USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 53
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PLACE OF DEATH
County Winthrop (City gr Town) 48 Bowdion No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return) ....
Registered No.
138
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Frank O' Rourke
(If deceased is a married, widowed, or divorced woman, give also maiden name.)
(a) Residence.
No.
40 Boundion
.St., ............... Ward,
(If nonresident, give city or town and state)
(Usual place of abode) Length of residence in city or town where death occurred 3 yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Dingle
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 83 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.
10 Date deceased last worked at this occupation (month and year) .. 1918 11 Total time (years) spent in this occupation .. 30mg
12 BIRTHPLACE (City) (State or country)
CasBoston mass
13 NAME OF
FATHER
Daniel O' Rourke
14 BIRTHPLACE OF FATHER (City)
Ireland
15 MAIDEN NAME OF MOTHER
Cm Cassidy
16 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
17 Is ellen Fraiser
Informant (Address) 40 Boudion St Vuille
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Tom &buildreps (Signature ttoE Agent of Board of Health or other) 140 3/1131
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Month)
(Day)
1431 (Year)
19. I HEREBY CERTIFY, That I attended deceased from 3 1931, to July 2 ,19 }/ Ilast saw h ...... alive on 3.0 .... , 19 3 .... , death is said to have occurred on the date stated above, at 2040%.
The principal cause of death and related causes of importance in order of onset were as follows: Dataofonset Imasdites
Contributory causes of importance not related to principal cause:
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? If so, specify
(Signed)
Bate
7/19
21 PLACE OF BURIAL, CREMATION OR REMOVAL
Holy Cross Malchin (Cemetery)
July
(City or town) 1931
22 NAME OF UNDERTAKER
DATE OF BURIAL William a. Treand 559 Saratoga St 2 .13.
Received and filed
JUL 7
-1931 19
A TRUE COPY, ATTEST: (Registrar)
1
1
L
(Address)
, M. D. 31
ADDRESS
1
Suffolk
2 FULL NAME
St.,
Ward
(If U. S. War Veteran, specify WAR)
4 COLOR OR RACE
Plummer
(State or country)
7-
1
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, soup 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
1015
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause : Fracture of arm
Automobile accident
May 3, 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, Orysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
M R-301
PLACE OF DEATH
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
1 (If death occurred in a hospital or institution, Ward ) give its NAME instead of street and number) (If U. S. War Veteran, specify WAR) Mary. Evelin. Though upham (If deceased is a married, widowed or divorced woinan, give also maiden name.)
(a) Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred
yTS.
10
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
7
4
1931
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
7/1
19.3 ..... to.
7/4
1931
I last saw he alive on.
7/4
19 ... 3 ..... 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
Contributory causes of importance not related to principal cause:
Eddig
1
Date of.
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Signed)
(Address)
M. D.
Date
19
.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Franklin. U.H.
DATE OF BURIAL
July 74- 1931
(City or town)
19
22 NAME OF
UNDERTAKER
Chas. P. Beringer
ADDRESS
Received and filed
JUL 7
.1931
19
A TRUE COPY, ATTEST: (Registrar)
1
Ward, (If nonresident, give city or town and state)
4 COLOR OR RACE
- While.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
manuel
5a If married, widowed, or divorced
HUSBAND of
acavemaiden name of wie kumpan
(or) WIFE of
(Husband's name in full)
G IF STILLBORN, enter that fact here.
7
46
Years
22
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.
House Recha
> Hostess
10 Date deceased last worked at this occupation (month and year).
11 Total time (years)
20
spent in this
occupation ..
12 BIRTHPLACE (City)
(State or country)
22.44 1.
13 NAME OF
FATHER
James . N. Gray ST.um
(State or country)
15 MAIDEN NAME
OF MOTHER
Vinca Jamal.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 alfer, S. Thompson
200 M-11-'29. No. 7180-a
1 No. 2 FULL NAME 3 SEY I tunale AGE OF PARENTS OCCUPATION| Informant (Address) 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. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 14 BIRTHPLACE OF FATHER (City)
Suffolk (County)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mmh Chilidices. a /(Signature of Agent of Board of Health or other)/ July 6131
(Official Designation) (Date of Issue of Permit)
Name of operation
What test confirmed diagnosis?
(Cemetery)
1 July 4, 1939 1 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, cotion 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
1915
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, orysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
M R-301
Juffikk
PLACE OF DEATH
"(County)
(City or Town) 15 Thulay St.,
Francesca Lamp
(If deceased is a married, widowed or divorced woman, give alsofmaiden name.)
(a)
Residence.
(Usual piace of abode)
Length of residence in city or town where death occurred
20
yTs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
BOs.
days.
PERSONAL AND STATISTICAL PARTICULARS .
(write the word)
5'å If married, widowed, or divorced HUSBAND of
(Give maiden came of wife in full)
Ladona
(Husband's name in full
6 IF STILLBORN, enter that fact here.
7
46
AGE
Years
9
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.
Hace wife
10 Date deceased last worked at this occupation (month and year) ..
11 Total time (years) spent in this occupation ..
13 NAME OF
FATHER
unable to obtian
r
4
17 Patei. Lampazona:
Informant
(Address)
15. Shirly Sl. Watching
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial ør transit permit was issued: Wine. D. Childress
(Signature of Agent of Board of Health or other)
Idealthe office. 7/9/31
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
(Month)
7 (Day)
1931 (Year)
19
I HEREBY CERTIFY, That I attended deceased from
-
192 1.
,192 9., to
› last saw h .... ...... alive on 19.2./ ..... , death is said to have occurred on the date stated above, at 10:40Pm 7/2/31 The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: Liban Pneumonia.
Contribatory causes of importance not related to principal cause: my randet chini
1920
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
(Signed)
If so, specify.
CP. W. Taylor.
M. D.
(Address) 270 Common alt & auE Date/8 193/
.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
)
DATE OF BURIAL
(City or town)
(Qemeters)
July 10
19 3/
22 NAME OF
UNDERTAKER
Chas 2 De
ADDRESS
Received and filed.
JUL 17-1931
19
A TRUE COPY, ATTEST: (Registrar)
"
(IF U. S. War Veteran, specify WAR)
St.,
Ward,
(If death occurred in a hospital or institution, give its NAME instead of street and number)
.Ward Cumala
Registered No
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD> CERTIFICATE OF DEATH
(City or town making return)
(If nonresident, give city or town and state)
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
1 No. 2 FULL NAME 3 SEX Vemale (or) WIFE of OCCUPATIONI 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 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. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 200M-11-'29. No. 7180-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)
1
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.
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