USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 9
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mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Feb. 2 , 1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Quant
19.3 .. /., to.
Peti. 2
1935
I last saw h.t.alive on ...
Hely.
2
19 .. 3 ..... , death is said
to have occurred on the date stated above, at 7:25%.m. The principal cause of death and related causes of importance in order of onset were as follows: Date of Onset UMAPORTANT 14:1 aneurysm of demanding corta Cardiac ushertropit & dilatation aortic insufficiency chronic inter fiat Thephry
Contributory causes of importance not related to principal cause: Tertiary sejatuition .
Name of operation.
What test confirmed diagnosis?
Was there an autopsy? . IL?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify ......... ,9+
(Signed)
alma
H. Binasco
M. D.
(Address) 536 Commonwealth Le Date Hebr 21935
Boston
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(City or town)
DATE OF BURIAL
Fick 5 1530
19
22 NAME OF
UNDERTAKER
CR Sense
ADDRESS
Received and filed
FEB 5 1935
19
(Official Designation) (Date of Issue of Permit)
5 SINGLE
(write the word) Marcel
5a If married, widowel, or divorced HUSBAND of
Temningo
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
If less than 1 day
Years Months .Days
.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.
Rail Road Portar
BRISTLAR.
10 Date deceased last worked at
this occupation (month and see 20/34
year)
11 Total time (years) spent in this occupation. 30 YER
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
·
16 BIRTHPLACE OF
MOTHER (City)
(State ør country)
17 Williams. S. Bachdio
(Ad ss) Winther 0 20 cemah di-
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Wm. D. Childrensx (Signature of Agent of Board of Health or other)
2/5/35
MARGIN RESERVED FOR BINDING
1 ... No. 3 SEX (or) WIFE of 7 69 AGE OCCUPATION PARENTS 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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 13 NAME OF FATHER 100m-9-'33. No. 9321-a
PLACE OF DEATH
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
4 COLOR OR RACE MARRIED WIDOWED OF DIVORCED
(Registrar)
Date of
Revised United Autes 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
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 LAK ! 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 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, 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.
ORM R-302
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.
50m-2-'30. No. 7997
A TRUE COPY.
ATTEST:
Lamm. Hanff
(Registrar of city or town where death occurred)
DATE FILED February 3, 1935 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
3
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
February ..... ]
135 ... February.
193.5
I last saw h ..
1m
February 3
35
.alive on 19 death is said
to have occurred on the date stated above, at
8:00 A.M.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Tuberculosis of the lungs
Unknown
Tuberculous Enteritis
Unknown
Pneumonia
Contributory causes of importance not related to principal cause:
Pericarditis
Unknown
Hypertrophy of the Heart
Unknown
Name of operation
None
Date of
What test confirmed diagnosis?
Autopsy
Was there an autopsy ?.
.Ves
NO
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
.J. Boland, Officer of the Dayo
(Signed)
VAFAddress)
Kutland Hts .Mass .. Date
2/3
.19 .. 35
21 PLACE OF BURIAL,
Holyhood, Brookline, Mass
CREMATION OR REMOVAL
February
6,1935
19
DATE OF BURIAL
22 NAME OF
UNDERTAKER
Frank H Miles Co.
ADDRESS
Jefferson Mass.
Received and filed MAD 2 1935
19
1
Kutland
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Rutland
(City or town making return)
2
(City or Town) No.Veterans ' Administration Facility
Ward
give its NAME instead of street and number)
2 FULL NAME
Joseph Thomas O'Keefe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No.
59 Quincy Ave.
St.,
Ward,
Winthrop, Mass.
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred yrs.
mos.
2
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
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
39
2
Years.
28
Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, Lineman
OCCUPATION
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)
Boston
(State or country) Mass.
13 NAME OF
FATHER
'l'homas O'Keefe
14 BIRTHPLACE OF
FATHER (City)
Grafton,
(State or country) l'ass .
15 MAIDEN NAME
OF MOTHER
Jennie Kyan
16 BIRTHPLACE OF
MOTHER (City)
Pictou.
(State or country)
Nova Scotia
17 Hospital Records
Informant (Address)
PLACE OF DEATH
Worcester
(County)
Registered No ..
22
(If death occurred in a hospital or institution,
(If U. S.
War Veteran,
World War
(Usual place of abode)
(write the word)
(Give maiden name of wife in full)
MARGIN RESERVED FOR BINDING N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- 1111
41 3H WOHJ SLOVYLX3
PARENTS
(Cemetery) (City or town)
Donctror of City or Town where deceased sed resided)
ORM R-301 A
Suffolk
// (County) Winthropa.
(City or Town) 275 /River Rd No.
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)
Robert & Lane.
(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
2 yrs. 11 nos 26
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Vingle
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
2
Years.
11
Monthsa .:
.Days
16
If less than 1 day
.Hours
Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ...
none
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc ..
none
10 Date deceased last worked at
this occupation (month and
year)
Boston,
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City)
(State or country)
masa .
13 NAME OF
FATHER
Edward L. Lane.
14 BIRTHPLACE OF
FATHER (City)
East Boston,
(State or country)
15 MAIDEN NAME
OF MOTHER
Christina a Neboter.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
mass.
17 Edward & Lanc (FATHER ) DATE OF BURIAL .
Informant
(Address)
173Fwer Rd Winthrop Man
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or trausit permit was issued:
Childress s
(Signature of Agent of Board of Health or other)
2/6/39
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
4
(Month)
(Day)
(Year)
19
HEREBY CERTIFY, That I attended deceased from
January 28
193 ... , to
February 4, 1935
I last saw h.
Mplive on
Feb -
4
19.3.3 ... , death is said
9-15A.m.
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 IMPORTANT
Lobar PNEUMONIA
Jan. 28.1935
Contributory causes of importance not related to principal cause:
1
1
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
Edward I Frame
(Signed)
(Address) 200
Washington Di Date Feb 5 1935
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Minthoop Miag
(Cemetery>
2-6.
/(City or towns
19 35.
22 NAME OF
Millian a Dreamor.
UNDERTAKER
ADDRESS
559 Varatoga SV E. B.
Received and filed.
.. 19
(Registrar)
MARGIN RESERVED FOR BINDING
7 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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 100m-9-'33. No. 9321-a
PLACE OF DEATH
1
2 FULL NAME
275 River Rd
Ward,
(If U. S.
War Veteran,
specify WAR)
1935
(or) WIFE of
(If nonresident, give city or town and state)
Ward
1
., M. D.
East Bootow
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 houseke ·per-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
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 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
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.
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