USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 16
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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
c11-3184
STANDARD CERTIFICATE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
1. PLACE OF DEATH
County
Suffolk
State . Massachusetts Registered No.
Township __ Winthrop
or Village
or
City
No. Station Hospital,Fort .. Banks
St ..
Ward
(If death occurred in a hospital or institution, give ita NAME instead of street and number)
Length of residence in city or town where death occurred .yrs. . mos. ds. How long In U. S. if of foreign birth? . yrs. _____ mos. .. ds.
2. FULL NAME
James
Edward ....
.Clark
(a) Residence: No.
14.Draper.
(Usual place of abode)
(if nonresident give city or town and State)
PERSONAL AND STATISTICAL PARTICULARS
3. SEX
Male
4. COLOR OR RACE
White
5. SINGLE, MARRIED. WIDOWED,
OR DIVORCED (write the word)
Single
5a. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Single
6. DATE OF BIRTH (month, day, and year) July 6, 1918
7. AGE
Years
Days
If LESS than 1 day, _____ hrs. or _____ min. -
8. Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. Laborer (ccc)
9. Industry or business In which
105th Co., CCC
work was done, as silk mill,
saw mill, bank, etc
Bourne Massachusetts
10. Date deceased last worked at
this occupation (month and
year) ... L'eb.
1935
11. Total time (years)
spent in this
occupation
1/12
12. BIRTHPLACE (city or town)
Boston, Massachusetts
(State or country)
13. NAME Walter Francis Clark
14. BIRTHPLACE (city or town) South Boston, Mass. (State or country)
MOTHER
15. MAIDEN NAME Mary Francis Metz
16. BIRTHPLACE (city or town) .South Boston ,Mass (State or country)
17. INFORMANT Lary Francis Clark
(Address) "14 Draper St., Dorchester Mass
18. BURIAL, CREMATION, OR REMOVAL
Place
Date
19
19. UNDERTAKER
(Address)
FEB 2 0 1935
20. FILED 19
Registrar.
MEDICAL CERTIFICATE OF DEATH
21. DATE OF DEATH (month, day, and year) Feb
19
, 19
22.
I HEREBY CERTIFY, That I attended deceased from
February.
.18
.. , 1935, to ... February.
.19
19.35
I last saw h_im alive on_February
12 ___ , 19_35 death is said
to have occurred on the date stated above, at9:124 __ m.
The principal cause of death and related causes of importance were as follows:
Appendicitis, acute,gangrenous
Date of onset 1935
Feb.15
Other contributory causes of Importance:
Peritonitis.,.generalized
1935
1
Feb.17
Name of operation ... Appendectomy.
Date of.Feb.18/35
What test confirmed diagnosis? Operationwas there an autopsy ?___ C
23. If death was due to external causes (violence) fill In also the following:
Accident, suicide, or homicide ?.
Date of injury.
19
Where did Injury occur ?.
(Specify city or town, county, and State)
Specify whether Injury occurred In industry, In home, or In public place.
Manner of injury. Nature of injury
24. Was disease or Injury in any way related to occupation of deceased?NO.
If so, specify
(Signed) Charles L. Candy, Lt. Col IC, USA M. D. (Address) Fort Banks, Lass. Feb . 19, 1935
C11-3184
1
V. S. NO. 98
OCCUPATION 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 N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of FATHER
1
--
16
Months
7
13
St., .15 ____ Ward. Dorchester Massachusetts.
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 onsel
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. G, GOVERNMENT PRINTING OFFICE: 1290
c11-3184
RM R-301 A
Inffolk.
PLACE OF DEATH Nod
(Counts)
(City or Town) 83 dim
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)
(If U. S. War Veteran, specify WAR) ...
(a) Residence. No ... (Usual place of abode) (If nonresident, give city or town and state) Length of residence in city or town where death occurred 12th mos. days. How long in U. S., if of foreign birth? TROS. days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE MARRIED WIDOWED or DIVORCED
(write the word)
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 84 Years 11 Months 17 Days
If less than 1 day
.... Hours. .Minutes
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) (State or country) Empada
14 BIRTHPLACE OF FATHER (City) Ga Lacland. (Statdor country)
15 MAIDEN NAME OF MOTHER margaret Producent
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Informant (Address) 03 Done
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Www. D. Childrenex (Signature of Agent of Board of Health or other) Health Officer (Official Designation) (Date of Issue of Permit),
2/19/35
MÉDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
19
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY That i attended deceased from 200.19 1955 to 72/19 19.
I last saw h Am alive on.
19.0.12 .. , death is said
to have occurred oh the date stated above, at .. MA .m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
2
2
Name of operation. 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) Thaton Date 2/69 1935
21 PLACE OF BURIAL, CREMATION OR REMOVAL
well. Lawell Cemetery) (City or town)
DATE OF BURIAL
2
22 NAME OF UNDERTAKER
ADDRES
Received and filed
19
(Registrar)
-
Ward
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Fre Ward, .St.,.,
1 3 SEX PARENTS 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 100m-9-'33. No. 9321-a' N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 13 NAME OF FATHER®
Fl Some
Contributory causes of importance not related to principal cause:
Date of
., M. D.
(Address)
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 nonc.
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, 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 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 are, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last scen 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 I 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, Chep. 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 a9 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.
DRM R-301A
PLACE OF DEATH
Suffolk bounty) Winthrop (City or Town) No. 145 main Julia Murphy
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 er intution, give its NAME instead of street and number) St.,
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
145 main
St.,
Ward,
(If nonresident, give city or town and state)
(Usual place of abode) Length of residence in city or town where death occurred 2 5 yrs.
mcs.
days. How long in U. S., if of foreign birth? 42 yrs. MOS. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female White
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Joseph a murphy
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE.
Days
Housework
at home
10 Date deceased last worked at this occupation (month and year)
Feb 10/36
spent in this occupation 4.0 yas
12 BIRTHPLACE (City)
(State or country)
Ireland
13 NAME OF
FATHER
Owen Callaghan
14 BIRTHPLACE OF FATHER (City) (State or country) Ireland
15 MAIDEN NAME
OF MOTHER
unknown
Irland
16 BIRTHPLACE OF MOTHER (City) (State or country) Teland
17 miss mary Murphy, Daughter
Informant (Address) 145 mainst, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Im. D. Childrens (Signature of Agent of Board of Health or other)
Health Officer
2/21/35 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
20
1935
(Year)
(Month)
(Day)
19
I HEREBY CERTIFY, That I attended deceased from
198 3. 3 .. , to
1937
last saw h., L ..... alive on .. 13 ... ], death is said to have occurred on the date stated above, at 9. 40Km.
The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: Calle hum
anlegg 2/11/9
Contributory causes of importance not related to principal cause: Inspectensioni
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)
, M. D.
(Address).
19 A. ..
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross, Malden.
DATE OF BURIAL
Jeb 22
1935
22 NAME OF
Frederick H Take
UNDERTAKER
ADDRESS
145 main st, Winthrop
Received and filed
FEB 26-1935
19
(Registrar)
-- --
7 62 Years .Months
If less than 1 day Hours. Minutes
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.
11 Total time (years)
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 75m-2-'30. No. 7997-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
1
Ward {
(If U. S.
specify WAR)
(Cemetery)
(City or town)
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, 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
1921
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause:
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