USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 78
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MRMANENT RECORDS EXACTLY. PHYSICES
Exact staten.
2546 District No. ..... 11-09
NON RESIDENT COPY
23
2. FULL NAME (a) Residence: No.
mele
-
١
٠٠
FIRM R-302
ALLA UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- MARGIN RESERVED FOR BINDING
important. N. B .- WRITE PLAINLY, 50m-2-'30. No. 7997-
PLACE OF DEATH
Bristol (County) Fall River) (City or Town) No Rose Hawthorne FalliskHome 2
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Fall River (City or town making return) 183
Registered No ..
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME Charles H. Roberts
(If deceased is a married, widowed or divorced woman, give also maiden name.)
No. 2020 Trace are N intsurla
(a) Residence.
(Usual place of abode)
Length of residence in city or town where death occurred yrs.
mos. 6
days. How long in U. S., if of foreign birth? yTS.
mos,
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ..
Lept
5
19 35
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from aug 30 1935 to Vypl 5 19 05
I last saw h .. C.c/alive on ..
Sept. $
19 .. 3 .. 5 .. , death is said
to have occurred on the date stated above, at. 4:20 pm. The principal cause of death and related causes of importance in order of Date ofonset onset were as follows: Cancer of frachele
193
Contributory causes of importance not related to principal cause:
Bilateral Nacectomy 3/3/1933
Supra pubce Cratita
Name of operation
Date of 3/2/3 3
What test confirmed diagnosis? treceaf, Was there an autopsy Me
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
M. D.
(Address) 1675 V. Main
Date 9-3-1935
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Woodlawn Errett
(Cemetery)
(City or town)
1933
DATE OF BURIAL
22 NAME OF
Wendellhux frenein
UNDERTAKER
ADDRESS
Received and filed.
OCT 24 1935
19
(Registrar of City or Town where deceased resided)
1
8 SEX
male
(or) WIFE of
7
OCCUPATION|
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Informant
(Address)
A TRUE COPY.
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
saw mill, bank, etc.
4 COLOR OR RACE
Ir lute
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
5a If married, widowed? or divorced
HUSBAND of
(Give maiden name of wife in full)
Karach (eddison)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
66
Years
2
Months
Days
If less than 1 day Hours. Minutes
8 Trade, profession, or particular Retirernote Booker sawyer, bookkeeper, etc .........
9 Industry or business in which
Mate Bookero office
10 Date deceased last worked at
11 Total time years)
this occupation (month and 9 32
year)
spent in/this occupation7.
12 BIRTHPLACE (City)
(State or country)
mars.
13 NAME OF
FATHER
Bevege & Roberts
Pertension
17
Leargelitabert
ATTEST: (Regimrar of city of town where death occurred)
DATE FILED Eventipt. 11, 19:30
19
Ward
(If U. S. War Veteran, specify WAR)
Ward,
(If nonresident, give city or town and state)
7
FRM R-302
MARGIN RESERVED FOR DINDING
ATTEST:
France . Milley. M. S.
Supt.
(Registrar of city or town where death occurred)
19.
35
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
29
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Sept ..
... 12
19.35to
Sept ..
29 ... , 19 ... 35
[ last saw him .... alive on
Septl
29 ........ , 155 .... , death is said
to have occurred on the date stated above, at 2 ... 40 .
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Arteriosclerosis
Not ... learned ..
Contributory causes of importance not related to principal cause:
Name of operation
None
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
M. D.
(Signed)
C. Winthrop Houghton
State Infirmary
Date 9/30.19 35
(Address)
21 PLACE OF BURIAL, .
Anthrop,Winthrop, less.
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
October 3
1935
22 NAME OF
UNDERTAKER
C. R. Bennison
ADDRESS
Winthrop ..... Mass.
Received and filed
OCT 17 1935
........
19
(Registrar of City or Town where deceased resided)
Tewksbury 1 (City or Town) No .. State Infirmary. 2 FULL NAME Frank ... Peas.lee (a) Residence. No .. (Usual place of abode) Length of residence in city or towa where death occurred yrs. 3 SEX 4 COLOR OR RACE White Male 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 86 Years 4 Months 0 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) Lynn (State or country) Mass 13 NAME OF FATHER Daniel Peaslee 14 BIRTHPLACE OF FATHER (City) Not learned PARENTS 16 BIRTHPLACE OF MOTHER (City) Not learned. (State or country) Not learned 17 Informant Hospital Records (Address) A TRUE COPY important. DATE FILED September 29 50m-9-'31. No. 338%=₪ N. B .- WRITE PLAINLY WITH UNFADING INK-THIS IS A PERMANENT RECORD. Ever Klem 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) New Hampshire
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 ...
456
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
181
(If deceased is a married, widowed or divorced woman, give also maiden name.)
224A .Bowdoin
St.,
. Ward,
Winthrop
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
If less than 1 day
Hours
Minutes
11 Total time (years) spent in this occupation
15 MAIDEN NAME
OF MOTHER
Lucy S. Cardis
St.,
Ward
mos.
15 days. How long in U. S., if of foreign birth? yrs.
---
OM R-301 A
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 stata 100m-9-'33. No. 9321-a N. B .- WRITE PLAINLY, IT) UNFADING BLACK INK-THIS IS A PERMANENT RECORD) Every item of PARENTS
....
(County)
1
(City or Town)
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
(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
8 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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 37 Years 8 Months
3 Days
If less than 1 day
.Hours ..
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ....
At Home
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)
East Boston
(State or country) Massachusetts
13 NAME OF
FATHER
John P. Casa.m.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
East Bost.
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Informant (Address)
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)
10/5/29
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
C.a
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
June
13
1935
to ..
cect
1935
9
I last saw h. SN alive on.
Cet
3
,19 35
death is said
to have occurred on the date stated above, 6:15 P. m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
Chronic hugo cadets
June 1931
Chronic hetistitial heplanten
June 13 1935
Contributory causes of importance not related to principal cause:
Name of operation.
home
.Date of
What test confirmed diagnosis? Pessoal Ghent Was there an autopsy? No
20 Was disease or injury in any way related to occupation of deceased? No
If so, specif
· Raymond B Parker
(Signed)
M. D.
(Address)
Winthrop Man
Date Rit 4 1935
21 PLACE OF BURIAL.
CREMATION OR REMOVAL .
Cemetery)
(City or town)
DATE OF BURIAL
19
22 NAME OF
UNDERTAKER
fur St. "LA
ADDRESS
ntr
Received and filed
OCT 3-1935
19
/ (Official Designation)
PLACE OF DEATH
No. .....
St.
Ward
(If U. S.
War Veteran,
specify WAR)
St., ..
.Ward,
(If nonresident, give city or town and state)
(Registrar)
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
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.
EXTRACTS FROM THE LAWS OF THE
COMMONWEALTH ASSACHUSETTS 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 carly 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 deccased 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, 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.
'ORM R-303A
Every item of
1
(City or Town)
No .. 150
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. Registered No 186
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME JULIei
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No. 150
(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
3 SEX
Female
4 COLOR OR RACE
Thite
5 SINGLE
MARRIED
WIDOWED
Widowed
5a If married, widowed, or divorced
HUSBAND of
Jeremiah F
(Give maiden name of wife in full)
(or) WIFE of
Jeremiah
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE
Years Months Days
Hours
Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. Housewife 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. Qum Home
10 Date deceased last worked at
11 Total time (years)
spent in this 40
occupation ..
this occupation month and 935
year) ..
12 BIRTHPLACE (City)
Boston
(State or country) Mass
13 NAME OF
FATHER
Antino Jacobi
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country) Italy
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17
Informant
Norman
Horrigan
(Address)
150 Washington Ave
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)
16/7/35
Official Designation) V
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death
of the person above-named and that the CAUSE AND MANNER thereof are
as follows:
(If an injury was involved, state fully)
... .. 6
2
(See reverse side for description for unknown person)
20 If death was due to external causes (VIOLENCE) fill in the following :
Accident,
Suicide or
Homicide ?
Date of injury.
0,ff. 195
Where did
injury occur ?
(City or town and State)
Manner of
0
Injury
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
M. D.
(Address)
Date
19
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Calvary
Boston
(Cemetery)
(City or town)
DATE OF BURIAL
Oct 7 1935
.. 19
23 NAME OF
UNDERTAKER
ADDRESS.
Winthroo
Received and filed. 19
(Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD." UNITY
MARGIN RESERVED FOR BINDING
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
25m-2-'30. No. 7997-b
PLACE OF DEATH
(County)
St.,
Ward
(If U. S. War Veteran, specify WAR)
.St.
Ward,
(If nonresident, give city or town and state)
4-1975
(write the word)
If less than 1 day
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 regis- tration 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 con- tracted, 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 under- taker 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 satisfactory 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 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.
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