Town of Winthrop : Record of Deaths 1928-1930, Part 191

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 191

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/ Lealito officer

9/5/30

(Official Designation) /

(Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF DEATH Septembre 3, 1930 (Day) KYear)

(Month)

19 I HEREBY CERTIFY, That I attended deceased from august 7,1930 to Sept. 2 1930 last saw .22.Zalive on ...... Sift , 1930., death is said to have occurred on the date stated above, at 2.5-2.m. The principal cause of death and related causes of importance in order of onset were as follows: Pulmonary tuberculosis

april 5

1930

Contributory causes of importance not related to principal cause: Chronic artritis. Nor 3 1926

Name of operation

What test confirmed diagnosis?

Clinical

Date of

Was there an autopsy? no

20 Was disease or injury in any way related to occupation of deceased? no

If so, specify.

Guysa, Bianco

, M. D.

(Signed)

Address 40 GladstoneS.

Dato

Safe4 19 30

21 PLACE OF BURIAL, CREMATION OR REMOVAL st. Michael Boston

( Cemetery)

(City or town)

DATE OF BURIAL

Sept: 5,

1930.

/22 NAME OF

UNDERTAKER

Michael + Parcella

ADDRESS

10 no. Bellett 21.

Received and filed

(Registrar)

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

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.

14 BIRTHPLACE OF

FATHER (City) ..

Italy

(State or country)

Undrew Sturing

St.,

.Ward

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

(If nonresident, give city or town and state)

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:

Date of onset

Arteriosclerosis

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 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 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. Lows, 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.

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 resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

-301

PLACE OF DEATH

(County)

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

16.6 (City or town making return)

Registered No .. 2376

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

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

(If nonresident, give city or town and state)

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Pynte I. tuto

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 67 Years Months .. Days

If less than 1 day

... Hours.

Minutes

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.

Electrical

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

11 Total time (years) spent in this occupation5

12 BIRTHPLACE (City) .... (State or country)

13 NAME OF FATHER

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

15 MAIDEN NAME OF MOTHER

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

17 Informant C (Address) 2211.2016

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

(Signature of Agent of Board of Health'or other) Health Slicer

(Official Designation)

(Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

718 DATE OF

DEATH

Sept

(Month)

5 (Day)

1930 (Year)

19 HEREBY CERTIFY, That I attended deceased from Sept 4 Lept 5, 1980 ,193.@, to

1 last saw h ... . "1 alive on Legat 5. , 19 .3 .. Q., death is said to have occurred on the date stated above, at 5:30 Pm.

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

Dateofonset

Myocarditis

Contributory causes of importance not related to principal cause: Cabral Hemorragia

Name of operation

Date of

What test confirmed diagnosis? Charming Vagyis Was there an autopsy ??

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

If so, specify. 12.0Bruin M.A.

(Signed)

., M. D.

(Address)

Date 2//

19 20 ..

21 PLACE OF BURIAL, /

CREMATION OR REMOVAL

DATE OF BURIAL

(Cemetery) (City or town) 19

22 NAME OF UNDERTAKER

ADDRESS

Received and filed.

A TRUE COPY, ATTEST: (Registrar)

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

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

(City or Towy 21 ft hicelack No.

2 FULL NAME

Ward St., ingeff. 2 hectare

(If deceased is a married, widowed of divorced woman, give also maiden name.) 2/19/ Quelack. .. St., ........... Ward

(a) Residence. No. (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.

4 COLOR OR RACE

9,70

ـسر

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, 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

IQ15

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, 1027

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. o.

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.

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, poritonitis, phlebitis, pyemia, septicemia, tetanus.

R-301

PLACE OF DEATH

Suffol's (County)

Winthrop

(City of Town) No. Fort. Banks, Mass ..

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

(City or town making return)

Registered No .. +84

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

2 FULL NAME

Theresa

Anna O'Brien

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

(a)

Residence.

Hout Banks

St., .... W. W. Ward,

(If nonresident, give city or town and state)

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

mos.

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

yTs.

mos. days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

FemalF.

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write 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 AGE 0 Years 0 Months 12. Days

If less than 1 day Hours Minutes

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)

Winthrop., ... Mass.

(State or country)

13 NAME OF

FATHER

Neal James O'Brien

14 BIRTHPLACE OF FATHER (City) ... (State or country)

Springfield, liass.

15 MAIDEN NAME

OF MOTHER

Mary Margaret Roberts

16 BIRTHPLACE OF MOTHER (City) Springfield, Mass ..

(State or country)

17 Informant (Address) ( For Banks

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial os transit permit was issued: Wm. & Childrens (Signature of Agent of Board of Health or other) 40.000 Sept. 8, 1430

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

September

8 ..

19:30

(Month)

(Day)

(Year)

19 I HEREBY CERTIFY, That I attended deceased from August .... 23., 1930 .. , to .... September .... 8., ... , 19 30 .. | last saw her ...... alive on September .... 8, 19.30 .. , death is said

to have occurred on the date stated above, at .. 6: 55Alm.

The principal cause of death and related causes of importance in order of Datesfonsef onset were as follows: 1 ... Hepatitis, ... acute. ... interstitial. Cause ... undetermined.

Sept.

.. 7,1930.

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

Name of operation

Nono

Date of

What test confirmed diagnosis ?. ...

None.

Was there an autopsy ?.

20 Was disease or injury in any way related to occupation of deceased? .No

If so, specify

Capt .M&C.

(Signed) .

(Address) Francis E. Council

Date Sept 89 1930

Station Hospital, Fy. Barks,Mass.

21 PLACE OF BURIAL, got Thehalls Springfield ¿Cemetery) (City or tosyn)

DATE OF BURIAL

1930

22 NAME OF

UNDERTAKER

Charley I Beruson

ADDRESS

Received and filed. 19

A TRUE COPY, ATTEST:

(Registrar)

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

OCCUPATIONI CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION PARENTS is very important. See instructions and extracts from the laws on back of certificate.

St.,

.Ward

(If U. S.

War Veteran,

specify WAR)

(Usual place of abode)

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.

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Town of Winthrop : Record of Deaths 1928-1930, Part 191

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

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