USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 64
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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.
ORM R-301
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of MARGIN RESERVED FOR BINDING
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
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
1
Winthrop
(City or Towh)
No. 10 Charles St.
St.,
.Ward
(If death occurred in a hospital or institution, 1
give its NAME instead of street and number)
2 FULL NAME
Annie ( Thorburn)/Brittain
(If deceased is a married, widowed or divorced woman, give also maiden name.) ;
(a) Residence.
.. 10 .... Charles.
St.
St.,
Ward,
(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?
yes.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
Female white
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Charles F. Brittain
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 63 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, saw mill, bank, etc.
At Home
10 Date deceased last worked at
this occupation (month and
year) ..
Boston ,
Mass.
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
(State or country)
13 NAME OF FATHER Alexander Thorpurn
14 BIRTHPLACE OF
FATHER (City) ...
Scotland
(State or country)
15 MAIDEN NAME
OF MOTHER
unknown
16 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
200M-11-'29. No. 7180-a
17 Mrs. Elsie B. Blatchrord
Informant (Address) 5% Howard St. Melrose
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Health fficer
(Date of Issue of Permit) 26/30
(Official Designation)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH Aug. 6.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
July
13
I last saw het
alive on
aug
6 , 1933, death is said
to have occurred on the date stated above, at.
9.45m.
The principal cause of death and related causes of importance In order of onset were as follows:
Dateofonset
Cerebral hemorrhage
Dug 4,19
arteriosclerosis chronic nephritis
Contributory causes of importance not related to principal cause:
Date of.
Name of operation
What test confirmed diagnosis?
Was there an autopsy? 200
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Samuel Smith
(Signed)
(Addres
310 Shirley AV
Date aug/ 1933
21 PLACE OF BURIAL
CREMATION OR REMOVAL Old ... Calvary Boston
(Cemetery)
(City or town)
DATE OF BURIAL AUS. B.
19.2.5.
22 NAME OF
UNDERTAKER
Richard H.White
ADDRESS
151
Pleasant St. Winthrop
Received and filed
19
A TRUE COPY, ATTEST: (Registrar)
Registered No.
162
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Widowed
33
19.3.3. to.
aug. 6
19.3.3
., M. D.
PARENTS
(Signature of Agent of Board of Health or other
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
1015
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 inake 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.
/
ORM R-301
MARGIN RESERVED FOR BINDING
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 200M-11-'29. No. 7180-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
interop
(City or town making return) 1123
Registered No.
(If death occurred in a hospital or institution, 1
give its NAME instead of street and number)
2 FULL NAME
Martha (Janes) May
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
36 madison Ave
St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yra.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
emale
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Edward Ernest ...... av
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 65 Years X Months
If less than 1 day
Hours
.Minutes
OCCUPATION|
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
House work
9 Industry or business in which
Own home
work was done, as silk mill,
saw mill, bank, etc ..
10 Date deceased last worked at
-Total time (years).
this occupation (month and ug . 16, 193 cent in this45
year) ..
occupation
12 BIRTHPLACE (City)
Newfoundland
(State or country)
13 NAME OF
FATHER
Janes
14 BIRTHPLACE OF
FATHER (City) Unable to obtain
(State or country)
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF MOTHER (City) Unable to obtain
(State or country)
17 Informant Edward E.May (Address) 36 Madison Ave. Winthrop lass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D. Miris
(Signature of Agent of Board of Health or other) Wealth Auer, 3/12/33
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
10
1933
Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
may 14
19.3.1 .. , to.
august 10
1933
I last saw her alive on
august
90
19.2.3, death is said
to have occurred on the date stated above, at.
2 P.m.
The principal cause of death and related causes of importance in order of onset were as follows: Chronic myocardial degeneration
Date ofonset 1931
Contributory causes of importance not related to principal cause:
acute Cardiac dilatation
1933 ...
Name of operation
What test confirmed diagnosis Chucol let
Date of
Was there an autopsy 20
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
d) Juert Cham MA
(Address) 562 & huiley St
.M. D.
Dat ong 11 1933
21 PLACE OF BURIAL,
winthrop
.inthrop
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
Aug. 12.1933
19
22 NAME OF
UNDERTAKER
Charles R. Bennison
ADDRESS
Winthrop, Miss
Received and filed.
19
1
winthrop
(City or Town)
No. 36 Madison Ave
St.,
Ward
(If U. S.
War Veteran,
specify WAR)
(Usual place of abode)
12
(write the word)
x Days
A TRUE COPY, ATTEST: (Registrar)
2
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
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.
RM R-301
-
PLACE OF DEATH
winthrop (City or Town)
Harwichbort Notified 8/25/33 Corrected copy The Commonwealth of Massachusetts mailed to Launch OFFICE OF THE SECRETARY Suffolk (County) (City or town making return) DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
4,8,33
164
Ward 5 (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
-bettie Dians ... Chase
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ...
Harwichport., .... Mass
St.,
Ward,
(If nonresident, give city or town and state)
(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?
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
Female
white
Single
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
73 75 Years ............. Months.15. .Days
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. none
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)
Harwichpert
(State or country)
Mass.
13 NAME OF FATHER Johnthan Chase
14 BIRTHPLACE OF
FATHER (City)
Harwich
Mass.
(State or country)
15 MAIDEN NAME ,
OF MOTHER
Lettuce a. Newcomb
not known
16 BIRTHPLACE OF
MOTHER (City)
Harvick Mass
(State or country)
not known
17
Informant Mary S. Tewksbury
(Address) 24 James Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
D. Childress
(Signature of Agent of Board of Health or other)
Health Officer
Cinq 11/33
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug ..
(Month)
11
33
(Year)
19
HEREBY CERTIF
¥. That I attended deceased from
to
10
1905 death is said
to have occurred on the date stated above, at.
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