USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 71
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PLACE OF DEATH
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
8150
(If death occurred in a hospital or institution,
Ward
give its NAME instead of street and number)
2 FULL NAME
William C. West
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No
46 Tewkesbury
.St.,
Ward,
Winthrop
(Usual place of abode)
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
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept.
24,
1931
(Month)
(Day)
(Year)
5a If married, widowed, or divore HUSBAND of
Mgt. J. Middleton
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 34
AGE
Years
9
Months
Days
29
If less than 1 day .. Hours Minutes
OCCUPATIONI
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Auto Mechanic
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ..
10 Date deceased last worked at 11 Total time (years) occupa sept. 1931 spent in this occupation .. 15 yrs. Contributory causes of importance not related to principal cause:
year) .
E Boston, Mass.
12 BIRTHPLACE (City)
(State or country)
13 NAME OF FATHER Walter West
PARENTS
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Sarah Loester
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17 Wife
Informant
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
C Sullivan
(Signature of Agent of Board of Health or other)
9/25/31
(Date of Issue of Permit)
A TRUE COPY, ATTEST:
(Registrar)
19 31
Received and filed.
Se pt .
28,
-
(Official Designation)
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Norman C .Baker
M. D.
(Address) Boston, Mass.
Date
9/25/9
3:
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
E Boston
Boston
DATE OF BURIAL
(Cemetery
Sept.
27
19
3]
22 NAME OF
UNDERTAKER
W T White
ADDRESS
Winthrop, Mass.
31
Suture of perforated.
9/22/
Name of operationIcer
What test confirmed diagnosis? Was there an autopsy ?-
Yes
14 BIRTHPLACE OF
FATHER (City)
50M-11-'29. No. 7180-b
important.
1
(County) Boston
(City or Town) Mass. General Hospital No.
St.,
(If U. S.
War Veteran,
specify WAR)
188
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
19 I HEREBY CERTIFY, That I attended deceased from
Sept. 22,
1931
to.
Sept.
24., , 19 .31
I last saw h
1malive on
Sept
24,
.... , 193.1 ..
death is said
to have occurred on the date stated above, at. 9:30₽.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Perforated duodenal ulcer with peritonitis 22 dys
)
(If nonresident, give city or town and state)
William C. Heat Dept. 24, 1931
-
RM R-302
Essex
(County) Dan vers
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Fli zabeth J. Williams
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Ward,
Winthrop
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED-
or DIVORCED! Owed
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE
Joh give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 76
AGE Years Months Days
If less than 1 day Hours. Minutes
OCCUPATION|
8 Trade, profession, or particular kind of work done, as spinder sawyer, bookkeeper, etc .......... ousewife
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)
Bermuda.,
(State or country)
W.I
13 NAME OF
FATHER
John Baul f
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF MOTHER (City) (State or country)
England
17
Informant
Gertrude F. Smith
Hat horne
A TRUE COPY.
ATTEST: (Registrar of city of town where death occurred) 10/5/31.
DATE FILED .19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct. 1, 1931.
(Month)
(Day)
19 I HEREBY CERTIFY,
July
1 ,
19
.3Ô to
Oct.
1,
31
I last saw f.
Oct .
alive
193.1
death is said
to have occurred on the date stated above, atl.2.20A.M.
The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: M ocarditis with renal disease 1920
1
Contributory causes of importance not related to principal cause: Psychosis with other somatic Disease; cardio renal disease 1921
.12.1.4
Name of operation
Date of
What test confirmed diagnosis?
clinicalwas there an autopsy ?...
20 Was disease or injury in any way related to occupation of deceased?
If so, specif
H. A. Tadpell
(Signed)
(Address)
Hathorne
18/2/31. 19
M. D.
21 PLACE OF BURIAL,
Winthrop Winthrop
CREMATION OR REMOVAL
(City or town)
DATE OF BURIAL
22 NAME OF
UNDERTAKER
C. R. Bennison
ADDRESS
Winthrop
Received and filed
OCT 10 1931
19
1
PLACE OF DEATH
(City or Town)
No Danvers State Hospital
St.,
Ward
(If U. S.
War Veteran,
189
(a)
Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred LO
yrs.
9mos.
2 7 days.
How long in U. S., if of foreign birth?
yrs.
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- 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 EXACTLY. PHYSICIANS should state CAUSE MARGIN RESERVED FOR BINDING
important.
50m-2-'30. No. 7997-1
(Address)
(Cemetery)
10/3/31.
19
no
fRegistrar of City or Town where deceased resided)
specify WAR)
St.,.
female
(Year)
That I attended deceased from
Elizabeth J. Hellianes Ect. 1,1931
RM R-301 A
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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-9-'30. No. 9954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
Suffolk {County) Winthrop. (City or Town) \ No 26 Ingleside Avest
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.
190 .....
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME Lovicy Inezetta May Davison. (If deceased is married, widowed or divorced woman, give also maiden name.)
(If U. S. War Veteran, specify WAR)
(a) Residence. No .. 26 Ingleside Aves, Ward,
(Usual place of abode)
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred 62 yrs. 4 mos. 29 days. How long in U. S., if of foreign birth? yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female/ White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single.
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
19 I HEREBY CERTIFY, That I attended deceased from Get. 11. 19.30, to ... , 199/
I last saw h / alive on.
Det. 3,
, 19.3 ...... , death is said
to have occurred on the date stated above, at / I. m. The principal cause of death and related causes of importance in order of onset were as follows:
Carcinoma
1900
6
Contributory causes of importance not related to principal cause:
12 BIRTHPLACE (City)
Winthrop.
(State or country)
Massachusetts.
13 NAME OF
FATHER
John W. Davison.
14 BIRTHPLACE OF
FATHER (City)
gloucester.
(State or country) Massachusetts.
15 MAIDEN NAME
OF MOTHER Lovicy Paddock White.
16 BIRTHPLACE OF
MOTHER (City)
Plymouth,
(State or country)
Vermont
17 Miss, Winnie Davison.
(Address)
26 Ingleside Are.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
(Signature of Agent of Board of Health or other)
He alte officer 10/5/31
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
108/1
(Year)
(er) WIFE of (Husband's name in full)
6 IF STILLBORN, enter that fact here
AGE 62 Years' 4 Months 29 Days
If less than 1 day
Hours
Minutes
OCCUPATION|
8 Trade, profession, or particular - kind of work done, as spinner, sawyer, bookkeeper, etc.
ayse keeper. at home.
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at 11 Total time (years) spent in this occupation 50
.....
abril 153%.
Name of operation Care Date of 12021- What test confirmed diagnosis ?...... Was there an autopsy ?. 20.
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
(Address) 3 Pressione trop
Date. 06.45.19.0.1 ....
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Winthrop.
(Cemetery)
(City or town)
DATE OF BURIAL
October
5,
1931.
22 NAME OF
UNDERTAKER
ERCharles R. Bennison
147 Winthro f St Win.
ADDRESS
Received and filed
OGT-13 1931
19
(Registrar)
1
Registered No.
Ward
S
200.
., M. D.
this occupation (month. and
year)
april, 1931
Date of Onset
Jack. 3, 1931 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 "employce," "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. "
mili, , 1," 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: Arteriosclerosis
Date of onset
1915
Chronic interstitial nephritis
1021
Cerebral hemorrhave
July 5, 1927
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 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 scen 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.
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 disease, and those of persons found dead.
RM R-301A
1 2 FULL NAME 3 SEX (or) WIFE AGE OCCUPATION 14 BIRTHPLACE OF FATHER (City) PARENTS 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-9-'30. No. 9954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 12 BIRTHPLACE (City) (State or country)
addington
(County) Winthrop
Winthrop Community Hospital
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. 191
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Eliza a. Me Fanden
ff deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No,!
(Usual place of abode)
Length of residence in city or town where death occurred
yrı.
.St.,
Ward,
Loves
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth? Trs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Widowed
5a If married, widowed, or divorced HUSBAND of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
61
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.
none
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
this occupation (month and
year)
Mathawakeq.
Magne
13 NAME
illian Stewart,
(State or country)
15 MAIDEN NA
Victoria Hodydon.
16 BIRTHPLACE OF MOTHER (City) (State or country) England.
17 res 19/08
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued: Wm.D. Vieldress (Signature of Agent of Board of Health or other)
10/6/3/
{Official Designation) (Date of Issue of Pefmit)
18 DATE OF
DEATH
Oct
4
(Month)
(Day)
1931 (Year)
19 I HEREBY
CERTIFY, That I attended deceased from
19.
36
32 ... to ...
Qt 4
, 19 31
I last/ saw her
alive on
Cet 4, 1931
death is said
Date of Onset to have occurred on the date stated above, at / D. m. The principal cause of death and related causes of importance in order of ofset were as follows: Perconte following Cholecystectomy for des por dle el 4 all Bladdas
3 days,
Confibátory causes, of importance not related to principal cause: Chronic Endocardite
3 typer trophy o Dilatation of Theart!
1986
Name of ope
holecystectomy
What test confirmed diagnosis?
no Date of. Sep 26/3/ Was there an autopsy !. to
20 Was disease or Injury in any way related to occupation of deceased?
If so, specity
Richard At Mom's
(Signed)
35 Curry Il Euroatt Da Det S 1931,
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Ght Prope. Banger, Maine,
DATE OF BURIAL
Cemetery)
(City or town)
1931
22 NAME OF UNDERTAKER Vim Contantisons
ADDRESSDifferent
Received and filed 19
(Registrar)
MEDICAL CERTIFICATE OF DEATH
(If U. S. War Veteran, specify WAR) ... .....
Birch
mos.
Ward
PLACE OF DEATH
Och. 4, 1931
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, 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: Arteriosclerosis
Date of omset
1915
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 19-7
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 piven in the order of onset, so that in a group of three causes the principal cause rity 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.
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