Town of Winthrop : Record of Deaths 1928-1930, Part 70

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 70

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MEDICAL CERTIFICATE OF DEATH

17 I HEREBY CERTIF That I attended deceased from

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH (month, day, and year)

an June 25,10

Days

(duration)

( yrs.)

mos.

ds.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs.

·----- mos.

ds.

18 Where was disease contracted

if not at place of death ?.

Did an operation precede death ?

Date of

Was there an autopsy?

What test confirmed diagnosis ?

(Signed) E a Landmay

M. D.

,19

(Address)

Plasten 4.4

* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, Or HOMICIDAL. (See reverse side for additional space.)

PARENTS

TION is very important. See instructions on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPA- mation should bo carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state

(lf nonresident give city or town and State)

REVISED UNITED STATES STANDARD 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, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, 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," "Foreman," "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 Housewife, House- work, 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, House- maid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation 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 DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever. (the only definite synonym is "Epidemic cerebro- spinal meningitis") ; Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, 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 symptomatic), "Atro- phy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaus- tion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weak- ness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, Or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Acci- dental drowning; Struck by railway train-accident; Revolver wound of head-homicide; Poisoned by carbolic acid-probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of tho American Medical Association.)

NOTE .- Individual offices may add to above list of undesirable terms and refuse to accept certificates containing them. Thus the form in uso in New York City states: "Certificates will be returned for additional information which give any of the following diseases, without explana- tion, as the sole cause of death: Abortion, cellulitis, childbirth, convul- sions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus." But general adoption of the minimum list suggested will work vast improve- ment, and its scope can be extended at a later date.

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN

11-3184

DEC 2 21358 AM

.30

03413030

RECEIVED

OF TOWA

OFF

WINTI

DEC 221958 AM

ENSE PETTY

Edward J. Gronin Secretary of the Commonwealth

The Commonwealth of. Massachusetts Office of the Secretary Rato House, Boston 33

December 17, 1958

Mr. John A. Clark Town Clerk Winthrop, Massachusetts

Dear Mr. Clark:

The enclosed certificate was found in a seldom used filing cabinet. It is sent to you for whatever use it may be to you. Possibly it is already a matter of record in your office.

Very truly yours, Kaiph R Cumer

Ralph R. Currier State Registrar of Vital Statistics

RRC/W Enc1.

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County

State

Registered No.

(Place of residence) St., -Ward

City or town

2 FULL NAME

(a) Residence.

State-

(Usual place of abod

Length of residence in city or town where dea

PERSONAL AND STAT

3 SEX

4 COLOR OR RA€

5a If married, widowed, or divorced Name of

S HUSBAND ? (or) WIFE

6 AGE

Years

Mol

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 or town) (State or country)

9 NAME OF FATHER

10 BIRTHPLACE OF FATHER (city or town) (State or country)

11 MAIDEN NAME

OF MOTHER

12 BIRTHPLACE OF MOTHER (city or town) (State or country)

13 Informant (Address)

Filed . 19

Filed 19

martha Parsons Ballou Jan. 1.1929.

Certificate of Death

Name, .arthersons

Place of Death, ...

Concord

No.

44. . youth. spring

Street

Ward,

Village,

How long a resident,

11 days

Previous residence,

inthron Ess

If death occurred at an institution give name of same

How long an inmate,

Where from,

Date of Death: Year, 192MMonth,.\ \\ Day, .. ] ...

Age: Years, 9.4. . Months,. 1 Days, .. 17

Place' of Birth,

Date of Birth: Year, 1. 86Month, . T.O.V. Day, ... .. ..

Married, Single,

Sex, .!!

Color,.

Widowed or

Divorced

Occupation,

Cause of Death, .Influenza

Duration,

6 days

Contributing Cause,

none

Duration,

[Record continued over.]

- give its NAME instead of street and number)

United States, give rank, organization, etc.) -St.

n birth?

years

months days

'IFICATE OF DEATH

Month)

(Day)

(Year)

TIFY, That I attended deceased from

_, to

., 19

e stated above, at

lows: (State fully)

(duration) yrs.

mos. ds.

(duration). yrs.

mos .. de.

For what

M. D.

R REMOVAL

(City or town)

DATE OF BURIAL

, 19

ADDRESS

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

. 4812

1 10844

1929

(City or town)

Registered No.

(Place of death)

No.

M R-301

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

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

BOSTON

Suffolk

State

lo 93 Pleasant

St., ___ Ward

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

2FULL NAME

Ellen &, Burke

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

Ka) Residence. No.

(Usual place of abode)

093Pleasant

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

4 COLOR QR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Female White

married

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

John W .

6 AGE

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

Housewife

8 BIRTHPLACE (City)

Berlin

(State or country)

mars

9 NAME OF

FATHER

Michael Garrity

PARENTS

10 BIRTHPLACE OF

FATHER (City)

(State or country)

Ireland

1 1 MAIDEN NAME OF MOTHER

Bridget Curran

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Ireland

13 John W. Burke,

Informant (Addres 193 PleasantIt

Filed 7000 6/23

(Month) (Day) / (Year)

REGISTRAR

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

Www. D. Children

Official position

19 UNDERTAKER Weah . Manatt

ADDRESS

Permit

1548

Date of Assue 1/3/21 itn .

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information should be carefully sup-

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.

27-204:

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

(Month)

1929 (Year)

I HEREBY CERTIFY , That I attended deceased from

Sept. 12-

., 19.27, to

Dan 1- 192

that I last saw h ___ __ alive on

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

chronic myocarditis

(duration) _. 3

_yrs .. ....... mos.

ds.

CONTRIBUTORY

(Secondary)

Chroine Carrive Cayalia

(duration). _yrs ._____ mas. 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 if inder one vear, was infant Breast Fed ? What test confirmed diagnosis

(Signed)

M. D.

(Address) 163 Mendian

Date Jan 2 -1929

18 PLACE OFBURIAL, CREMATION, OR REMOVAL DATE OF BURIAL A. Forall. frstury1-4-29 (City or town)

(Cemetery)

Massachusetts

(City or town)

Registered No. 2.

City or Town

Boston Ninthink

200.000. 9-26. NO. 6373

Years

TO P

19.2

(Day)

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, 88 Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupa- tion at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death .- Name, first, the Disease Causing Death (the primary affection with respect to time and causation). using always the same accepted term for the same disease. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid. pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sarcoma, etc., of. .(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symp- tomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility'" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAI 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, givo primary cause.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, menin- gitis, miscarriago, necrosis, peritonitis, phlebitis, premia, 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 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. 6.

.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.

No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46. G. L., as amended.

R-303

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

The Commonwealth of Massachusetts

Medical Examiner's Certificate of Death

(City or town)

1 PLACE OF DEATH

(ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)

County

Sull lla

State

275

main

St.,

. Ward

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

2 FULL NAME

(a) Residence. No Willing, 275 Mand

(Usual place of abode)

.. 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 toreign birth?

years

months days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH.

(Day)

1429

( Year)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Augustus T.

6 AGE

Years

Months

Days

If less than 1 day ...... hrs. or ..... mia.

IF STILLBORN, eater that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

at home

8 BIRTHPLACE (City)

...

Ellsworth

Maine

9 NAME OF

FATHER

Cyprus Murch

10 BIRTHPLACE OF

FATHER (City)

Trenton

(State or country)

Maine

11 MAIDEN NAME

OF MOTHER

Rhoda Leland

12 BIRTHPLACE OF

MOTHER (City)

(State or country)

Virenter Maine.

13 F. a. Somerby

Cale

(Month)

(Day)

(Year)

18 PLACE OF BURIAL CREMATION, or REMOVAL

Woodlawn

(Cemetery)

(City or town)

DATE OF BURIAL

Jan. 6/28

(Month) (Day) (Year)

19 UNDERTAKER

Bil. Sullins

ADDRESS

3. Boston

20 Burial permit

issued by

Mm. D. Children

Official

position

Halit Officer

21 Date of issue ... 1/4/29

Permit No.

1549

16 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows :

Intend in guis with association Shah candy an accidentes Jule downton

(See reverse side for description for unknown person)

17 Where was injury sustained

if not at place of death ?

M.D.

Medical Examiner for.

Suffering.

51 1929.

Winthrop Mass

Filed

(Month) (Day) (Year)

REGISTRAR

16,946

3 SEX Female (State or country) PARENTS Informant (Address) 14 Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF (b) Name of employer

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Widow

Registered No.

City or Town

Winthrop

Frances 2 Jamesby

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

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has at- tended during his last illness, at the request of an under- taker 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 so that it can be clas- sified under the international classification of causes of death), 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. . . .- General Laws, Chapter 46, Section 9.

No undertaker or other person shall bury or other- wise dispose of a human body in a town, or remove there- from a human body which has not been buried, until he has received a permit from the board of health . . . , 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 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, ... or clerk .. .. a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied . . . by a satisfac- tory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as herein- after 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 physi- cian 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. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The per- son 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 man- ner or cause of the death, which the clerk or regis- trar may require .- General Laws, Chap 114, Sec. 45 as amended.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are sup- posed 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; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.

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 physi- cian is absent from home when the certificate of death is needed.

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Town of Winthrop : Record of Deaths 1928-1930, Part 70

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

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