USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1934 > Part 53
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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.
RM R-302
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Ever. . em 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
PLACE OF DEATH
wald feux (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Leger (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
Watter& Taylor
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
Nowinthrop Green) Hotel St.,
(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
8 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
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.
AGE
7
33
Years
13
Months
.Days
If less than 1 day
Hours
Minutes
OCCUPATIONI
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Soldier.
9 Industry or business in which work was done, as silk mill, National Guard 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) Cambridge (State or country)
ase
13 NAME OF
FATHER
william
PARENTS
15 MAIDEN NAME
OF MOTHER
Lacy a Hurley
16 BIRTHPLACE OF
MOTHER (City)
Cambridge
(State or country)
La 11.
17 Informant Stru d" 101de Fa ch-4 ( Ad State House, Boston was
A TRUE COPY.
ATTEST:
(Registrar of dity or town where death occurred)
DATE FILED
2>
1984
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 21,1934.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
July 21
.193cf to July 21
1934
I last saw halive on
faces 21, 1934
death is said
to have occurred on the date stated above, at 1400 m.
Dateofonset The principal cause of death and related causes of importance in order of onset were as follows: Valvulariheart disease
chroune.
aartic and initial
Insuffici
Contributory causes of importance not related to principal cause: Pulmonary edecca
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy fee.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D.
(Address) For Licenceel
Date
19
21 PLACE OF BURIAL Kaly Chose walder CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
Sucy 24
19844
22 NAME OF
UNDERTAKER
W.C florido.
ADDRESS
Clinton, Laut
Received and filed
JUL 3-0 1934
19
{Registrar of City or Town where deceased resided)
important.
50m-2-'30. No. 7997-
1
Legea (City or Town) Notation Harfetal, Fault stevens Ward
(If U. S.
War Veteran,
specify WAR)
Ward, le winthrop lease
(If nonresident, give city or town and state)
weare
14 BIRTHPLACE OF
FATHER (City)
Somersworth
(State or country) n.tr.
M R-301 A
Every item of N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECO is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
PLACE OF DEATH
Suffolk (County) Winthrop
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, S
give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX ?
4 COLOR OF RACE White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Vinge
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
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) Winthrop,
(State or country}
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
(Penere,
(State or country)
15 MAIDEN NAME OF MOTHER Buthe MinVale
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Informant (Address) Bagel
100m-9-'33. No. 9321-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
cuarenta
ignature of Agent of Board of Health of Other) Lealthe fficer 7/24/31 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
22
(Month
(Day) 1934 (Year)
19
I
HEREBY CERTIFY, That I attended deceased from
June 22
19 34, to July 22
19.3.9 ....
I last saw him alive on
July 22
, 1934
death is said
to have occurred on the date stated above, at J A.m. The principal cause of death and related causes of importance in order of onset were as follows: Date of Onset IMPORTANT Premo nature Birch
june 22-34
(2 month) .
Contributory causes of importance not related to principal cause:
citalectasis
June 2 2 -3 +
Name of operation
What test confirmed diagnosis?
Was there an autopsy? . . U.
20
If so, specify
mark
(Signed)
., M. D.
(Address)
Datemiw, 241934
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Joly Cross Malden
DATE OF BURIAL
July 215
(City or town) 19 34
22 NAME OF
UNDERTAKER
45 Mountains we
ADDRESS 1
Received and filed
AUG 2
1934
19
(Registrar)
1
(City or Town) 0 No Winthrop Immunity NOR 08 total
Ward
2 FULL NAME
(a) Residence( ' No.
(If deceased is a married, widowed or divorced woman, give also maiden name.) 4) Lage. IL Resteere 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.
(Cemetery)
Date of
PARENTS
(Give maiden name of wife in full)
Revised United States Standard Certificate of Death
Statement of occupation .- Pre cise 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 of 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 29 "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.
EXTRACTS FROM THE L S 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 such a permit for the removal of a human body, not previously interred, from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired 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 statement 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 by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
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.
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.
ARM R-305
Essex
(County)
Danvers (City or Town) Nanvers State Hospital
The Commmwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Dan vers
(City or town making return) Registered No ..... 3
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME Carah ... Potts
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Elmwood
St.,
Ward,inthrop
' (If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
-
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCEDWidowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE
Zebalon Potts
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
73
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.
housework
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 (CityMudWinstowe
(State or country)
England
13 NAME OF
FATHER
William Brett
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Edwinstowe,
(State or country) England
15 MAIDEN NAME
OF MOTHER
Lucy Antcliffe
16 BIRTHPLACE OF
MOTHER (City)
Edwinstowe.
(State or country) England
17
Informant
Gertrude F. Smith,
(Address) Ha thorne
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
7/31/34.
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 22, 1334
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the personlafovelnadgd and thatsthe CAUSE AND MEANNER thergof are as follows I'(If an injury was invdived, state fully) 8.1 11.20P
Arteri sclerosis
"Chr. myocarditis
1333
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 ?
(City or town and State)
Manner of
Injury
Nature of
Injury.
21 Was disease or injury in any way related to occupation of deceasedno If so, specify
(Signed) H. Tadzel!
M. D.
(Address)
Hathorne
Date
7/20631
22 PLACE OF BURIAL, CREMATION OR REMOVAL ForestHills Boston
Julfcemetery) 1934 (City or town)
DATE OF BURIAL
19
23 NAME OF
R. I. aite
UNDERTAKER
ADDRESS
winthrop
Received and filed 19
AUG 1.0 1934
(Regi ty or Town where deceased resided)
MARGIN ALULIL ... . ... .........
WI
25m-2-'30. No. 7997-6
DE
PLACE OF DEATH
1
.St.,
Ward
(If U. S. War Veteran, specify WAR) -
(a)
Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos1 0
days. How long in U. S., if of foreign birth?
yrs.
(write the word)
1927
HE VA
IM R-501 A
PLACE OF DEATH
Suffolk (County)
No. 40 Willow Ave.
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.
131
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Mary Ella ( Coonerty) Dow
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
198 Cottage Park Road St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
26
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
5a If married, widowed, or divorced HUSBAND of Alfred Perry Dow (Husband's name in full)
(Give maiden name of wife in full)
If less than 1 day
Hours Minutes
House work
sawyer, bookkeeper, etc.
Own Home
1 1 Total time (years) June 193Ment in this 57
occupation
13 NAME OF -
FATHER
John C. Coonerty
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF MOTHER (City) . Unable to obtain
17 Herbert .... C ...... Dow ..
Informant
(Address)
198 Cottage Pk. Rd. 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) Hearthe fficer 7/27/34
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
25
1934
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from 29
1925
25
19.3 Y
I last saw han alive on Je
25
19 34
death is said
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:
Dale of Onset IMPORTANT
Central Hemontage
War 29 192.5 June 22 1934
Contributory causes of importance not related to principal cause:
Name of operation.
What test confirmed diagnosis Obscure
Was there an autopsy?
No
20 Was disease or injury in any way related to occupation of deceased? 200
If so, specify
(Signed)
(Addre
Writing Man
Datefully ??
19 34
21 PLACE OF BURIAL.
Albany Vermont
CREMATION OR REMOVAL
(Cemetery)
(City or towa)
DATE OF BURIAL
July 29 1934
19
22 NAME OF
Charles R. Bennison
UNDERTAKER
ADDRESS
Winthrop. Mass.
Received and filed
AUG ... 2.
1934
.. 19
(Registrar)
1925 + 1425 +
Date of.
M. D.
1 Winthrop (City or Town) (Usual place of abode) 3 SEX 4 COLOR OR RACE White Female (or) WIFE of 6 IF STILLBORN, enter that fact here. 7 AGE 74 8 Trade, profession, or particular 9 Industry or business in which work was done, as ailk mill, saw mill, bank, etc. 10 Date deceased last worked at this occupation (month and year) (State or country) Vermont 14 BIRTHPLACE OF FATHER (City) PARENTS OCCUPATION (State or country) 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 100m-9-'33. No. 9321-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORDDEEvery item of 12 BIRTHPLACE (City) Albany
St., ..........
............... Ward
(If U. S.
War Veteran,
specify WAR)
" P.
.m.
Years
6
Months
25
Days
Revised Und 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 houseke per-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.
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