USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 99
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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.
EX THẠC IS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
-
MR-301A
Suffolk
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. 234
Registered No. (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Robert Flater
(If deceased is a married, widowed or divorced woman, give also maiden name.)
439 Winthrop
.St., ............
.Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Vale
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a lf 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 ............ 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)
spent in this
occupation.
12 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER Albert 7. Flater
14 BIRTHPLACE OF
FATHER (City)
Chelsea
(State or country) lucas
15 MAIDEN NAME
OF MOTHER
Geraldine Fitzgerald
16 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country) Class.
17 Albert 7. Flater Relation, if any (Futher
Informant. (Address) 439 Winthrop St; Wire .
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Burial or transit permit was issued: m. L. Culdresy
(Signature of Agent of Board of Health or other) De allte brucer (Official Designation)
12/19/33 (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
-
19.3,5 .... to.
en 16, 198
I last saw b
in alive on
en 18, 1984, death Is said
to have occurred on the date stated above, at /. 30Pm The principal cause of death and related causes of Importance In order of onset were as follows:
Date of Onset IMPORTANT
Conque teletoris
Ceatributory causes of importance not related to principal cause;
Name of operation
What test confirmed diagnosis?
Date of.
Was there an autopsy? Is
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D.
(Address)
mina in Date (2/1/19 3
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Gross Maldere
Cemetery)
(City or town)
DATE OF BURIAL
December 19
1935
22 NAME OF
.
- Filly
UNDERTAKER
ADDRESS
11 Meridian St1 5.13.
Received and filed. .19
DEC
(Registrar)
100m-12-'34. No. 2938-f
PARENTS information Would be carefully supplied. AGE should be stated EXACTLY. PHler CIANS should state OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DASATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
PLACE OF DEATH
1
..... /County) Winthrop
Winthrop Community Hospital No
(If U. S.
War Veteran,
specify WAR)
(a) Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
-
mos.
dayı.
How long in U. S., if of foreign birth? -
yrs.
18
1435
10 Date deceased last worked at
this occupation (month and
year)
Winthrop
class
-_
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:
Date of onset '
Arteriosclerosis ...
Chronic interstitial nephritis
I021
Cerebral hemorrhage
July 9, 1027
Contributory causos 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 CERTIFICATEES 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 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. - Chop. 114, Sec. 45, G. L., (Tercentenary Edition.)
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., (Tercentenary Edition.)
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.
...
.......
- --
M R-302
1
PLACE OF DEATH
SUFFOLK (County) BOSTON (City or Town)
No.
Mass ... General Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No .. .. 10970
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Mary J
Briggs
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
(Usual place of abode)
18 .. Edge Hill .. Rd
.St.,.
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yra.
mos.
days. How long in U. S., if of foreign birth?
yrs.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec 20 .193.5.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That ! attended deceased from
Dec 3
193.5., to.
Dec 20
193.5
I last saw her ...... alive on.
Dec.20
19 .. 35., death is said
to have occurred on the date stated above, at ... 5. 55Am. The principal cause of death and related causes of importance in order of onset were as follows:
Date ofonset
cancer of cervix
2.mos.
Contributory causes of importance not related to principal cause: uremia
2 .dys
Name of operation
What test confirmed diagnosis?
Was there an autopsy ?.. y.O.s
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
N C Baker
M. D.
(Address)
Boston ..... Dat 12/20/19 35
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Rural .....
Walpole
(Cemetery)
(City or town) 19.35
22 NAME OF
UNDERTAKER
W H Graham
ADDRESS
Boston
Received and filed
JAN 7 1936
19 .. 35
DATE FILED
Dec
24
19 .. 35
50m-9-'31. No. 3385-fr
17 Informant Frank E. Partridge. ...... Son-in-law (Address)
important.
A TRUE COPY.
Hilda Ofeditions Quirks
ATTEST:
(Registrar of city or town where death occurred)
N. B .- WRITE PLAING, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Ever em 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
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country)
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.
at home
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation. 42 yrs
this occupation (month and
year)
Dec 1 1935
12 BIRTHPLACE (City) (State or country) Cambridge Mass
13 NAME OF
FATHER
unknown Meanix
OCCUPATIONI
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widowed
5a If married, widowed, or divorced HUSBAND of
(es) WIFE of
(Give maiden name of wife in full)
Lewis C. Briggs
(Husband's name in Tufl)
6 IF STILLBORN, enter that fact here.
7 AGE 6.7
.Years Months Days
Ward
(If U. S.
235
War Veteran,
specify WAR)
8 SEX
F
(Registrar of City or Town where deceased resided)
Date of
DATE OF BURIAL
Dec
-22
E
1
1
11-
1
1
OM R-301
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 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
Boston natura
1/7/36
The Cmamonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
1
PLACE OF DEATH
Sufflok
....
(County)
Winthrop
(City or Town)
No ... Winthrop Community Hospitast,
Ward
give its NAME instead of street and number)
2 FULL NAME
Anthony Joly
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. No ......
101.Waldeck.St.
St., .............
.Ward, .... 17 .Boston.Mass
(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
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
23
1935
(Month)
(Day)
(Year)
5a If married, widowed, oz divorced
HUSBAND of
Mary Duffy Joly
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 65
AGE
Years.
4
Months
A .... Days
If less than 1 day
.Hours
.. 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 ..
Foreman
10 Date deceased last worked at
11 Total time (years)
this occupation (month andNov. 1935 spent in this
year)
occupation.
35
12 BIRTHPLACE (City)
Montreal
(State or country)
Canada
18 NAME OF
FATHER
Paul Joly
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
Marceline Rochon
16 BIRTHPLACE OF
MOTHER (City)
Montreal
(State or country)
Canada
Relation, if any
Informant
(Address) 101 Waldeck St. Boston Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: I m. D. Juldress (Signature of Agent of Board of Health or other)
Jealtin Mich 12/26/35
Koncial Designation (Date of Issue of Permit)
19 I HEREBY CERTIFY, That I attended deceased from
July
1
1935, to Dec. 23
,19 35
I last saw h. svt.allve on
Dec. 23
35
death is said
19.
to have occurred on the date stated above, at. 11.35 p.m. The principal cause of death and related causes of Importance In order of onset were as follows: Cancer of the bladder
Date of Onset July 1st 1935
Contributory causes of importance not related to principal cause:
Date of
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
(Signed)
, M. D.
(Address)
Winthrop mars
Dec 25 1935
Date
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
......
.Winthrop.
(Cemetery)
(City or town)
22 NAME OF
UNDERTAKER
Charles R.Bennison
ADDRESS
Winthrop Mass
Received and filed. 19
JAN 2
A TRUE COPY, ATTEST:
(Registrar)
100m-12-'34. No. 2938-m
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widower
Registered No
(If death occurred in a hospital or institution,
(If U. S.
War Veteran,
(If nonresident, give city or town and state)
8 SEX
Male
Tailoring shop
Name of operation.
more
Clinical
Was there an autopsy ?..........
17
Miss Juanita Joly
..... (daughter)
DATE OF BURIAL
December 27 1935
19
Revised Uni
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 donc.
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.
Exampio
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Dato of onset
1015
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July g. 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 L_ 3 OF THE COMMONWEALTH OF MASACHUSETTS 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 disposa 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 healthi 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., (Tercentenary Edition.)
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