USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 65
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.m.
The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: Cerchas Demanila SE
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)
(Address)
DateO
8/11
, M. D.
19.3.3
21 PLACE OF BURIAL,
(City or town)
35
CREMATION OR REMOVALMt.Pleasant ... Harwichport
Aug . jemetery)
DATE OF BURIAL
19
22 NAME OF
UNDERTAKER
R ...... H ..... White
ADDRESS
151 Pleasant St., winthro
Received and filed
AUG 22 1933
1
.
19
A TRUE COPY, ATTEST: (Registrar)
.....
Lima
, 19
17
33
I last saw halive on
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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of . PARENTS 200M-11-'29. No. 7180-a
1
No. 40 WillowAve ...... Winthrop.St., Lettuce N.
Registered No.
(I U. S.
War Veteran,
specify WAR)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(Day)
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 .. . Chop. 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.
1
RATED
SEPT /4
SEAL OF
INCORP
1694
HARWICH
ADOPTED SEPT.
4 .1897.
HENRY K, BEARSE
Harwich, Mass.,
aug. 29
1932 3
TOWN CLERK
Donald & Mchero. Town Clerk. Winthrop. Nos.
My dear Sir- How just received the death report of me Letti Diana Chose a resident of Harwich. My I assist you in having a true and correct record of the above named parte ,
#2- Lettuce r. Chase. /
#7-
12
14 -
15
-
#
16
13 ypro - 15 days. (for July 27, 1860) atariich, Mass Harwich 11 Lettuce A Newcomb
- Harwich Marx. This data is copied from the Tren Reads.
very truly. Henry 15. Bears Joun & Cok.
OFFICE OF Selectmen, Assessors, Overseers of Public Welfare and Board of Health
TOWN OF HARWICH
RM R-301
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 200M-11-'29. No. 7180-a
1 No. 3 SEX Male 7 AGE 64 OCCUPATION! 14 BIRTHPLACE OF FATHER (City) (State or country) 15 MAIDEN NAME OF MOTHER 16 BIRTHPLACE OF MOTHER (City) 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 saw mill, bank, etc ..
PLACE OF DEATH
Suffolk (County)
winthrop (City or Town) 164 Woodside Ave
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop (City or town making return)
165
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Edward .Vincent Atcherley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
164 woodside Ave.
St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
30
yrs.
mos.
days. How long in U. S., if of foreign birth? yra.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
(Month)
(Day)
5a If married, widowed, or divorchillips
HUSBAND of
Agnes P
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years 8
23
Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Clerk
9 Industry or business in which work was done, as silk mill,
R.R. office
10 Date deceased last worked at
11 Total time (years)
spent in this
40
occupation (month a
year) July 1933
occupation
12 BIRTHPLACE (City)
Providence
(State or country) Rhode Island
13 NAME OF
FATHER
John Atcherley
Wolverhampton
England
Drusilla Greatorex
(State or country)
England
17 Agnes P.Atcherley
Informant (Address) 164 woodside ave winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: m. D. Chil dress
(Signature of Agent of Board of Health or other)
/5/33
Health Devices
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
august
12
1933
(Year)
19 I HEREBY CERTIFY That I attended deceased from Jan 26 1933 august 12, 193.3 ... , to.
Dast saw hadalive on Cinq 120, 193, death is said to have occurred on the date stated above, at 11.201 m.
The principal cause of death and related causes of importance In order of onset were as follows: Dateafonset Cirrhosis y Luna 6
Contributory causes of importance not related to principal cause: ascite
Name of operation
Paracentinaio
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)
(Address)
Date
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
winthrop
winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
Aug.15 1933
19
22 NAME OF
UNDERTAKER
Charles .R.Bennison
ADDRESS
winthrop,
Mass
Received and filed
AUG 22
1933
19
A TRUE COPY, ATTEST: (Registrar)
1
?
!
1
Date of
4 COLOR OR RACE
White
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
St.,
Ward
(If U. S. War Veteran, specify WAR)
M. D.
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, rook-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,' "4 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
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 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.
RM R-305
PLACE OF DEATH
SUFFOLK (County)
BOSTON
(City or Town)
No. Mass ... General ... Hospital
St.,
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON 166
(City or town making return)
Registered No. 69.9.8
(If death occurred in a hospital or institution, - Ward
2 FULL NAME
Henry ... W.
LaDuke
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No.
36 Revere St
Winthrop 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? yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
Male
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
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 1. Years ... 11 Months 27 Days
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ....
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years) spent in this occupation.
Bos ton
12 BIRTHPLACE (City)
(State or country)
Mess
13 NAME OF
FATHER
Donald LaDuke
PARENTS.
14 BIRTHPLACE OF
FATHER (City)
(State or country) Canada
15 MAIDEN NAME
OF MOTHER
Eane Wade
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
Mas8
17 Informant (Address)
Donald La Duko
thro
A TRUE COPY.
·ATTEST:
James J. Mulvey
(Registrar of city rown where death occurred
Aug
18
19 33
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug. .13 1933
(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)
Poisoning by lead (enaphalites )
incidental to gnawing of painted
surfaces.
1?
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 ?
inthrop
Manner of
Injury
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
G. B. Magrath
M. D.
(Address)
Boston
Date.8.1.5.19.3.3 ...
22 PLACE OF BURIAL,
CREMATION OR REMOVAL .... Holy Cross
"Cemetery)
Maldon
(City or town)
DATE OF BURIAL
Aug
.. 16
19.33
23 NAME OF
UNDERTAKER
M ... J Kelly
ADDRESS
East Boston
Received and filed.
AUG :
(Registrar of City or Town where deceased resfled)
1933 19
DATE FILED
25m-2-'30. No. 7997-e
1
give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
(City of town and State)
RM R-301
Suffolk
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making r turn)
Registered No 16?
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
CASSIUS V. GILLIS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No .... Station Hospital,U. S. Army, For. Banks .Ward, (Usual place of abode)
Length of residence in city or town where death occurred yrs.
23 days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
18 DATE OF DEATH August
15th 1933
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That 1 attended deceased from July 24, 19.33 . to August 15, , 19. 33
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 43 Years O Months 2.1 Days
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Machinist
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Unknown
10 Date deceased last worked at 11 Total time (years) spent in this occupation. ?
this occupation (month andInknown.
year)
12 BIRTHPLACE (City)
E ..... Westmoreland,
(State or country) N.H.
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