Town of Winthrop : Record of Deaths 1936, Part 106

Author: Winthrop (Mass.)
Publication date: 1936
Publisher:
Number of Pages: 530

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 106

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FATHER

David Sweeney

PARENTS

(State or country)

15 MAIDEN NAME

OF MOTHER

Mary Mccarthy

16 BIRTHPLACE OF MOTHER (City) (State or country) Ireland

17 Informant (Address)

Ellen Frazer

(Daughter)

Winthrop

A TRUE COPY.

Hilda Ofedition Quirks

ATTEST:

(Registrar of city or town where death occurred)

DATE FILED 12/31/36

19.35.

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

December 28/36

(Month)

(Day)

(Year)

12/28/36

19 I HEREBY CERTIFY, That I attended deceased from

11/2/36

l last saw h .... Or .. alive on

12/28/36

death is said

to have occurred on the date stated above, 10:508 m.

The principal cause of death and related causes of importance in order of Dateefonset onset were as follows: General Arteriosclerosis

Chronic Myocarditis

Contributory causes of importance not related to principal cause:

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)

R. M. Crossfield

6 Parley Vale, J.P.

(Address)

Holy Cross Malden

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

12/31/36

(City or town)

19.3.5

DATE OF BURIAL

22 NAME OF

UNDERTAKER

D. J/ Dooley

ADDRESS

Boston

Received and filed

:3 1937 W

VMOL

19.35

(Registrar of Guy or Town where deceased resided)

important.

50m-9-'31. No. 3385-g

Daniel J. Sweeney

(If U. S.

War Veteran,

specify WAR)

219

(If nonresident, give city or town and state)

MARGIN RESERVED FOR BINDING

Boston

14 BIRTHPLACE OF

FATHER (City)

Ireland

Date

12/28

M. D.

STANDARD CERTIFICATE OF DEATH

DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS

Registered No. 6.2.9

or Village

Decalsariana

St ..

Ward

(If death occurred in a hospital or institution, give its NAME instead of street und number)

ds. How long In U. S. If of foreign birth? -yrs. . mos. ... ds.

2. FULL NAME

P Jannet

St.

Ward.

Printhran, Mars

(If nonresident give city or town and State)

MEDICAL CERTIFICATE OF DEATH

DATE OF DEATH (month, day, and year)

. 19 36

22.

I HEREBY CERTIFY, That I attended deceased from

19_

-, to

last saw h.

alive on

;

death Is said

tp]have occurred on the date stated above, at m.

The principal cause of death and related causes of Importance vere as follows: .

min.

quening injuries

Date of onset

7.0

Credit

de colomera,

Diner contributory causes of importance:

Name of operation

Date of

What test confirmed diagnosis?

Was there an autopsy ?.

23. If death was due to external causes (violence) fill in also the following:

Accident, suicide, or homicide ?~

Date of injury_

.. 19 30

Where did Injury occur?

So. Burlington

(Specify city or town, county, and State)

Specify whether In Jury occurred in industry, In home, or in public place. Industry

Manner of Injury

Terapiane craxá

Nature of injury

24 Was disease or injury In any way related to occupation of deceased? Le If so, specify what a plane

(Signed) “

6 0 medienes

M. D.

20. FI_ĘD, 9

VINTHROPOMAZ

FEB-9537 AM

Date 19

8-209 g V. S. No. 98

County

Chittenden

City

Burlington

No. .

Length of residence in city or town where death occurred

_ yrs.

(Usual place of abode)

PERSONAL AND STATISTICAL PARTICULARS

Days

8. Trade, profession, or particular

kind of work done, as spinner,

sawyer, bookkeeper, etc.

Tikai

12. BIRTHPLACE (city or town)

Commington

13. NAME

Samuel Tanner.

14. BIRTHPLACE (city or town).

(State or country)

Genio

15. MAIDEN NAME

Armanda Thay

16. BIRTHPLACE (city or town)

cincinnati

(State or country)

alio

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

saw mill, bank, etc

" Zuying Jacken

1. PLACE OF DEATH

Township

c11-10931

(a) Residence: No.

3. SEX

on.

5a. If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6. DATE OF BIRTH (month, day, and year)

7. AGE

Years

Months

9. Industry or business in which

work was done, as silk mill,

10. Date deceased last worked at

this occupation (month and

OCCUPATION

(State or country)

FATHER

MOTHER

17. INFORMANT.

(Address) i)

18. BURIAL CREMATION, OR REMOVAL

Place:

information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should

year).

4. COLOR OR RACE |5. SINGLE, MARRIED. WIDOWED,

OR DIVORCED (write the word)

.m.

Katherine Hackliteace

7200.1,1900

If LESS Inen

1 day,.

_hrs.

11. Total time (years)

spent in this

occupation

19 38

19. UNDERTAKER.

(Address)

Registrar.

(Address)

Turlington Hl

MARGIN RESERVED FOR BINDING

N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of

State 27.

. mos.

UNITED STATES STANDARD CERTIFICATE OF DEATH

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housewife in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as servant --- private family, cook-hotel, etc. For a person who had no occupation whatever write none. To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation.

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the particular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store," "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured, Do not use the word "mechanic," but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

Statement of cause of death .- Cause of death means the disease, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under other contributory causes of importance, name other important diseases or injuries. Examples:

Example I

Example II

The principal cause of death and related causes of importance were as follows:

Date of onset

The principal cause of death and related causes of importance were as follows:

Date of onset

Arteriosclerosis

1915

Attack of epilepsy

1 week ago

Chronic interstitial nephritis

1921

Run over by street car

1 week ago

Cercbral hemorrhage

July 5, 1927

Peritonitis

3 days ago

Other contributory causes of importance:

Gallstones

May 1, 1923

Gastroenteritis

1 year

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN

U. S. GOVERNMENT PRINTING OFFICE: 1990

c11-3184

Body was found in Winthrop, Mass.

FORM R-303 B ? Suffolk "?"

(County) ? Bustin ? PLACE OF DEATH ... (City or Town) " Boston Harbor"?" No

7.2. City notified 3/9/37 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 .. ....

(If death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME. nunzio Minore

(If deceased is a married, widowed or divorced woman, give also maiden name.) (a) Residence. No. 746 Lexington any, new york Cityhar 6,1, 4 (Usual place of abode) Length of residence in city or town where death occurred Yrs. S. mos.

days. How long in U. S., if of foreign birth? yTs.

mos. days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Mal

4 COLOR OR RACE

5 SINGLE MARRIED WIDOWED or DIVORCED

(write the word) Marcel

5a If married, widowed, or divorced HUSBAND of Esther Roy

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 25

AGE Years Months 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.

Handro Dresser

10 Date deceased last worked at

1 Total time (years)

this occupation (month and Dec 1934

year)

spent in this occupation ... Maitéz

12 BIRTHPLACE (City) (State or country) Mich -City

13 NAME OF

FATHER

Bastare Minore

PARENTS

14 BIRTHPLACE OF FATHER (City)

aly

(State or country)

15 MAIDEN NAME

OF MOTHER

Gioacchino Seana

aly

16 BIRTHPLACE OF MOTHER (City) (State or country) Ithay

17 Informant (Address) 744 Lexington due dateity

I HEREBY CERTIFY thata 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) FEB 1 5 1937

(ORBOSTON; HEALTH DEFT. (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF about Nur- 27 -1936 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.) Presumably Drowning Place & manner not Known

Found dead in teach at Muth wh mar Feb-13-1937

(See reverse side for description for unknown person)

20 IN WHAT CITY OR TOWN

notknown

WAS INJURY SUSTAINED ?. .

(Signed)

M. D.

(Address)

Brottichala longedstand

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Cemetery)

(City or town)

2/17/

1987

DATE OF BURIAL

22 NAME OF

UNDERTAKER

S, Eastman 65

ADDRESS

Acacio de Borton

Received and filed.

1 8

(Registrar)

5m-2-'30. No. 7997-c

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

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of MARGIN RESERVED FOR BINDING

St., ............

.......

.Ward

(I U. S. War Veteran, specify WAR) 251

(If nonresident give city or town and state)

Date - 14

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 havebeen 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.

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 cemetery or burial ground in which the interment is made .. ..- Chap. 114, Sec. 46, G. L. as amended

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ;...- General 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; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.

.. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.

RULES OF PRACTICE

The fulfilment 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 unrelated to any form of injury, have died without recent medical attendance 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.

STATEMENT OF CAUSE OF DEATH

Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anasthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."

If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause. its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorr- hage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.) "

DESCRIPTION (for unknown person)

NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.

THIS CERTIFICATE CONSTITUTES SUCH PERMIT

STANDARD CERTIFICATE OF DEATH

66979 DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS

1. PLACE OF DEATH

County

Onondaga

State

new york

Registered No

252

Township

City

Syracuse

No.

.. or Village

Crouse- Driving Hospital

(If death occurred in a hospital or institution, givo its NAME Mstead of street and number)

Length of residence In city or town where death occurred

____ yrs.

mos. ____ ds. How long in U. G. If of foreign birth? _____ yrs. _____ mos. ....... ds.

2. FULL NAME

John H. Shoke

(a) Residence: No.

(Usual place of abode)

(If nonresident give hty or town and State)

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3. SEX

4. COLOR OR RACE |5. SINGLE, MARRIED. WIDOWED,

OR DIVORCED (write the word)

married

I HEREBY CERTIFY, That I attended deceased from

to.

T Tast saw h.

alive on

: death Is said

ap have occurred on the date stated above, at.

_m.

6. DATE OF BIRTH (month, day, and year).

Sept. 8,190

7. AGE

Years

Months

Days

If LESS than.

1 day,

hrs.

or _____ min

8. Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.

aircraft open air plane accident

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 or town)

(State or country)

13. NAME

allen, Co

14. BIRTHPLACE (city or town)

(State or country)

Ohio

15. MAIDEN NAME

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 19

24. Was disease or Injury In any way related to occupation of deceased?

If so, specify ..

(Signed) _.

9. Howard FergusonD.

20. FILED 19

MAR2 61937 AM

Ohio

NFORMANT ... (Address) }

6:55

19 BURIAL, GREMATION OR REMOVAL

10Place!

WW THROP MASS

Date

19. UNDERTAKERS (Address)

Registrar.

(Address)

MARGIN RESERVED FOR BINDING

8-209 g V. S. No. 98

0 11-10931 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

MOTHER

16, BIRTHPLACE Ofty or towr Etate by county

10. Date deceased last worked at

this occupation (month and

year)

Spencerville

Ohio

The principal cause of death and related causes of importance

were as follows:

accidental extensive

Date of onsel

superficial burne.

crashes

Hand

burns.

Other contributory causes of importance:

Name of operation

Date of.

What test confirmed diagnosis ?.

.Was there an autopsy ?_

23. If death was due to external causes (violence) fill In also the following:

Ward

St.,

Ward.

Winthrop, mais.

5a. If married, widowed, or divorced

HUSBAND of

(or) WIFE of

21 DATE OF DEATH (month, day, and year)

200.16. 1936

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.

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.

Example I

Example II

The principal cause of death and related causes of importance were as follows:

Date of onset

The principal cause of death and related causes of importance were as follows:

Date of onset

Arteriosclerosis

1915

Attack of epilepsy

1 week ago

Chronic interstitial nephritis

1921

Run over by street car

1 week ago

Cerebral hemorrhage

July 5, 1927

Peritonitis

3 days ago

Other contributory causes of importance:

Gallstones

May 1, 1923

Gastroenteritis

1 year

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN

U. S. GOVERNMENT PRINTING OFFICE: 1930

011-3184

STANDARD CERTIFICATE OF DEATH

1. PLACE OF DEATH

County

Township

City new York City

or Village No.

(If death occurred in a hospital or institution, give its NAME instead of street and number)

. mos. ..

.ds. How long in U. S. if of foreign birth?

- yrs.

. mos. .

..... ds.

2. FULL NAME

(a) Residencee No.

(Usual place of abode)

(If nonresident give city or town and State)

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3. SEX

4. COLOR OR RACE 5. SINGLE, MARRIED. WIDOWED,

OR DIVORCED (write the word)

Married

21g DATE OF DEATH (month, day, and year)

200.18

. 193 6

21.

I HEREBY CERTIFY, That I attended deceased from 19 19 __ ., to

5a. If married, widowed, or divorced

HUSBAND of

(or) WIFE of

T Tast saw h.

alive on

death is said

6. DATE OF BIRTH (month, day, and year)

7. AGE

Years

Months

Days

If LESS than

1 day,

__ hrs.

min

Chronic

Imyocarditis

8. Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.

retired

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

Other contributory causes of importance:

12. BIRTHPLACE (city or town)

(State or country)

mass.

13. NAME

14. BIRTHPLACE (city or town)

(State or country)

Ireland

23 .

23. If death was due to external causes (violence) fill in also the following:

15. MAIDEN NAME

Accident, suicide, or homicide?

Date of injury.

, 19

16. BIRTHPLACE (city or town)

(State or country)

Treland

Where did Injury occur ?.

(Specify city or town, county, and State)

Specify whether injury occurred in industry, in home, or in public place.

17. INFORMANT

(Address)

Manner of injury

18. BURIAL, CREMATION, OR REMOVAL

Place

Date

24. Was disease or injury In any way related to occupation of deceased?

19. UNDERTAKER.

(Address)

If so, specify

(Signed).

Robert C. Fisher

M. D.

20. FILED 19

MARGIN RESERVED FOR BINDING

S-209 g V. S. No. 98

011-10931 MOTHER 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

25005 DEPARTMENT OF COMMERCE BUREAU OF THE SENSOŞ

State new york

Registered No.

Ward

St.,

Length of residence in city or town where death'occurred _____ yrs.

John H. Sullivan

St.,

Ward.

Winthrop mark.

b have occurred on the date stated above, at

The principal cause of death and related causes of Importance

vere as follows:

Coronary artery disease

Date of onset

Date of.

Name of operation

What test confirmed diagnosis ?.

Was there an autopsy ?.

Nature of injury

APR 24 1937

Registrar. (Address)

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 stork 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 non indefinite terms as "employee," "worker," "operative," etc. Find out the particular kind of work done and return that as spinmer, weaver, 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.

Example I

Example II

The principal cause of death and related causes of importance were as follows:

Date of onset

The principal cause of death and related causes of importance were as follows:

Date of onset

Arteriosclerosis

1915

Attack of epilepsy

1 week ago

Chronic interstitial nephritis

1921

Run over by street car

1 week ago

Cerebral hemorrhage

July 5, 1927

Peritonitis

3 days ago

Other contributory causes of importance:

Gallstones

May 1, 1923

Gastroenteritis

1 year

ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN

U. S. GOVERNMENT PRINTING OFFICE: 1930

c11-3184

: 1

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Town of Winthrop : Record of Deaths 1936, Part 106

Author: Winthrop (Mass.) Publication date: 1936 Publisher: Number of Pages: 530

Author: Winthrop (Mass.)
Publication date: 1936
Publisher:
Number of Pages: 530