USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1934 > Part 89
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(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.
M R-301
Suffolk
(County)
Winthrop
(City or Town) No. .Winthrop Communi ty Hospital St.,
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop, Mans (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 ..
Howell.C.Wardwell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
114 .. Pleasant
.....
St., .............
Ward,
(Usual place of abode)
Length of residence in city or town where death occurred 22
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
Widowed
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
Ida (Barrett) Wardwell
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years 3 Months 8Days
If less than 1 day . Hours .Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Salesman
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Clothing Store
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation.
this occupation (month andgay .1931
year)
12 BIRTHPLACE (City)
Stoneham
(State or country) Massachusetts
13 NAME OF
FATHER
David K. Wardwell
14 BIRTHPLACE OF
FATHER (City)
Olsfield
(State or country) Maine
Susan Briggs
16 BIRTHPLACE OF
MOTHER (City)
Paris
(State or country) Maine
17 Record of Welfare Dept.
Town of 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)
Realthe 13/7/35
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
Fifth
(Day)
19.34
(Month)
(Year)
19
HEREBY CERTIFY, That I attended deceased from
-
V تعري 19
I last saw h Lalive on
1937 to Un 5 19 ..... 7., death is said
10 Pm.
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
Contributory causes of importance not related to principal cause:
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)
nhatran Date 12/191
M. D.
(Address)
Lindenwood
Mass ...
(City or town)
DATE OF BURIAL
December
7th.
19.3.4
22 NAME OF
Richard H ... White
UNDERTAKER
ADDRESS
147 Winthrop St. Winthrop, Mass
Received and filed
DEC 1-2 1934
19
A TRUE COPY, ATTEST: (Registrar)
١
Ward
War
(If U. S.
War Veteran,
specify WAR)
(If nonresident give city or town and state)
4 COLOR OR RACE
Whi te
PLACE OF DEATH
1 3 SEX Male 7 AGE 77 OCCUPATION PARENTS (Address) 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 PLAII, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 15 MAIDEN NAME OF MOTHER 100m-11-'30. No. 605-b
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
Stoneham
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
1021
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.
IM R-302
ISU!
(Countr) BOSTON
(City or Town)
No. Strong. Hospital
St.,
..... Ward
BOSTON
(City or town making return)
Registered No.
104.7.2
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Jackson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
(Usual place of abode)
1.08 ... Brookfield ... Rd
St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
утв.
mos.
days. How long in U. S., if of foreign birth?
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec 6 1934
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from Dec 6 19.34, to.
Dec 6 19 ... 34
I last saw
im alive on
Dec
6
19
34death is said
to have occurred on the date stated above, at. -
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
premature birth
7.mos pregnancy
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)
JH Strong
M. D.
(Address)
Boston
Date12/7/ 19 34
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
D.ec
8
1934
22 NAME OF
UNDERTAKER
C ... R.Bennison
ADDRESS
Winthrop
Received and filed JAN 9
1535
(Registrar of City or Town where deceased resided)
important.
50m-9-31 No. 3385_₪
17 Informant (Address)
Mrs. Carl ... Olafsson WA beop
A TRUE, COPY.
ATTEST.
(Registrar of city or town where death occurred)
DATE FILED
Dec
11
19.34
(write the word)
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
OF 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.
7
AGE .Years. Months Days
If less than 1 day
Hours .... 1.5 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
11 Total time (years)
spent in this
occupation.
this occupation (month and
year)
12 BIRTHPLACE (City)
E Boston Mass
(State or country)
13 NAME OF
FATHER
Nels C Jackson
14 BIRTHPLACE OF
FATHER (City)
PARENTS
(State or country) Sweden
15 MAIDEN NAME
OF MOTHER
Pura Olafsson
16 BIRTHPLACE OF MOTHER (City) (State or country) East Boston
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
1
PLACE OF DEATH
JEFOLK
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(If U. S.
War Veteran,
specify WAR) Winthrop
19
M R-302
PLACE OF DEATH
SUFFOLK BOSTON (City or Town)
No. Infants ... Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
10497
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Jackson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
108 Brookfield Rd
.St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred yTs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
(Give maiden name of wife in full)
If less than 1 day
Hours
.Minutes
11 Total time (years) spent in this occupation.
E Boston Mass
Niels Jackson
Tora Olafson
16 BIRTHPLACE OF MOTHER (City) (State or country) E Boston
Grandmother T Olafson above
(Registrar of city or town where death occurred)
Dec 11 19.34
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Deo 8
1934
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Dec
6.
19 .. 3.4 to
Dec
8
19 ...
3.4
I last saw h ..
.......... alive on
19
death is said
to have occurred on the date stated above, at
m.
The principal cause of death and related causes of importance in order of onset were as follows: prematurity
Date of onset
12/8/34
Contributory causes of importance not related to principal cause:
ateleclasis
Name of operation
What test confirmed diagnosis?
Date of
Was there an autopsy?
no
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
M Gill
M. D.
(Address)
Boston
Date
12/8/ 19.34 ..
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
Cemetery)
(City or town)
DATE OF BURIAL
Dec
10
19 ..... 34
22 NAME OF
UNDERTAKER
C ... R.Bennison
ADDRESS
Winthrop
Received and filed
JAN 9
1935
19
(Registrar of City or Town where deceased resided)
1 2 FULL NAME (a) Residence. No. (Usual place of abode) 3 SEX M 4 COLOR OR RACE W 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 .2 Days 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) 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 17 Informant (Address) A TRUE COPY. ATTEST: tion should be carefully 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. DATE FILED 50m-9-'31. No. 3385_ N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country) Sweden
.St.,
.....
Ward
(L U. S.
War Veteran,
218
specify WAR)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
M-
2
M R-301
Suffolk
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
219
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
Harriet (Owen) Winter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
483 ... Shirley.
.St., ..
..........
.Ward,
(If nonresident give city or town and state)
Length of residence in city or town where death occurred
I 8 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
Dec.
9
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from January 8 1932 to December 4, 1934
Mast saw her
... alive on
December 9, 1934 death is said
6:30Am.
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
Chronic Myocardial Degeneration 1931
Contributory causes of importance not related to principal cause: arteriosclerosis
1930
Senility
1934
Name of operation
What test confirmed diagnosis Cancelx
Labrary
none
Date of
Was there an autopsy 220
20 Was disease or injury in any way related to occupation of deceased?
M. D.
If so, specify.
(Signed) Jacobo abiqua 100
(Address) 562 Stanley
Date: Dec 10 9 34.
21 PLACE OF BURIAL,
CREMATION QR-REMOVAL
Forest Hills Boston
(Cemetery)
(City or town)
DATE OF BURIAL
Dec. 12 /34
19
22 NAME OF
Richard H. White
UNDERTAKER
ADDRESS
147 Winthrop St. Winthrop
Received and filed 19
A TRUE COPY, ATTEST:
DEC 12 1934
(Registrar)
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Charles G. Winter
(Husband's name in full)
If less than 1 day
Hours. .Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. Housewife
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D. Children (Signature of Agent of Board of Health or other)
Health Khivier 7 (Official Designation) V
(Date of Issue of Permit)
12/10/34
St.,.
.......... Ward
PLACE OF DEATH
Winthrop 1 (City or Town) No. 483 Shirley (Usual place of abode) 3 SEX 4 COLOR OR RACE Femsle White (or) WIFE of 6 IF STILLBORN, enter that fact here. 7 AGE 75 Years. 7 Months 3 .Days 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. this occupation (month and OCCUPATION year) 12 BIRTHPLACE (City) Manchester (State or country) England 13 NAME OF FATHER Elias Owen 14 BIRTHPLACE OF FATHER (City) (State or country) Wales PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) England 17 Son Harold R. Winter Informant 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-11-'30. No. 605-b N. B .- WRITE PLAINSY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 15 MAIDEN NAME OF MOTHER Jane Barnett
(Address) 15 Elliott St. Winthrop Mass.
(If U. S.
War Veteran,
specify WAR)
34
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
1015
Chronic interstitial nephritis
1021
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.
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