USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 86
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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.
FORM R-305
Essex
(County)
Danv
No .. Danvers ... State ... Hospital
St.,
Ward
give its NAME instead of street and number)
2 FULL NAME
Mary .... I ..... Bowman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
(Usual place of abode)
5 Bates Ave.
St.,
Ward, Winthrop
Length of residence in city or town where death occurred
13 yrs.
mos. 6
days. How long in U. S., if of foreign birth? yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
wido wed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Herbert Bowman.
(Husband's name in fuli)
6 IF STILLBORN, enter that fact here.
7 AGE Y7a2
Months Days
. Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Housework
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ..
this occupation (month and
year)
12 BIRTHPLACE (City)
{ Charlestown} Boston,
(State or country)
Mass
13 NAME OF
FATHER
Wm. J. Andrew
PARENTSE
14 BIRTHPLACE OF
FATHER (City)
Nova Scotia
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Ö'Brien
16 BIRTHPLACE OF MOTHER (City) (State or country)
Canada
17
Gertrude F. Smith,
Informant
(Address)
Hathorne
A TRUE COPY.
.ATTEST:
(Registrar of city or town where death occurred)
DATE FILED 11/15/33
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH Nov .... 1933
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)
Pulmonary oedema
"Coronary sclerosis Generalized arteriosclerosis Sudden Death
20 If death was due to external causes (VIOLENCE) fill in the following : Accident, Suicide or
Homicide ?
Where did injury occur ?
(City or town and State)
Manner of
Injury
Nature of
Injury yes
21 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
S ..... Chase Tucker
M. D.
(Address)
Peabody
Date 11 /119 33
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
St. Paul Arlington
(Cemetery)
(City or town)
DATE OF BURIAL
Nov ..... 13 1933
19
23 NAME OF UNDERTAKER Joseph J . Kelley & Sons
ADDRESS
Cambridge
Received and filed.
NUV 2 4 1933
19
(Registrar of City or Town where deceased resided)
---
MARGIN RESERVED FOR BINDING
25m-2-'30. No. 7997-e
1
PLACE OF DEATH
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
(If death occurred in a hospital or institution,
(If U. S. War Veteran, specify WAR)
220
(If nonresident, give city or town and state)
"Day) (Year)
female
(write the word)
If less than 1 day
Hours
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Date of injury.
19
1
RM R-301
OCCUPATION 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 100m-11-'30. No. 605-b
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No .. 117 Pleasant
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Henry Arthur Weeks
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
117 Pleasant
.St., ..
........
Ward,
(Usual place of abode)
Length of residence in city or town where death occurred
14yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos. ,
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married
hotdog divneedRierstead
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 54
Years
4
Months
.15
Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Accountant
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Bank
10 Date deceased last worked at this occupation (month and year)
Nov.
1933spent in this
occupation
Total time (years) 38
12 BIRTHPLACE (City)
Salem
(State or country)
Massachusetts
13 NAME OF
FATHER
Alonzo P.Weeks
14 BIRTHPLACE OF
Lawrence
FATHER (City)
Massachusetts
(State or country)
15 MAIDEN NAME
OF MOTHER
Emma Chipman
16 BIRTHPLACE OF
MOTHER (City)
Salem
Massachusetts
17 Mrs.Ella M.Weeks
Informant
(Address)
117 Pleasant St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Chil dressx
(Signature of Agent of Board of Health or other)
11/14/33
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
3 3
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That
attended deceased from
3 3
[ last saw h.
M ..... alive on
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:
Date of Onset .
Contributory causes of importance not related to principal cause:
0
2 4
Name of operation
What test confirmed diagnosis?
Date of
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased? if so, specify
(Signed)
M. D.
(Address)
Date
11/13/1923
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
DATE OF BURIAL
Nov. 14, 1983
(City or town)
19
22 NAME OF
Charles R.Bennison
UNDERTAKER
ADDRESS
Winthrop, Lass
Received and filed
NOV 1* 1933
19
A TRUE COPY, ATTEST:
(Registrar)
1
St., ..
.Ward
Winthrop (City or town making return)
(If U. S.
War Veteran,
specify WAR)
221
(If nonresident give city or town and state)
12
19
29 11/12
19.8 3
death is said
AGE
(State or country)
Winthrop
Winthrop
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:
Date of onset
Arteriosclerosis
1015
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-301
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 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
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transif permit was issued: I m. D. Childress (Signature of Agent of Board of Health or other)
Health Orlick 11/15/33
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
12.
(Day)
(Month)
1933
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
3
0
1930 to
12
I last saw h &m alive on.
19 33
-
19.3.3
., death is said
to have occurred on the date stated above, at.
a
m.
The principal cause of death and related causes of importance in order of onset were as follows: nie. Dateofonset
mandati
how 1932
Contributory causes of importance not related to principal cause:
Central Hemorragia
June 3. 17.30
Name of operation
Date of
What test confirmed diagnosis? Personal Orrent Was there an autopsy?
20
20 Was disease or injury in any way related to occupation of deceased?
no.
If so, specify ...
1
(Signed)
Raymond B Parker
M. D.
(Address)
Date Wav, Y 1933.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
15
19.33
22 NAME OF
UNDERTAKER ..?
ADDRESS
Received and filed.
NOV 21 1933
19
A TRUE COPY, ATTEST: (Registrar)
1
(City of Town)/
No. - 2/20 200
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed. or divorced woman, give also maiden name.)
(a) Residence. No. 151 2 asn . 11
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
St.,
Ward,
(If nonresident, give city or town and state)
days.
How long in U. S., if of foreign birth?
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
-
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
51
5a If married, widowed, or divorced
HUSBAND of
7
(or) WIFE of
(Give maiden name of wife in full)
Comuni
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
7 19 Years 2 Months Days
If less than 1 day
Hours
Minutes
OCCUPATION|
8 Trade, profession, or particular
kind of work done, as spinner, faceauxin
sawyer, bookkeeper, etc.
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
10 Date deceased fast worked at
this occupation (month and
year)
11 Total time (years) spent in this occupation
12 BIRTHPLACE (City)
(State or country)
Inuso.
13 NAME OF
FATHER
PARENTS
14 BIRTHPLACE OF
FATHER (City)
not known-
(State or country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City) -22 UM
(State or country)
Informant
(Address)
PLACE OF DEATH
J. (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(If U. S.
War Veteran,
222
specify WAR)
(write the word)
.
MARGIN RESERVED FOR BINDING
I Justan
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 torty-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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