Town of Winthrop : Record of Deaths 1928-1930, Part 34

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 34

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1925

that I last saw hez alive on

may 21

1929

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

7.10

The CAUSE OF DEATH was as follows: (State fully)

Vauriarteatt devine

_mos.

(duration)_

yrs.

.ds.

CONTRIBUTORY

Passur congestion

(Secondary)

.(duration).

yrs. mos.

ds.

1 7 Where was disease contracted

if not at place of death

Did an operation precede death For what

Date of operation

Was there an autopsy

210

What test confirmed diagnosis

(Signed)

M. D.

(Address) (sc Unation & = NumeTo Mels

Date limite + 19: 30

18 PLACE OF BURIAL, CREMATION, QR REMOVAL,

Withrop

DATE OF BURIAL Way 25

(Cemetery)

(City or town)

19 UNDERTAKER Kalles P. Bennison Withrop

14 Filed (Month) (Day) (Year)

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

Wm D. Childress Official position agent

Date of issue of permit/ may 24/28 Permit 14/8/

plied. AGE should be stated-EXACTLY. PHYSICIANS should state 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.

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

2FULL NAME

Ka) Residence. No.

(Usual place of abode)

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

200,000. 9-26. NO. 6373

PARENTS

Stoughton:

REVISED UNITED STATESSTANDARD CERTIFICATE 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 onty (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 irom 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, 88 the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, menin- gitia, 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 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, 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, If the death certi- the medical examiner shall make such certificate. 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 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 cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46. G. L., as amended.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

Boston

(City or town)

1 PLACE OF DEATH

County

Suffolk

State

Registered No.

(Place of residence.

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

2 FULL NAME

ELIZABETH L. STAPLES

(If in the Army or Navy of the United States, give rank, organization, etc.)

No.

29 THORNTON PK.

St.

(a) Residence.

State

MASS,

(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

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

: S HUSBAND

Name of ? (or) WIFE

EDMUND B.

Years

Months 1

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. AT HOME

(b) Name of employer

8 BIRTHPLACE (city or town)

SEARSPORT

(State or country)

MAINE

9 NAME OF

FATHER

SAWALL LANCASTER

10 BIRTHPLACE OF

FATHER (city or town)

SEARSPORT

(State or country)

11 MAIDEN NAME

OF MOTHER

ELIZABETH CARVER

12 BIRTHPLACE OF

MOTHER (city or town).

SEARSPORT

(State or country)

MAINE

13 E. P. STAPLES

Informant

(Address)

29 THORNSTON PK, WINTHROP

Filed

, 19 28 Eum Seinen

File June 5 1938

Registrar of city or town where death occurred

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

MAY 24

1928

(Month)

(Day)

(Year)

I HEREBY CERTIFY,

That I attended deceased from

MAY 18

28to.

MAY 24

1.28

that I last saw h_ER alive on

MAY 24

1928

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

1OP

The CAUSE OF DEATH was as follows: (State fully)

LOBAR PNEUMONIA

(duration).

yrs.

mos ..

da.

CONTRIBUTORY

(SECONDARY)

(duration)

YT8.

mos ..

.ds.

17 Where was disease contracted

if not at place of death.

Did an operation precede death

For what.

Date of operation

Was there an autopsy

What test confirmed diagnosis.

CLINICAL AND LABORATORY

(Signed)

C. L. CLAY

(Address)

Date

MAY 25, 1928

18 PLACE OF BURIAL, CREMATION, OR REMOVAL SEARSPORT SEARSPORT ,ME (Cemetery) (City or town)

DATE OF BURIAL

5-26

, 19 28

19 UNDERTAKER

WALTER T. WHITE

ADDRESS

4312

3 SEX

6 AGE

59 UTCA LIVIVILT . TTIIJICIANS Should state CAUSE OF DEATH In plain terms, so that it

may be properly classified. Exact statement of OCCUPATION is very important.

Registered No.

5185

( Place of death)

City or town

Boston

No.

PETER BENT BRIGHAM HOSPITAL

Ward

City or Town

WINTHROP

MAINE

PARENTS

M. D.

Elizabeth L. Staples may 24: 19128

M R-301

The Commonwealth of Massachusetts

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

STANDARD CERTIFICATE OF DEATH

State Mas

(City or town)

Registered No. 102

City or Town

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

2FULL NAME

Bally Se

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

Ka) Residence. No.

(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 days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

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

(b) Name of employer

8 BIRTHPLACE (City)

(State or country)

9 NAME OF

FATHER

10 BIRTHPLACE OF FATHER (City) Boston-

(State or country)

Maso

1 1 MAIDEN NAME

OF MOTHER

ada. Fr. dinovo

12 BIRTHPLACE OF

MOTHER (City)

Boston

(State or country)

Informant I. may nail dicono

(Address)

108 Lifeand .it Muchas

Filed

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

(Day)

(Year)

16 I HEREBY CERTIEY , That I attended deceased from ky 26 , 198, to

1925-

that I last saw be alive on Zumy 26 ,19 25

8 P m.

and that death occurred, on the date stated above, at The CAUSE OF DEATH was as follows: (State fully) Prematura about- 100000 marasmens

(duration)_yrs .- mos. 3 ds.

CONTRIBUTORY

(Secondary)

(duration) ____ yrs.

ds.

1 7 Where was disease contracted

if not at place of death

200

Did an operation precede death.

For what

Date of operation

Was there an autopsy

200

What test confirmed diagnosis

Clinical

(Signed)

(Address)

123 Uhrfechas

Date

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

(Cemetery)

(City or town)

DATE OF BURIAL 6/8/28

19 UNDERTAKER

ADDRESS

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

M.D.

Official Health Iler

Date of issue of permit 6/7/28

Permit No.

1426

200.000. 9-26. NO. 6373

Exact statement of OCCUPATION. is .very important. See instructions and extracts from the laws on back of certificate. plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. ien IT-II IJ ATERMANENT RECORD. Every item of information should be carefully sup-

15 3 Chipland R1

St.

Ward,

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

1428

_mos.

, M. D.

PARENTS

REVISEDUNITEDSTATESSTANDARD CERTIFICATE OF DEATH

(Approved by U. S. Cansus and American Public Health Association)

EXTRACTS

FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE

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 only (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 discase. 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.

Stato 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- Citis, miscarriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

RETURN OF CERTIFICATES OF DEATH

No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, 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 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 only such persons as are supposed to have died by violence .- Gen. Laws, Chap. 38, Sec. G.

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.

M R-301

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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Suffolk

State

Registered No.

City of Town.

Winthrop

No. 160 (the Park Kon St.

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

I Etta Janett

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

"(a) Residence. No.

(Usual place of abode)

160 Cottage Park Road

St.

Ward,

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

Length of residence in city or town where death occurred years

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

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Female

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word) Married

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

William H. Garrett

6 AGE

Years

Months

Days

IF LESS than 1 day, ........ hrs. cr ........ min.

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

8 BIRTHPLACE (City)

Hotcroft

(State or country) Maine

9 NAME OF

FATHER

Daniel Brown

1 O BIRTHPLACE OF

FATHER (City)

(State or country)

Marine

1 1 MAIDEN NAME

OF MOTHER

Mary Jane Starbord

12 BIRTHPLACE OF

MOTHER (City).

(State or country)

13 Husband

Informant

(Address)

Filed 11

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

May

(Month)

(Day)

1928 (Year)

Į HEREBY CERTIFY , That I attended deceased from

anne

27, to

May

19.

that I last saw h 2/2 alive on

May 26

19_0 28

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

The CAUSE OF DEATH was as follows: (State fully)

2 Pr

Chronic interstitial

myocarditis

(duration).

_yrs.

mos. _de.

CONTRIBUTORY

(Secondary)

(hypostatic) (duration)>

ds.

Where was disease contracted

if not at place of death

Did an operation precede death

720

For what

Date of operation

Was there an autopsy

History: hisical examination

Symptome

(Signed)

Salle b. Saunders, M. D.

(Address) 32 Woodside Park. Winthrop

Date

May 29, 1928

18 PLACE OF BURIAL, CREMATION OR REMOVALS

Lowell Cemetery Lowell

(Cemetery)

(City or town)

DATE OF BURIAL

+ Hay 29/28

ADDRESS

19 UNDERTAKER Walter J. Winto Winthrop?

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

Date of Issue 3/29/28 No. Permit 1721

Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified- INLi, WITTE VRE MUHYU BLACK INK-THIS IS A PERMANENT RECORD. Every item of information should be carefully sup-

200.000. 9-26. NO. 6373

(City or towm)

Ward

2FULL NAME

Branches. pneumonia

PARENTS

Ividas

REVISED UNITED STATESSTANDARD CERTIFICATE OF DEATH

(Approved by U. S. Census and American Public Health Association)

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Town of Winthrop : Record of Deaths 1928-1930, Part 34

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

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