USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1934 > Part 22
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(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.
R-302
Middlesex
(County)
Melrose :
...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Melrose
(City or town making return)
Registered No.
(City or Town)
No. Melrose Hospital
St.,
Ward
give its NAME instead of street and number)
Baby
2 FULL NAME
Leary
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
47 Centre
.St.,.
........
Ward,
Winthrop
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
18 DATE OF
DEATH
March 12, 1934
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Stillborn
7 AGE 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.
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)
Melrose
(State or country)
Mass
13 NAME OF
FATHER
Frederick J. Leary
14 BIRTHPLACE OF
FATHER (City)
Point Comfort
(State or country) Virginia
15 MAIDEN NAME
OF MOTHER
Agnes R. Kirby
16 BIRTHPLACE OF
MOTHER (City)
Cambridge
(State or country)
Mass.
17 F .J.Leary Informant (Address)47 Centre St. Winthrop
A TRUE COPY.
ATTEST: (Registrar of city or town where death occurred)
· DATE FILED
March 13, 1934
19
MEDICAL CERTIFICATE OF DEATH
19 I HEREBY CERTIFY, That I attended deceased from March 12, 34 to March 12. 19 .. 19 .... 34 last saw him alive on ... March ... 12. 193.4 ... , death is said
to have occurred on the date stated above, at 11 A m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Stillborn 5 month Premature
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)
R. ..
Layton
M. D.
(Address)
Boston, Mass
Date3/ 12
19
34
21 PLACE OF BURIAL,
CREMATION OR REMOVAL inthrop
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
Llarch 14 1934
19
22 NAME OF
UNDERTAKER
John F. O'Maley
ADDRESS
Winthrop, Mass.
Received and filed
MAR 1 . 19:37
19
(Registrar of City or Town where deceased resided)
LUII anouia pe careruny supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important.
50m-2-'30. No. 7997-đ
PLACE OF DEATH
1
(If death occurred in a hospital or institution,
(I U. S. War Veteran, specify WAR)
(Usual place of abode)
Length of residence in city or town where death occurred
утв.
mos.
days. How long in U. S., if of foreign birth?
yTs.
(write the word)
(Give maiden name of wife in full)
-
PARENTS
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.
2587
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Fannie
Grishaver
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March 12
1934
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Israel Grishaver
(Husband's name in fully
6 IF STILLBORN, enter that fact here.
7
AGE
82
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. 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
at home
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
spent in this
occupation
60
year)
Sept 1933
12 BIRTHPLACE (City)
(State or country)
Boston Ma.88
13 NAME OF
FATHER
Jacob Cornell
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Holland
15 MAIDEN NAME
OF MOTHER
Julia -
16 BIRTHPLACE OF
MOTHER (City)
Holland
(State or country)
17 Morris Grishaver
Informant
(Address)
A TRUE COPY.
Peida Ofedition Quirks
ATTEST:
....
(Registrar of city or town where death occurred)
March
15
19. 34
19 I HEREBY CERTIFY, That I attended deceased from
Sept ...... 15
19.33., to.
... Maroh
12 ..... , 19.34
I last saw h .... ep alive on.
March
12
...... , 19.34, death is said
to have occurred on the date stated above, at 3.45Pm. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
parainoma of tongue
July 1933
Contributory causes of importance not related to principal cause:
Name of operation
implantation of radium
9/18/33
What test confirmed diagnosis? ...
biopsy
Was there an autopsy!
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify.
(Signed)
C C Lund
M. D.
(Address)
Boston
Date.
3/12/19 34
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Netherland SooMelrose
(Cemetery)
(City or town)
DATE OF BURIAL
March
14
19 34
22 NAME OF
UNDERTAKER
B Schlossberg
ADDRESS
Dorchester
Received and filed 19
APR 2 193:
(Registrar of City or Town where deceased resided)
uon should be careruny supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important.
50m-2-'30. No. 7997-đ
PLACE OF DEATH
1
No. Palmer Memorial Hospital
Ward
(If U. S.
War Veteran,
58
specify WAR) Winthrop
9 Trident Ave
.St., ............
Ward,
(If nonresident, give city or town and state)
3 SEX F
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Wid
(write the word)
PARENTS
DATE FILED
R-301 A
PLACE OF DEATH
(County)
Winthrop
(City or Town)
No
23 Elmwood Av.,
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Thomas
Hannaford
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ....
23 Elmwood
avenue St,
Ward,
3
(Usual place of abode)
Length of residence in city or town where death occurred
32
yrs.
mos.
days. How long in U. S., if of foreign birth!@yra. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or HUSBAND of
Bertha May Laforet
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here
Years.
8
Months
16
.Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ....
Master Mechanic
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Boston Post.
10 Date deceased last worked at this occupation (month and year)
3/1/34
11 Total time (years) spent in this occupation
26
12 BIRTHPLACE (City) (State or country) Mass.
13 NAME OF
FATHER
Oliver B.Hannaford
14 BIRTHPLACE OF
FATHER (City)
Cape Elizabeth Maine
15 MAIDEN NAME
OF MOTHER
Sarah A.Barstro
16 BIRTHPLACE OF MOTHER (City) (State or country) Maine.
17 Mrs. Bertha L.Hannaford
Informant . (Address) 23 Elmwood Av. Winthrop.
1 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 effects 3/17/34
(Official Designation)
(Date of Issue of Permitf
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March
16
(Month)
(Day)
1434
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
march
1
1934, to.
March 16, 1939
I last saw h .. kun .. alive on
mann
64 , 19 J.Y .... , death is said
7.A. .. m.
to have occurred on the date stated above, at
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
8 .
Primi
March 1 1934
Contributory causes of importance not related to principal cause:
1931
Name of operation
What test confirmed diagnosis? location
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 was L/1935
Winthrop Winthrop
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
March 18,
DATE OF BURIAL
22 NAME OF
UNDERTAKER
Charles R. Rolling J.E.P.
ADDRESS 300 Meridian St.E.B. ,Mass.
Received and filed .19
MAR 19 1934
(Registrar)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
100m-9-'30. No. 9954.
1 3 SEX Male 7 AGE 61 OCCUPATION: AL sivuia ve slated CAACILI. PHYSICIANS should state (or) WIFE of
PARENTS
(State or country)
Biddeford
St.,
Ward
(L U. S.
1
War Veteran,
specify WAR)
59
(If nonresident, give city or town and state)
petery)
(City or town)
34
Chelsea
(write the word)
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, soup 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
1919
Chronic interstitial nephritis
I021
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 n-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. Lows, 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 clirectly 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.
R-301 A
Suffolk
(County)
Winthrop
(City or Town)
No.
61 Washington Ave.
St., ...................
Ward
To be filed for burial permit with Board of Health or its Agent.
Registered No. (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Addie Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. No.
(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
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH March 20
(Month)
(Day)
1934 (Year)
19
I
HEREBY CERTIFY, That I attended deceased from
Dee /
1919
to ..
Mar 20, 1934
I last saw h .......... alive on
Mar 19
1934, death is said
3 Am. to have occurred on the date stated above, at. The principal cause of death and related causes of importance in order of onset were as follows: Carmona of Uterus
Date of Onset 1918
Contributory causes of importance not related to principal cause:
Vacuna
Double Kyelitis.
Name of operation .. What test confirmed diagnosis ?. Path F
.. Date of.
.Was there an autopsy?
Ho
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
M. D.
475 Cours Que Dato Mes 20, 34 (Address)
21 PLACE OF BURIAL.
Cambridge- Cambridge
CREMATION OR REMOVAL (Çemete (City or town)
DATE OF BURIAL.
22 NAME OF
Charlie B. Watson
UNDERTAKER
ADDRESS
Cambridge, Mass,
Received and filed MAR 27 1934 19
(Registrar)
100m-9-'33. No. 9321-a'
17 Mr. Arthur H. Smith,
Informan!
(Address)
61 Washington Ave, Winthrop, Mass,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
(Signature of Agent of Board of Health ofothery Health Officer 3/21/34
(Official Designation)
(Date of Issue of Permat)
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
OF DIVORCED
5a If married, widowed, or divorced HUSBAND of Arthurvemmaides namgof wife in full) (Husband's name in full)
7 71 Years 9 ... Months .. 13 .... Days
If less than 1 day .Hours Minutes
None.
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City)
Portland,
13 NAME OF
FATHER
John W. Downing.
Portland,
Almeda R. Poole.
Portland, Maine.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION PARENTS
PLACE OF DEATH
1
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(If U. S. War Veteran,
61 Washington Ave.
... St., ................ Ward,
(If nonresident, give city or town and state)
3 SEX
F.
4 COLOR OR RACE
W.
(or) WIFE of
6 IF STILLBORN, enter that fact here.
AGE
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
OCCUPATION
year)
(State or country)
Maine.
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
is very important. See instructions and extracts from the laws on back of certificate.
(State or country)
Maine.
War 13 1934
Du11919
March 22,1934
LAIRAGIG THẨM THE LAWS
Standard Certificate of Death
Revised United S
Statement of occupation .- Precise statement of occupation is Very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation.
11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative." etc. Find out the parti- cular kind of work done and return that, as spinner. weaver, etc.
In stating the industry or business, avoid the use of such general terms as "store, " "factory," "mill," etc. State the particular . kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc ..
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onset
1015
Chronic interstitial nephritis
1021
·Cerebral hemorrhage
July 5. 1027
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.
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