USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 104
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(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.
1
DRM R-302
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
important.
A TRUE COPY.
Heids Ofedition Quirks
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Jan.
1936
.. 19 .. 35
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dee
31
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Dec30
19 .3.5 to.
Dea ... 31
19.35 ..
I last saw him. alive on
Deo .... 31
19 .... 35 death is said
to have occurred on the date stated above, at.
4.42An.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
arteriosclerotic & hypertensive heart disease
10 yrs
Contribatory causes of importance not related to principal cause:
Congestive heart failure
cerebral embolus with cerebral
infarction
2 wks
16 dys
Name of operation
Date of.
What test confirmed diagnosis?
Was there an autopsy? yes
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
L V Ragadale
M. D.
(Address)
Boston
Data/2/
.19.86
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Malone NY
(City or town)
DATE OF BURIAL
(Cemetery)
Jan
3
1936
.79.96
22 NAME OF
UNDERTAKER
J S Waterman & Sons
Boston
ADDRESS
Received and filed
JAN 14 1936
19 .. 35
1
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.
11395
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
John B
Williams
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No ..
(Usual place of abode)
52 Pebble
.St.,.
Ward,
Winthrop
(If nonresident, give city or town and state)
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
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of
Lucy B Young
(Give maiden name of wife in full)
(or) WIFE of (Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 66 3 Months Days
16
If less than 1 day Hours .Minutes
OCCUPATION :
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
sal.8man
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)
1935
11 Total time (years) spent in this occupation
40
12 BIRTHPLACE (City)
(State or country )
Springfield Mass
13 NAME OF
FATHER
John W Williams
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Mary C Malone
16 BIRTHPLACE OF MOTHER (City) (State or country)
Hartford Conn
17 Wife- Lucy B Williams
Informant (Address)
above
50m-9-'31. No. 3385-fr
PLACE OF DEATH
SUFFOLK (County)
No. Mass ... General .. Hospital
.St., ..
Ward
(If U. S.
War Veteran,
247
(write the word)
AGE
Years
(Registrar of City or Town where deceased resided)
-
STANDARD CERTIFICATE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
Registered No.
248
Township
Kensington
or Village
or
City
Tweet
No.
(If death occurred in a hospital or institution, give ita NAME instead of street and number)
ds. How long in U. S. if of foreign birth? -yrs. .. mos. .... ds.
2. FULL NAME
Frank Hanley
(a) Residence: No.
(Usual place of abodr)
(If nonresident five city or town and State)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3. SEX
m.
4. COLOR OR RACE | 5. SINGLE, MARRIED. WIDOWED,
qR DIVORCED (write the word)
OWED .
21g DATE OF DEATH (month, day, and year)
DO ct. 12. 1935
22.
I HEREBY CERTIFY, That I attended deceased from
19
., to
19
5a. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
I last saw h. alive on 19 ....; death is said
6. DATE OF BIRTH (month, day, and year) Una 10, 186 1st
do have occurred on the date stated above, at
.m.
7. AGE
20
Years
Days
If LESS than
1 day,
___ TITS.
The principal cause of death and related causes of Importance
were as follows:
Arterio rclerotic brant
Date of onsel many
CCCUPATION
8. Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Retired Laboran Visterio Clerosis
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
Othercontributory causes of importance:
Cerebral Thrombosis or
seconds.
12. BIRTHPLACE (city or town)
(State or country)
13. NAME Francia Hanley
14. BIRTHPLACE (city or town)
(State or country)
England
15. MAIDENA Jannie Hawthorne
16. BIRTHPLACE (city or town)
(State or country)
Scotland
Where did Injury occur? (Specify city or town, county, and State) Specify whether Injury occurred in industry, in home, or in public place.
17. INFORMANT (Address)
Manner of Injury
18. BURIAL, CREMATION, OR REMOVAL
Nature of injury
Place
Date
19
24. Was disease or injury in any way related to occupation of deceased?
19. UNDERTAKER. (Address)
If so, specify
(Signed).
J. Sandin
M. D.
20. FILED 19 FEB 2 - 1936
Registrar.
(Address)
Portsmouth n. H.
0 11-10031 OCCUPATION is very important. See instructions on back of certificate. state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should
V. S. No. 98 N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of -
1. PLACE OF DEATH
County
Rockingham
State
n.N
St ..
.Ward
Length of residence In city or town where death occurred
_yrs
a
. mos.
St.
Ward.
Winthrop man
wh
Months
2
2
or
min
disease, generalized
Memontage
FATHER
Name of operation
Date of.
What test confirmed diagnosis?
Was there an autopsy?
23. If death was due to external causes (violence) fill in also the following: Accident, suicide, or homicide ?. Date of injury. 19
MOTHER
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 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 housewife 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 servant-private family, cook-hotel, etc. For a person who had no occupation whatever 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 particular 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 other contributory causes of importance, name other important diseases or injuries. Examples:
Example I
Example II
The principal cause of death and related causes of importance were as follows:
Date of onset
The principal cause of death and related causes of importance were as follows:
Date of onset
Arteriosclerosis
1915
Attack of epilepsy
1 week ago
Chronic interstitial nephritis
1921
Run over by street car
1 week ago
Cerebral hemorrhage
July 5, 1927
Peritonitis
3 days ago
Other contributory causes of importance:
Other contributory causes of importance:
Gallstones
May 1, 1923
Gastroenteritis
1 year
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
U. S. GOVERNMENT PRINTING OFFICE: 1990
C11-3184
1
- --------
RM R-302
PLACE OF DEATH
Middlesex (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
State Infirmary Tewksbury, Mass. (City or town making return)
Registered No.
572
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Louise Noonan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18 Wadsworth
St.,.
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
16
days. How long in U. S., if of foreign birth?
7 YTS.
?
mos.
7 days
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
(Give maiden name of wife in full) (Husband's name in full)
7 AGE 77 Years Months Days
If less than 1 day Hours Minutes
Housework
11 Total time (years) spent in this occupation.
12 BIRTHPLACE (City)
Not learned
John Noonan
14 BIRTHPLACE OF
FATHER (City)
Not learned
Elizabeth Hickey
16 BIRTHPLACE OF
MOTHER (City)
Not learned
(State or country)
P.E.I.
A TRUE COPY.
ATTEST:
Jamence XX. Afully, M.D.
(Registrar of city or town where death occurred)
December
28
19 ... 35
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
28 1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That i attended deceased from
Dec ..
12
19 .. 3.5to
De.c ....... 28 ., .... , 19 .. 35
I last saw h .... e.I.alive on
D.e.c ..
28., ........ , 19 .. 35, death is said
to have occurred on the date stated above, at. 1.1 .: 45n. AM The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Arteriosclerosis
fyr.s.
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis?
Clinical Was there an autopsy ?.. No.
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
Charles L. Holland
M. D.
(Address)
State Infirmary
Dat1 2/28 19 35
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Tewksbury - Tewksbury
(Cemetery)
(City or town)
DATE OF BURIAL
December ...... 31
1$3.5.
22 NAME OF
UNDERTAKER
H. L. Farmer & Son
ADDRESS
Lee St., Tewksbury, Mass
Received and filed
FFB 2 : 1936
19
(Registrar of City or Town where deceased resided)
MARGIN RESERVED PUR BINDING
1 Tewksbury (City or Town) No. State Infirmary 2 FULL NAME (a) Residence. No. (Usual place of abode) 3 SEX 4 COLOR OR RACE hite Female 5a If married, widowed, or divorced HUSBAND of (OT) WIFE of 6 IF STILLBORN, enter that fact here. 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 OCCUPATIONI year) (State or country) PE.I. 13 NAME OF FATHER 15 MAIDEN NAME OF MOTHER PARENTS 17 Informant Hospital Records (Address) important. DATE FILED 50m-9-'31. No. 3385-fr N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE (State or country) P.E.I.
St.,
Ward
(If U. S.
War Veteran,
219
specify WAR)
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