, M.C.

M. D.

(Address)

Fort Banks, Mass.

Date

April 18,1930

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Locust Grove

Gloucester, Mass

(Cemetery) (City or town)

DATE OF BURIAL Apr. 22/30

19 UNDERTAKER George L.Browne,

ADDRESS

Gamcester,

Į Mass.

20 1 HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued

Nm. S. Childress cial

Date of

- Permit We athe officier 4/21/30PM 1722

NAME OF

FATHER

Chas. Billings

Male.

City or Town Winthrop, Fort Banks Mass.

REVISED UNITED STATESSTANDARDCERTIFICATE OF DEATH

(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 onry (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 cause 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 wae 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, or from one cemetery to another, until he has received a permit from the board of health of 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, shall 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 onty 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.

[ R-303

DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

17,595

Winthrop

(City or town) ... (ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)

1 PLACE OF DEATH

County

Sull

lk.

State Massachusetts

Registered No.

City or Town inthrop: Winthrop Community Hood

St., .Ward

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

2 FULL NAME

J. Sleeper-

U. S. War Veteran, specify WAR)

(a) Residence.

No.

Think : 105 Loving Rd

.St.

.Ward.

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

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

mos.

days

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

yrs. mos. days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX Male White

5 SINGLE, MARRIED, WIDOWED,

or DIVORCED (write the word)

Married

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

Imogene Bartlett

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.

Lawyer

(b) Name of employer March 291930

8 BIRTHPLACE (City)

South thomaston

(State or country) maine

9 NAME OF

FATHER

Elias Sleeper

10 BIRTHPLACE OF

FATHER (City)

maine

South thomaston

11 MAIDEN NAME

OF MOTHER

Unknown

12 BIRTHPLACE OF

MOTHER (City) .

South thomaston

(State or country)

maine

13 Harveyes Keeper,

66 Laring Ram Nathromano South thomaston, Maine

HENRY F. RILEY

14 Filed (Month) (Day) (Year)

APR 1 8 1930

20 Burial permit issued by

Official position

21 Date of issue.

Permit No .. 11947

BOSTON HEALTH DEPT

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

april 15

(Month)

(Day)

(Year)

16 I HEREBY CERTIFY that I have made examination of the dead body of the person above named and that to the best of my knowledge and belief the CAUSE AND MANNER of death are as follows: (If an injury was involved, state fully)

Harmorrhage, traumatic,

Sub dural, of the brain, wesociated with a motor vehicle accident. ( Passenger. injury sustained 19 days here death-)

(See reverse side for description for unknown person)

17 In what City, or town

was injury sustained ?

(Signed)

M. D.

(Address)

Medical Examiner for ..

1930

Date

april 15

(Month)

(Day)

(Year)

18 PLACE OF BURIAL CREMATION, OR REMOVAL .

(Cemetery) (City or town)

DATE OF BURIAL

: 22/30

(Month) (Day) (Year)

ADDRESS

19 UNDERTAKER 6.a. Rollins

....

6 AGE Years PARENTS Informant (Address) Causes of Death. See reverse side for extracts from the laws relative to the return of certificates of death. OF DEATH in plain terms, so that it may be properly classified under the International Classification of miformation Siodia pe careruny supplied. MEDICAL BAAMINERS should state CAUSE AND MANNER (State or country)

4 COLOR OR RACE

19.04.

721

(Usual place of bode)

MEDICAL EXAMINER'S CERTIFICATE OF DEATH

REGISTRAR

with

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

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Town of Winthrop : Record of Deaths 1928-1930, Part 158

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

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