Town of Winthrop : Record of Deaths 1928-1930, Part 174

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 174

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2 FULL NAME

To Brookfield Road Robert U. S. Collamore

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

(a)

Residence. No.

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

(write the word)

If less than 1 day

Hours

Minutes

Com

Thrombous

Date of.

Boston

1750

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 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, 19:7

Contributory causes of importance not related to principal cause:

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

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.

.... 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.

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.

(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.

(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia). and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease we an infection related to occupation, the

-302

7 OF DEATH in plain terms, so that it may be properly classined. Exact statement of OCCUPATION Is Very PARENTS

important.

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: James A. Dumas, M. D.

(Signature of Agent of Board of Health or other)

Commissioner 6-21-30

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

(write the word)

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

Married

5a If married, widowed, or divond ry Chorotas

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(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.

Salesman

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

Grocery

10 Date deceased last worked at

11 Total time (years)

this occupation (moq hunde

14, 1930pent in this

year)

occupation

12 BIRTHPLACE (City)

(State or country)

Greece

13 NAME OF

FATHER

Anastasios Simitris

14 BIRTHPLACE OF

FATHER (City)

(State or country)

Greece

15 MAIDEN NAME

OF MOTHER

Tilen Kalyves

16 BIRTHPLACE OF

MOTHER (City)

(State or country)

Greece

17 Louis Simitis

Informant

(Address) Have way, inthrop

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

PLACE OF DEATH

Essex

(County)

Lynn

(City or Town)

No. Lynn Hospital

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

Lynn (City or town making return)

Registered No.

941.31

(If death occurred in a hospital or institution,

Ward

give its NAME instead of street and number)

2 FULL NAME

Peter .... Simitsis

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

(If U. S.

War Veteran,

specify WAR)

(a) Residence. No. (Usual place of abode).

52 Tave Way

venue

St.,

Ward,

Winthrop, Mass.

(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.

18 DATE OF

DEATH

June 20, 1930

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

June 16

19.30

June 20

to.

I last saw h

alive on

June 20

1980

199

death is said

7.25p.m.

to have occurred on the date stated above,

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

Hypertension

5/17/20

Contributory causes of importance not related to principal cause:

Name of operation

none

What test confirmed diagnosis?

Date of

Labora tor Was there an autopsy? 10

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

If so, specify

(Signed)

Then.

Zarvas

(Address)

21 PLACE OF BURIAL,

N't. Hope, Boston

CREMATION OR REMOVAL

June 2Cemetery)

DATE OF BURIAL

(City or town) 130

22 NAME OF

Chas. R. Bennison

UNDERTAKER

ADDRESS

inthrop, Mass.

Received and filed July, 53/

archite N. Attwell

1930

"Registrar)

A TRUE COPY, ATTEST:

Date

6-71

.M. D. 1950

St.,

PERSONAL AND STATISTICAL PARTICULARS

1 m

June 20. 1990

-302

important. Of DEATH In plain terais, so that it may be properly classified. LAact statonicht of Severalion is very PARENTS

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

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William Q. Parking (Signature of Agent of Boafd of Health or other)

Town Click June 22, 1930

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

Female White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

Wiclow

5a If married, widowed, or divorced

HUSBAND of

give maiden name of wife in fumy

(or) WIFE of

William C. Kelley

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

AGE

75 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

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)

Boston

(State or country)

class.

13 NAME OF

FATHER

William J. Cole

14 BIRTHPLACE OF

FATHER (City)

(State or country)

England

15 MAIDEN NAME

OF MOTHER

Chan Ward

16 BIRTHPLACE OF

MOTHER (City)

(State or country)

England

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

If so, specify

(Signed)

Byron Detanborn

M. D.

(Address)

to paspeldi ) Dass. Date June 2219 30

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Hint of Na throp Mass

(Cemetery)

June 24,

(City or town)

DATE OF BURIAL

19 30

22 NAME OF

UNDERTAKER

NA Gorby

ADDRESS

Mars.

Received and filed

June 22,

19.30

[William C. Jenkins

A TRUE COPY, ATTEST:

(Registrar)

PLACE OF DEATH

1.sex (County) ofshield (City or Town)

No.

Salem

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

01 Afisfiled (City or town making return) Registered No. 820

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

2 FULL NAME

Unnie E. Kelley

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

Bates are

St.,

Ward,

(a) Residence. No.

(Usual place of abode) ,

Length of residence in city or town where death occurred

yrs.

mos.

21 days.

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

yrs.

(If U. S.

War Veteran,

specify WAR)

Winthrop, Mais.

(If nonresident, give city or town and state)

mos. days.

18 DATE OF

DEATH

June

21.

19.30

(7 (Month)

(Day)

(Year)

19 I HEREBY CERTIFY, That I attended deceased from

May 20

, 1921, to June 21, 19.

19 death is said I last saw h Eralive on June 21 30

to have occurred on the date stated above, at 1/b. .m.

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

Dateofonset

(isteriosclerosis

1923

Chronic Endocarditis

leute Endocarditis.

June 19,19

1922

Contributory causes of importance not related to principal cause:

Date of

Name of operation

What test confirmed diagnosis?

Was there an autopsy? 200

17 Mrs. John Swindell

Informant

(Address)

Thisfield, Mark.

St.,

.......

.Ward

PERSONAL AND STATISTICAL PARTICULARS

June 21. 1930.

3 B

Sufull

KCounty)

City &Town) botas.

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH

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

17,717 Registered No.

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

(If nonresident give city or town and state)

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

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male.

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

Married.

5a If married, widowed, or divorced HUSBAND of

Albie A. Dodges

(er) WIFE of

(Give maiden name of wife in full)

Maiden name +

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

If less than 1 day

Hours. .Minutes

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

Chemist (retired)

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 1 0yrs.

occupation .. ..

12 BIRTHPLACE (City)

Edge comb

(State or country)

Maine.

13 NAME OF

FATHER

Asa Dodge.

14 BIRTHPLACE OF

FATHER (City)

(State or country)

Edge comb Maine

15 MAIDEN NAME

OF MOTHER

Louisa Davidson.

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

Edgecomb Maine.

17 Walde C. Dodge. (Son.)

(Address) 200 Pauline St. 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) Nm. X. Childress 6/23/30

(Official Designation) " D"(Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

1980

(Day)

(Year)

19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)

Drowning, Quiedal

(See reverse side for description for unknown person)

20 IN WHAT CITY OR TOWN

WAS INJURY SUSTAINEDA

M. D.

(Signed)

Date 2 7 . 19 30

EdgeComb

DATE OF BURIAL

June 25,

22 NAME OF

Charles R. Bennison.

UNDERTAKER

ADDRESS

Winthrop

Mass.

Received and filed.

1032

(Registrar)

PLACE OF DEATH

No ....

2 FULL NAME

Curtis

H. Andre-

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

(a) Residence.

No ...

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

mos.

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

.Ward,

Str RR. hedge - (If U. S. War Veteran, specify WAR)

OCCUPATION of Death. See reverse side for extracts from the laws relative to the return of certificates of death. PARENTS

5m-2-'30. No. 7997-c

21 PLACE OF BURIAL.

CREMATION OR REMOVAL

Edgecomb Maine.

(Cemetery)

(City or town)

19:3.0

this occur year). citation. menth year ago

7 AGE 74 Years Months Days

EXTRACTS

FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

physician or registered hospital medical officer shall forth- h, after the death of a person whom he has attended during his ; illness, at the request of an undertaker or other authorized son or of any member of the family of the deceased, furnish for regis- cion a standard certificate of death, stating to the best of his knowledge belief the name of the deceased, his supposed age, the disease of ch he died, defined as required by section one, where same was con- ted, the duration of his last illness, when last seen alive by the sician or officer and the date of his death .... Gen. Laws, Chap. 46, . 9.

lo undertaker or other person shall bury or otherwise dispose human body in a town, or remove therefrom a human body which not been buried, until he has received a permit from the board of Ith or its agent appointed to issue such permits, or if there is no such rd, from the clerk of the town where the person died; and no under- er or other person shall exhume a human body and remove it from wn, from ne cemetery to another, or from one grave or tomb other n the receiving tom 'another in the same cemetery, until he has ived a permit from me board of health or its agent aforesaid or from clerk of the town where the body is buried. No such permit shall ssued until there shall have been delivered to such board, agent or k, as the case may be, a satisfactory written statement containing facts required by law to be returned and recorded, which shall be ompanied, in case of an original interment, by a satisfactory certificate he attending physician, if any, as required by law, or in lieu thereof rtificate as hereinafter provided. If there is no attending physician, , for sufficient reasons, his certificate cannot be obtained early enough the purpose, or is insufficient, a physician who is a member of the rd of health, or employed by it or by the selectmen for the purpose, 1 upon application make the certificate required of the attending sician. If death is caused by violence, the medical examiner shall e such certificate. If the death certificate contains a recital, as ired by section ten of chapter forty-six, that the deceased served he army, navy or marine corps of the United States in any war in ch it has been engaged, such recital shall appear upon the permit. board of health or its agent, upon receipt of such statement and ificate, shall forthwith countersign it and transmit it to the clerk he town for registration. The person to whom the permit is so given the physician certifying the cause of death shall thereafter furnish registration any other necessary information which can be obtained o the deceased, or as to the manner or cause of the death, which the k or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.

o undertaker or other person shall bury a human body or the ashes eof which have been brought into the commonwealth until he has ived a permit so to do from the board of health or its agent appointed sue 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

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ;...- General 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; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.

.. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.

RULES OF PRACTICE

The fulfilment 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.

(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

STATEMENT OF CAUSE OF DEATH

Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident. " " Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."

If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorr- hage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"

SCRIPTION (for unknown person)

NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the ody of any person supposed to have met his death by violence, until a permit, signed by the Medical xaminer, has first been obtained .- General Laws, Chap. 38, Sec. 14.

THIS CERTIFICATE CONSTITUTES SUCH PERMIT

June 22, 1930

Suffolk (County)

(City OF Town)

No 84. Triton Que

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

(City or town making return)

Registered No.

122

.(If death occurred in a hospital or institution,

give its NAME instead of street and number)

Frederick Barnes

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

(a)

Residence.

No.

84 Inton Que

St.

Ward,

(Usual place of abode)

Length of residence in city or town where death occurred 3 yrs.

mos.

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

mos. days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

Manned

5a If married, widowed, or divorced

HUSBAND of

anna lignes Kan Shell (Call)

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

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Town of Winthrop : Record of Deaths 1928-1930, Part 174

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

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