Town of Winthrop : Record of Deaths 1928-1930, Part 172

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 172

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? Pancreas

? ovary

Contributory causes of importance not related to principal cause:

(

Name of operation

What test confirmed diagnosis?

Date of

Was there an autopsy?

Yes

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

(Signed)

, M. D.

(Address)

Peter B. Brigham Date6/ 15 19 30

22 PLACE OF BURIAL,

CREMATION OR REMOVAL

Mt. Auburn Cambridg

(Cemeteryne

City or towa)

17,

DATE OF BURIAL

22 NAME OF

UNDERTAKER

H F Cates

Test Newton

ADDRESS

Received and filed

June, /18, 19 30

A TRUE COPY, ATTEST:

(Registrar)

13 8

PLACE OF DEATH

No.

St.,

Ward

(If U. S.

War Veteran,

specify WAR)

Winthrop

(If nonresident, give city or town and state)

8: 40pm.

PARENTS

50M-11-'29. No. 7180-b

(Give maiden name of wife in full)

June 14, 1930. 5

R-301

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.

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

I HEREBY GERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William W. Childrens (Signature of Agent of Board of Health or other)

agent June 17 th

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

(Month)

1830

(Day)

(Year)

19 I HEREBY CERTIFY, That I attended deceased from

.19 ... . .. , to

19 30

16 1930 death is said Vlast saw h ... Malive on

to have occurred on the date stated above, at 3.45P .. m.

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

Dateofonset

6/8

Stattorino mens

Contributory causes of importance not related to principal cause:

4/5

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) (Address)

Date 19

21 PLACE OF BURIAL, CREMATION OR REMOVAL

Italy Curs. Malche Cemetery

(City or town) 193.0

22 NAME OF

UNDERTAKER

DATE OF BURIAL

Heat A. Magialle.

ADDRESS

Bart Bistra

Received and filed.

30 19

A TRUE COPY, ATTEST: (Registrar)

PLACE OF DEATH

Suffich Winthings Louny)

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)

(If U. S. War Veteran,

specify WAR)

(a) Residence.

(Usual place of abode)

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

mes.

days.

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

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX 4 COLOR ØP RACE Fender blute

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(wate the word) Single

5a If married, widowed, or divorced HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 17 AGE Years 3 Months 3 .Days

If less than1 day Hours .Minutes

OCCUPATIONI

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 ..

Student Strach Salival

10 Date deceased last worked at this occupation (month and year)

6-4-30

11 Total time (years) spent in this occupation.

12 BIRTHPLACE (City) (State or country)

mars

13 NAME OF FATHER

Joseph A. Nelson Part Pentru

(State or country)

15 MAIDEN NAME OF MOTHER

Jean J. Smith

16 BIRTHPLACE OF MOTHER (City)

(State or country)

17 mus

Informant (Address)

J., Nelson dio Leyman LA

Ward.

Nelson

(City or Towy No20 Seymour Helen

2 FULL NAME

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

seymour

St.,

Ward,

(If nonresident, give city or town and state)

Sortland

14 BIRTHPLACE OF FATHER ( City)

PARENTS

M. D.

June 16. 1930 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 & 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

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 .. . 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.

-302

PLACE OF DEATH

Middlesex (County)

Cambridge. (City or Town) No.Cambridge City Hospital

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

Car bridge

(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

Cornelius Doherty

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

(a)

Residence. No. 36 Pearl ve.

(Usual place of abode)

St.,

Ward,

Winthrop

(If nonresident, 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

5 SINGLE

(write the word)

MARRIED

WIDOWEDWidowed

or DIVORCED

5a If married, widowed, or divorced

HUSBAND of

Ella J Du ly

(Give maiden name of wife in fully

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 AGE 69 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.

Retired Hotel

9 Industry or business in which

work was done, as silk mill,

saw mill, bank, etc.

Keeper

10 Date deceased last worked at

this occupation (month and

year) ..

11 Total time (years)

spent in this

occupation.

12 BIRTHPLACE (City) .Boston.

(State or country)

Mass,

PARENTS

15 MAIDEN NAME

OF MOTHER

Unknown

16 BIRTHPLACE OF

MOTHER (City)

(State or country)

Ireland

Informant

Philip Doherty

(Address)

36 Pearl ave. winthrop

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

(Signature of Agent of Board of Health or other)

(Official Designation)

(Date of Issue of Permit) 1/12

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

June 17 1030

(Month)

(Day)

(Year)

19 I HEREBY CERTIFY, That I attended deceased from

May 11

19:30 to June 17

to.

1930

I last saw him. .. alive on.

June .... 17

193Q .. , death is said

to have occurred on the date stated above, at 10. 15 A The principal cause of death and related causes of importance in order of onset were as follows:

Dateofonset

Carcinoma cf Tongue

unknown

Contributory causes of importance not related to principal cause:

Diabetes Mellitus

Unknown

Name of operation

Clinical & Lab

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) Frank J Gavolio

, M. D.

(Address)Cambridge .... City. .... Hos pate 6/17193.0

Holy Cross Cem.

Lalaen

22 PLACE OF BURIAL.

CREMATION OR REMOVAL

(Cemetery)

(City or town)

DATE OF BURIAL June 20 1930

22 NAME OF

UNDERTAKER

Eawin . Lane

ADDRESS

201 Bowdoin St. Dorchester

Received and filed

June 20 1930

Frederick H. Nurie

A TRUE COPY, ATTEST:

(Registrar)

important.

50M-11-'29. No. 7180-b

13 NAME OF

FATHER

Michael Doherty

14 BIRTHPLACE OF

FATHER (City)

(State or country)

Ireland

St.,

Ward

(If U. S.

War Veteran,

specify WAR).

June 17. 1930.

01A

15 very important. Dee instructions and extracts from the laws on back of certificate. PARENTS

75m-2-'30. No. 7997-a

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

(Signature of Agent of board Of Health or other)

Health Officer 6/18/30

(Official Designation) (Date of Issue of'Permit)

- MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

(Month)

/18

(Day)

130 (Year)

I HEREBY CERTIFY, That I attended deceased from

1920 to

6/18

, 19 50

I last saw h ... LAalive on

6/18

,30

death is said

to have occurred on the date stated above,

at 2.10am.

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

Dateofonset

Prematura Baby

8the month.

Contributory causes of importance not related to principal cause:

Placenta Previa

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 Funchal Lithic

(Signed)

, M. D. (Address) toturliy ave For. Date 6/18 19 31

21 PLACE OF BURIAL, CREMATION OR REMOVAL Oak Grove Medford (Cent) (City or town) 28.4 1930

DATE OF BURIAL

june

22 NAME OF

Chago R. Leursson.

UNDERTAKER

ADDRESS

Vuithrop. Mars.

Received and filledwith

...............

......

.. 19

(Registrar)

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

5a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 AGE Years. Months

Days

If less than 1 day

3 ... 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)

truthof

11 Total time (years) spent in this occupation .

12 BIRTHPLACE (City).

(State or country)

massachusetts.

13 NAME OF

FATHER

Harold Harrigan.

14 BIRTHPLACE OF

FATHER (City)

Somerville Massachusetts.

15 MAIDEN NAME

OF MOTHER

Dorothy Mc Carthy

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

Lavere Massachusetts.

Harold Harrigan R

To be filed for burial permit with Board of Health or its Agent,

Registered No. 1/6

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

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

Ressere

ard,

(a)

Residence.

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

(If deceasedAs a married, widowed or livorced woman, give also maiden name.) 1 01 Oak Island Live.

mos.

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

PLACE OF DEATH No

2 FULL NAME

Rever alifie

Suffolk (County) Winthrop (City or Topm) . WinthropCommunity Hospital Baby Harrigan.

Jorpital Ward

{If nonresident, give city or town and state)

days. How long in U. S., ilof foreign birth?

yrs.

moi?

4 COLOR OR RACE

(State or country)

17 Informant (Address) 101 Oak Island Well were

Julie 18. 1936 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.

Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease 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 contributory causes of importance not related to principal cause, name other important diseases.

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:

In a group of causes containing the principal cause and related

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 be' ief 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.

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

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Town of Winthrop : Record of Deaths 1928-1930, Part 172

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

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