USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 85
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PLACE OF DEATH
Suffolk (County)
1
Winthrop
(City or Town)
No ... 295 Winthrop
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
linthrop (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 .... Phoebe .... Estelle Bent
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
295 Winthrop
St., .............
Ward,
(If nonresident give city or town and state)
Length of residence in city or town where death occurred
20
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE 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.
Saleslady
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Shoe store
10 Date deceased last worked at this occupation (month and year)
11 Total time (years)
July 193spent in this
30
occupation.
12 BIRTHPLACE (City)
(State or country)
Massachusetts
13 NAME OF
FATHER
Charles C.Bent
14 BIRTHPLACE OF
FATHER (City)
Canton,
Massachusetts
(State or country)
15 MAIDEN NAME Phoebe Ann Malin OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
Chester
(State or country)
Pennsylvania
17 Informant Alfred 295 (Address) Intresgtst Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
Health officer 11/6/33
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Nov
3
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Cent
8
1931, to Nov
3
19.3.w.
I last saw h&& ....... alive on
Nov
2
19 33 death is said
to have occurred on the date stated above, at 12:15 A m. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
Chronic myocarditis
Sept 12 1133
Contributory causes of importance not related to principal cause:
Cerebral Humanhagen
Cent 8 19 31
Name of operation
none
.Date of.
What test confirmed diagnosis? Pasmal illeation Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify~
Payment & Parker
(Signed)
M. D.
(Address)
Winthrop
Mars
Date.
Nov 5 1932
21 PLACE OF BURIAL,
North Dorchester
CREMATION OR REMOVAL
Burying GroundCemetery)
(City or town)
DATE OF
NOV .6 1933
19
22 NAME OF
UNDERTAKER
Charles R.Bennison
ADDRESS
Winthrop, Mass
Received and filed
19
4. .. 1933
A TRUE COPY, ATTEST:
(Registrar)
217
specify WAR)
1933
(Give maiden name of wife in full)
AGE
Dorchester
St.,
Ward
(If U. S.
War Veteran,
Revised United States Standard Certificate of Death
Statement of occupation .- Precise statement of occupation is ervy 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 onset
1915
Chronic interstitial nephritis
1921
Cerebral hemorrhage
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 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.
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.
ORM R-302
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No
9125
(If death occurred in a hospital or institution,
Ward
give its NAME instead of street and number)
2 FULL NAME
Margaret
Simpson Leveille
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
99Cliff Ave
St.,.
Ward,
Winthrop
(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?
уrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(er) WIFE o
J.a
ph E Laveille
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE 38 Years 3.2. Months .. 20 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)
192.9
11 Total time (years) spent in this occupation 14
12 BIRTHPLACE (City)
Newton
Mass
John S Johnson
Canada
15 MAIDEN NAME
OF MOTHER
Catherine McDonald
Canada
17
Informant
Jos E Leveille
Winthrop
ATTEST :.
James A. Mulvey
(Registrar of city oftown where death occurred
Nov 8
33
19.
18 DATE OF
DEATH
Nov.
4
1933
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Oct ...... 24
1933., to.
.Nov.
A.
19.33.
I last saw h .... er .. alive on.
A
19 .. 33., death is said
to have occurred on the date stated above, at. 5.30Am. The principal cause of death and related causes of importance in order of onset were as follows:
Dateafonsot
fibre tract degeneration in spinal cord?pernicious anaemia carcinoma .. of ... bladder with .. lymphnode .. metastases
mo8.
2 ... yrs
Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis? ..
Date of
autopsy
Was there an autopsy ?... yes
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
.O.L.Clay
M. D.
(Address)
Boston
Date. 11/4/.19.33.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
Nov
6
19.33.
22 NAME OF
UNDERTAKER
C ... R ... Bennison
ADDRESS
Winthrop
Received and filed
DECU
1933
19
(Registrar of City or Town where deceased resided)
MARGIN RESERVED FOR BINDING
1 No. 3 SEX F 7 OCCUPATION (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) (Address) A TRUE COPY. important. DATE FILED 50m-2-'30. No. 7997-đ 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 (State or country)
PLACE OF DEATH
Peter .. Bont.Brigham.Hospital ... St.,
(If U. S.
War Veteran,
219
specify WAR)
(If nonresident, give city or town and state)
MEDICAL CERTIFICATE OF DEATH
FORM R-301
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) No. 54 Highland avesy,
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(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
A annie Marcel analy
(If deceased is a married, widowed or diyorced woman, give also maiden name.)
St.,
Ward,
(If nonresident, give city or town and state)
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 nov 7
(Month)
(Day)
1933 (Year)
19 I HEREBY CERTIFY, That I attended deceased from nov. 7, 8:P.M. 1933 to. Nov. 7, 9p.M. 1933
I last saw her alive on.
19.33 ... , death is said
to have occurred on the date stated above, at 9%. .. m.
The principal cause of death and related causes of importance In order of onset were as follows: Coronary Thrombosis Dateofonset arteriosclerosis 1929
Contributory causes of importance not related to principal cause:
Pulmonary Edema
Name of operation
Date of.
What test confirmed diagnosis?
Was there an autopsy?
no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
Samuel B. Goldberg
(Address) 270 Shirley ST
Whichcap
Date
, M. D.
21 PLACE OF BURIAL,
Pine Grove Lynn
(Cemetery)
(City (or town) 19 33
22 NAME OF
UNDERTAKER ..
Richard 16 While
ADDRESS
Winthrop Mass
Received and filed
19
(Signature of Xgent of Board of Health of other)
11/9/33 (Official Designation) (Date of Issue of Permit)
200M-11-'29. No. 7180-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
13 NAME OF
FATHER
Hadley MacDonald
14 BIRTHPLACE OF
FATHER (City)
Boston
(State or country) 1Mass
15 MAIDEN NAME
OF MOTHER
Known
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
mass
17 não 1 R 16 alcander
Informant (Address) 235 Withmyton are Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjal or transit permit was issued:
.Ward
(If U. S. War Veteran,
specify WAR) 219
(a)
Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred
yTs.
5 SINGLE
(write the word)
MARRIED
WIDOWED
5a If married, widowed, or divorced
HUSBAND of
Thanks
(Giye maiden name of wife in full)
Dracoto
(or) WIFE of
(Husband's pame in full)
6 IF STILLBORN, enter that fact here.
7 AGE 68 Years 5 Months
13
.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.
26 ausewife
at 16 one
10 Date deceased last worked at this occupation (month and year) Itouchenter
11 Total time (years) spent in this occupation
12 BIRTHPLACE (City) (State or country) mass
PARENTS
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of MARGIN RESERVED FOR BINDING
DATE OF BURIAL
over
A TRUE COPY, ATTEST:
(Registrar)
3 SEX
Minale White
4 COLOR OR RACE
mos.
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.
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