USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1937 > Part 71
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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 dissase, and those of persons found dead.
R-302
PLACE OF DEATH
SUFFOLK (County)
BOSTON
(City or Town)
No. 39 .. Howland
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No. 6882
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Francea
Aiasen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
(Usual place of abode)
52a ... Trident .. Ave
St., .............
Ward, .Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yTs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
Fe
white
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of Adolph Aissen (Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 48
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.
housewife
9 Industry or business in which
work was done, as silk mill,
at home
saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
this occupation (month andOct 1936
year)
spent in this
occupation.
12 BIRTHPLACE (City) (State or country)
Russia
13 NAME OF
FATHER
Louis Silvermen
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
16 MAIDEN NAME
OF MOTHER
Gertrude Sedersky
16 BIRTHPLACE OF MOTHER (City)
(State or country)
17 Laformant (Address)
Husband-
abgre
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED July 21 19.3 7
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
18
193
7
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
April 25
193.7 .. , to.
July 17
19 37
I last saw h ..
ex .. . alive on
July 17
19.37
death is said
to have occurred on the date stated above, at 11 A m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
carcinoma of stomach
Oct. 1937
darcinomatosis , ribs innominate bones, femur liver and ? brain.
25 Contributory causes of importance not related to principal cause:
Hypostatic pneumonia
7/17/37 !
Name of operation Date of What test confirmed diagnosis? Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed)
M. D.
(Address)
F. F Henderson Boston Date7 /19/
196 193. 7. Everett
21 PLACE OF BURIAL. CREMATION OR REMOVAL
International Workers cruetery
July
(City or town) 19 3.7.
22 NAME OF UNDERTAKER
ADDRESS
B Schlossberg & Son Dorchester
Received and filed
19
133
(Registrar of City or Town where deceased resided)
important.
50m-9-'31. No. 3385-x
tion should be carefully supplied. 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
1
St.,
Ward
(If U. S.
War Veteran,
185
specify WAR)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
PARENTS
Russia
DATE OF BURIAL
SEP 181937 PM 5
MATS.
R-302
PLACE OF DEATH
SUFFOLK (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No. 7097
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Ben jamin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
310 Shirley
St., ............
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
Esther Sandler
(Give maiden name of wife in full)
(Husband's name in full)
If less than 1 day
Hours
Minutes
retired
leather worker
11 Total time (years) spent in this occupation ... Б yrs
Russia
Max Sogoloff
Russia,
mimomm
17 Samo Morris Sogoloff 10 Surfside Bà Lym
ATTEST:
Huida Sedation Quick
(Registrar of city or town where death occurred)
DATE FILED
July 30
19 57
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
27.
1937
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
July 14
19 ... 37 to.
July ... 27
.....
19.3.7 ...
1 last saw h ....
n. alive on
July 27
19.3.7 .. , death is said
to have occurred on the date stated above, at. 6.20P.m. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
carcinoma .. of ... stomach
5.mos
Contributory causes of importance not related to principal cause:
broncho .. pneumonia
4 .. dys!
Name of operation
resection stomach
Date of
7/24/37
What test confirmed diagnosis?autopsy
Was there an autopsy? yes
20 Was disease or injury in any way related to occupation of deceasmo
If so, specify
(Signed)
M. D.
(Address)
Date
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Maple Hill
Peabody
(Cemetery)
(City or town)
DATE OF BURIAL
July 28
19 37
22 NAME OF
UNDERTAKER
L Hymanson
Lynn
ADDRESS
Received and filed
19 567
(Registrar of City or Town where deceased resided)
50m-9-'31. No. 3385.
1 BOSTON (City or Town) No (a) Residence. No. (Usual place of abode) 3 SEX 4 COLOR OR RACE Male white 5a lí married, widowed, or divorced HUSBAND of (or) WIFE of 6 IF STILLBORN, enter that fact here. 7 65 AGE Years Months 8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. 9 Industry or business in which work was done, as alk mill, saw mill, bank, etc .. 10 Date deceased last worked at this occupation (month and OCCUPATION 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) (State or country) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) Informant (Address) A TRUE COPY. tion should be carefully supplied. AGE should be stated Chacitt. FITISfelANS shedid state CAvet year) Har1922 OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
Peter Bont Brigham Hospital St.,
Ward
Sogoloff.
(If U. S.
War Veteran,
186
specify WAR)
WB 08 good
Boston
7/27/ 19 37
Days
R-302
PLACE OF DEATH
SUFFOLK (County)
BOSTON
(City or Town)
No. Infants .. Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No. 7.139
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Belson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No
(Usual place of abode)
81 Shore Drive
St.,
..........
. Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yTs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of (Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE
Years Months
Days
If less than 1 day
10
.Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
OCCUPATION
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
11 Total time (years) spent in this occupation
year)
12 BIRTHPLACE (City)
(State or country)
Everett Mass
13 NAME OF
FATHER
Benjamin J Belson
14 BIRTHPLACE OF
FATHER (City)
PARENTS
15 MAIDEN NAME
OF MOTHER
Blanche Landy
16 BIRTHPLACE OF MOTHER (City)
Russia
(State or country)
17 Laformant (Address)
Father.
A TRUE COPY.
ATTEST:
Auta Predations turks
(Registrar of city or town where death occurred)
DATE FILED 193 7
Aug 2
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 28
193
7
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
July 28
1957, to ...... July 28
19.3.7
[ last saw h ... @r ... alive on
July 28
19.37, death is said
to have occurred on the date stated above, at .... 11. .. P.m. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
prematurity
7/28/37
bilateral.atelectasia ... of ... lung
7/28/37
Contributory causes of importance not related to principal cause: respiratory failure
7/28/37
Name of operation What test confirmed diagnosis? Was there an autopsy? 8
Date of
20 Was disease or injury in any way related to occupation of deceased? If so, specify
M. D.
(Signed)
R. T. Moulton
(Address)
Boston
Date
7/28/193 ... 7
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Woburn
DATE OF BURIAL
Beth Joseph (Cemetery) (City or town) July 30 19 3 ... 7
22 NAME OF
UNDERTAKER
M Stanetsky
Boaton
ADDRESS
Received and filed 19
DET
(Registrar of City or Town where deceased resided)
important.
50m-9-'31. No. 3385-g
tion should be carefully supplied. 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
1
... St.,
Ward
(If U. S.
War Veteran,
182
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(State or country)
Russia
R-302
PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
The Commonwealth of Massachusetts COFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No ..
73.76
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
John F
Greene
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ....... 134 .. Circuit ... Rd
(Usual place of abode)
St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
(write the word)
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
widowed
5a If married, widowed, or divorced HUSBAND of Elizabeth Doyle (Give maiden name of wife in fully
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
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. ...
WPA
10 Date deceased last worked at this occupation (month and
11 Total time (years) spent in this
Aug 1 1937
8 mas
12 BIRTHPLACE (City)
(State or country)
Boston
13 NAME OF
FATHER
Patrick J Greene
14 BIRTHPLACE OF FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary E Molaughlin
16 BIRTHPLACE OF MOTHER (City) (State or country)
Winchester Mass
Dau: Elizabeth Groene
above
A TRUE COPY.
Hilda Ofedition Juink
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Aug 10 1937
MEDICAL CERTIFICATE OF DEATH
(Month)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
Aug 3
1937 .. , to.
Aug .... 5
19.37.
I last saw h ...
imalive on
Aug 5
19 .. 37., death is said
to have occurred on the date stated above, atl 1.2.5Am.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
paratyphoid. B.fever
broncho ... pneumonia
1 wk
8/3/37
Contributory causes of importance not related to principal cause:
general arterioslcerosis
yr.s.
Name of operation Date of What test confirmed diagnosis? Was there an autopsy? no.
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
(Address)
W. B. Osgood Boston
Dat 8/5/.
. 19 37.
21 PLACE OF BURIAL, CREMATION OR REMOVAL Holy Cross Malden
(Cemetery)
(City or town)
DATE OF BURIAL Aug 9
22 NAME OF
UNDERTAKER
W J Cashin
ADDRESS
Boston
Received and filed
1027
1935.
CT
(Registrar of City or Town where deceased resided)
501-9-'31. No. 3385.7
1 3 SEX Male (or) WIFE of 7 AGE 64 OCCUPATION! PARENTS 17 Informant (Address) important. OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated LAAciLf. FHISICIANS should state CAVDe year)
No. Peter Bent Brigham Hospital ..... St.,
Ward
(If U. S.
War Veteran,
specify WAR)
188
18 DATE OF
DEATH
(Day)
August 5.
1937
M. D.
R-305
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
7669
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Berton
Segal
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
7.Thornton Pk
St.,
Ward,
Winthrop
(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?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Malo
4 COLOR OR RACE
white
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
single
18 DATE OF DEATH August ... 17 1937
(Month)
(Day)
(Year)
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 18 11 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 ..
olark
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc ..
groot Total time (years)
10 Date deceased last worked at
this occupation (month and
year) .
Kug 1937
spent in this occupation .. 1 Homicide ?
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass
13 NAME OF
FATHER
Josoph Segal
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Ida Swarts
16 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
17 Informant (Address)
Uncle- Jacob Segal
hulpf21 Juston StBrooklineNE OF
A TRUE COPY
ATTEST:
Alda Ofedition Juinte
(Registrar of city or town where death occurred)
DATE FILED
Ång 20 1937
MEDICAL CERTIFICATE OF DEATH
19 I 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- presumably accidental.
Found ... under water .in.rear of Elks Home Winthrop where he had been bathing.
20 If death was due to external causes (VIOLENCE) fill in the following : Accident, Suicide or
Date of injury 19
1
Where did injury occur ? Winthrop Mass
(City or town and State)
Manner of
Injury
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
W J Briokley
M. D.
(Address)
Boston
Date
8/18/19 37
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Adath Israel Wakefield
(Cemetery)
(City or town)
DATE OF BURIAL
Aug. 19
19.3.7.
UNDERTAKER
B .... F .... Solomon
ADDRESS
Brookline
Received and filed 19
(Registrar of City or Town where deceased resided)
25m-2-'30. No. 7997-e
PARENTSE
1
No. Masa General Hospital
... st.,
Ward
(If U. S.
War Veteran,
189
specify WAR)
1
R-302
PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
.7637
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Rubin
Fisher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No.
(Usual place of abode)
52 .. Loouat
.St.
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of Elisabeth Himelfarb
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years Months
Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
shoe ... store
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
Feb 1937
11 Total time (years) spent in this occupation. 30
12 BIRTHPLACE (City) (State or country)
Russia
13 NAME OF
FATHER
Israel Fisher
14 BIRTHPLACE OF FATHER (City)
(State or country)
Bussia
15 MAIDEN NAME
OF MOTHER
Esther -
16 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
Wife-
above
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Aug 19
19.3
7
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August 17
193
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Aug 2
193.7 ... , to.
Aug 17
19 .. 3
.7
I last saw h ... 1m.alive on
Aug 17
19 ..... 3.7
death is said
to have occurred on the date stated above, at. 10.154
The principal cause of death and related causes of importance in order of onset were as follows:
Date ofonset
generalized arteriosclerosis chronio myocarditis
yrs
yr.8
Contributory causes of importance not related to principal cause:
broncho ... pneumonia
16 .. dyı
Name of operation What test confirmed diagnosis?
Date of
Was there an autopsy? DO
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed)
W. B. Osgood
M. D.
(Address)
Boston
Date 8/17/19 3.7
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Rumania
Danvers
(Cemetery)
(City or towa)
DATE OF BURIAL
Aug 18
1937
13
22 NAME OF
UNDERTAKER
ADDRESS
B Schlossberg & Son
Boston
Received and filed
19
(Registrar of City or How where deceased resided)
important.
50m-2-'30. No. 7997-d
1 3 SEX Male (or) WIFE of 7 AGE .. 57 OCCUPATION PARENTS 17 Informant (Address) A TRUE COPY tion should be carefully supplied. AGE should be stated EAACILI. PHYSICIANS should state CAUSE year) .. OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
No.
Peter ... Bent Brigham.Hospital ...... St.,
Ward
(L U. S.
War Veteran,
1.90
specify WAR)
301A
1
...
(County) WIN THRO F (City or Town) No. WINTHROP COMMUNITY JOSP. S .St., ...... Ward
10/9/37 Commonthralth 'of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME.
BABY SACCO (STILLBORN)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
(Usual place of abode)
71 EUTAW ST. EASE POSTON Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
益OS。 days. How long in U. S., if of foreign birth? yTE.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH
September
1
1937
(Year)
(Month)
(Day)
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.
STILLBORN
7 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 ...
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-
(State or country)
MAS.
13 NAME OF
FATHER
Carl Jacco
14 BIRTHPLACE OF
FATHER (City).
00- Queller
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
nellie trongillo
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
setores
Relation, if any
Informant
(Address)
710 low St. Qua int
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transu permit was issued: Mm. D. Childressx (Signature of Ment of Board of Health of other )
Wealth Slecht
(Date of Issue of Permit) 9/9/37
(Ficial Designation)
(Registrar)
1
19
I last saw h. allve on 19 death Is said
to have occurred on the date stated above, at. m. The principal cause of death and related causes of Importance in order of onset were as follows:
Date of Onset IMPORTANT
asplupia Neonatouna
Contributory causes of importance not related to principal cause:
Obesity of mother.
6
Name of operation.
-What test confirmed diagnosis ?.
Date of.
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify
D. D. Patito
(Signed)
M. D.
(Address)
) Central Sa Date 8/7
1937
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
DATE OF BURIAL
(Cemetery) 7 93/ 19
22 NAME OF
UNDERTAKER
1215 Month,It Sich
ADDRESS
Received and filed.
SEP 8
..... .19
100m-12-'34. No. 2938-f
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.
PLACE OF DEATH
SUFFOLK
17
Carl Sacer
(City or town)
O
PARENTS
19 I HEREBY CERTIFY, That I attended deceased from
19
to
MEDICAL CERTIFICATE OF DEATH
(If U. S.
War Veteran,
specify WAR)
191
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.
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