USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 170
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(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Tay 31 1930
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
30 LAV 31
19®
I last saw her
.alive on
130 death is said
to have occurred on the date stated above, at. 8.25P
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Concer of neck
l'etastasis from breast
1978
Contributory causes of importance not related to principal cause:
Name of operation
R. breast removed
Date of
1928
What test confirmed diagnosis? Was there an autopsy?XO
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Daniel MckillOD
(Address)
Cambridge Moss.
Date
6/7
19
Lit Benedict Cem.
3: ston
(City or town)
19
DATE OF BURIAL
22 NAME OF
UNDERTAKER
John E. J'Nelley
ADDRESS
Vinthron Moss.
June 3 1930
Received and filed.
Frederick H. Burke
19
A TRUE COPY, ATTEST: (Registrar)
Important.
50M-11-'29. No. 7180-b
No ..
St.,
Ward
(If U. S.
War Veteran,
,30
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
June 3℃
(Cemetery)
hmm .. )
may 31. 19 30.
30
1
PLACE OF DEATH
NORFOLK
(County)
BROOKLINE (City or Town) No. 910 BOYLSTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BROOKLINE (City or town making return)
Registered No 24/12
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
ELIZABETH ...
.. JANE .. MC ... COY
(Ir deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S. War Veteran, specify WAR)
(a)
Residence.
No.
104 HIGHLAND
AVE
C.,
Ward,
WINTHROP
MASS
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Divorced
18 DATE OF
DEATH
JUNE
4
1930
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
A Christian Scientist under their care Death probably due to Chronio Endocar- ditis and Chronic Inflammatory Arthritis
20 If death was due to external causes (VIOLENCE) fill in the following : Accident, Suicide or Homicide ?
Date of injury
19
Where did injury occur ?
(City or town and State)
Manner of
Injury
Nature of
Injury
5
21 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
William C. Mackie
, M. D.
(Address)
.. 37. Lee St. BrooklineDate
19
30.
22 PLACE OF BURIAL
CREMATION OR REMOVAL
Woodlawn.
- Nashua,. N .... H. g
(City or town)
19
30
DATE OF BURIAL
23 NAME OF
UNDERTAKER
A. E. Long & Son Inc.
ADDRESS
#1979 Mass. Ave. Cambridge
Received and filed
June 4
19
30
A TRUE COPY, ATTEST:
(Registrar)
25 M-11-'29. No. 7180-d
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
Tomm Clerk June/4/1930
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
(write the word)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Walter ...
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
58
Years
3
Months
25 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, saw mill, bank, etc. .
At home
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
occupation
33
12 BIRTHPLACE (City)
Cannotbe .... Learned ..
(State or country)
13 NAME OF
FATHER
Unknown Thompson
14 BIRTHPLACE OF
FATHER (City)
Belfast
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Sarah Adams
16 BIRTHPLACE OF MOTHER (City) (State or country)
Scotland
17
Informant
Mr .. Poff
(Address)
Providence, R. I.
PARENTS.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
7
mos.
8
days.
How long in U. S., if of foreign birth?
yrs.
St.,.
........
Ward
(Cemetery)
June 6
June 4. 1930
-301
PLACE OF DEATH Suffolk ( County ) Winthrop (City or Town)/t 24 Fairview
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop (City or town making feturn)
Registered No.
(If death occurred in a hospital or institution, 5
give its NAME instead of street and number)
John Francis Hasson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
24 Fairview
St.,
......
Ward,
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
1
No
2 FULL NAME
(Usual place of abode)
3 SEX
4 COLOR OR RACE
Male White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
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
67
AGE
Years
-
Months
.Days
8 Trade, profession, or particular
kind of work done, as spinner,
Retired
sawyer, bookkeeper, etc ...
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
this occupation (month and
8/19/27
OCCUPATIONI
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
Le John Hasson
FATHER
(State or country)
PARENTS
17
Susan T. Hasson
Informant
(Address)
24 Jourviens SA
is very important. See instructions and extracts from the laws on back of certificate.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
year)
Boston
mass.
200M-11-'29. No. 7180-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was file with me BEFORE the burial or transit permit was issued: Nom. D. Chuxdrie (Signature of Agent of Board of Health or other) Health Officer
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
4
1930
(Month)
(Day)
(Year)
1930
19 I HEREBY CERTIFY, That I attended deceased from
Sept
21
19.8. to
I last saw h.L.alive on.
3
19 3 Q .. , death is said
to have occurred on the date stated above, at .!...... A .m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Carcinoma of Stomach
Cert 8 1928.
Contributory causes of importance not related to principal cause:
Name of operation
home. x
Date of.
What test confirmed diagnosis Pusmal Olacunt Was there an autopsy? ha
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify
Raymond B. Parker
(Signed)
M. D.
(Address)
Winthrop Man Date June 5 1930.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross Malden
Leretery)
(City or town)
19:30
DATE OF BURIAL
M.
1. Kelly
ADDRESS
22 NAME OF
UNDERTAKER
Il Meridian St. East Boston
.19 ...
A TRUE COPY, ATTEST:
(Registrar)
(If U. S. War Veteran, specify WAR)
Length of residence in city or town where death occurred
33
yrs.
mos.
(write the word)
Single
If less than 1 day
Hours
Minutes
Letter Carrier
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation.
31 yr
14 BIRTHPLACE OF Londondery
FATHER (City)
Ireland
15 MAIDEN NAME
OF MOTHER
Elizabeth a. Hasson
16 BIRTHPLACE OF Londondry
MOTHER (City)
(State or country)
Ireland
Received and filed.
6/6/30
St.,
Ward
days
How long in U. S., if of foreign birth?
yrs.
June
4
une 4. 1930 .
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, 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
I915
Chronic interstitial nephritis
1921
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause: Fracture of arm
Automobile accident
May 3, 1927
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 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, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. . Chap. 114. Sec. 46, G. L., as amended.
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, peritonitis, phlebitis, pyemia, septicemia, tetanus.
301A
Suffolk.
(County)
Winthrop (City or Town)
The Commonwealth 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
(If deceased is a married, widowed or divorced woman, give also maiden name.)
106 Summit Ave Winthrop 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. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
whit
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married.
5a If married, widowed, or divorced
HUSBAND of
George W.Miles
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 71
Years
2
Months
.Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
Housework
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Own Home .
10 Date deceased last worked at
this occupation (month and
year)
1930
11 Total time (years)
spent in this
occupation
50
12 BIRTHPLACE (City)
Albany N.Y.
(State or country)
13 NAME OF FATHER Mapssa Roden
14 BIRTHPLACE OF FATHER (City) (State or country)
Ireland.
15 MAIDEN NAME
OF MOTHER
unknown )Dunelle
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England.
17
Informant
(Address)
106 Summit Aveo
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D. Chil dress (Signature of Agent er Board of Health or other) health officer 6/14/30
"(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June (Month)
12 30 (Year)
(Day)
19
June 12
Jun
INast saw h.
alive on
19.30
I HEREBY CERTIFY, That i attended deceased from
19-30
. to
June 42, 1930, 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:
Dateofonset
Edema a Lungo.
·
6/10/30
Contributory causes of importance not related to principal cause: Senenul arterio Sileuses Queria Bronchitis
Name of operation
What test confirmed diagnosis?
Date of ..
no
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
Haug auf eller
(Address)
Date
6/12 /93.0.
21 PLACE OF BURIAL,
Milford Conn
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
June 15 1930
19
22 NAME OF
UNDERTAKER
ADDRESS
Boston
Received and filed
193d,
(Registrar)
OCCUPATION| is very important. See instructions and extracts from the laws on back of certificate. PARENTS
75m-2-'30. No. 7997-a
.
PLACE OF DEATH
1
No.
106 Summit Ave. Winthrop
Ward
Alice A.Miles
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
, M. D.
George W.Miles.
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, "? «4 . "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, 1027
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker of 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 thea 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 reasofis, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health,sor employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. .. Chap. 114, Sec. 46, G. L. as amended.
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