USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 19
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(Official Designation) V
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widowed
6 IF STILLBORN, enter that fact here.
Years
9
Months
5
Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular · · kind of work done, as spinner, sawyer, bookkeeper, etc ..
Housekeeper
Own Home
10 Date deceased last worked at 11 Total time (years) spent in this occupation 58m
this occupation (monty and
year)
ashford
1925 bonn
13 NAME OF
FATHER
Sanford Snow
Unknown - Leonn:
Menerva Barrow
Unknown, jeonn:
17 pro Clara Hile Relation if any ( Daughter DATE OF BURIAL February 25 1936
laformant (Address) 87 Loving Road W
1 OCCUPATION BLACK INK-THIS IS A PERMANENT REARD. Every item of (or) WIFE of
information Would be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state DIN
(County) Winthough 2 FULL NAME ... 8 SEX Female 4 COLOR OR RACE White 5a If married, widowed, or divorced HUSBAND of John 7 AGE 86 12 BIRTHPLACE (City). (State or country) 14 BIRTHPLACE OF FATHER (City) (State or country) 15 MAIDEN NAME OF MOTHER 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) 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 9 Industry or business in which work was done, as alk mill, saw mill, bank, etc.
St ........................ Ward Dray
I U. S War Veteran,
specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of residence in city or town where death occurred
10 yrs.
mos.
days.
How long in U. S., if of foreign birth?
(Give maiden name of wife in full)
Dray
(Husband's mame in full)
21
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, cotion 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 al 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:
Dato of onset
Arteriosclerosis
1015
Chronic interstitial nephritis
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.
GOVERNING THE
RETURN OF CERTIFICATE 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 .... Cen. 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, cr 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 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 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.)
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.
A R-301
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Elizabeth S.
(Harris) Cillespie
(If deceased is a married, widowed or divorced woman, give also maiden name.)
87 Pleasunt
.St., ...
.Ward,
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth?
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
24
1436
(Year)
(Month)
(Day)
19 I HEREBY CERTIFY, That I attended deceased from
may 14
1935 to Felmay 24, 1936
I last saw h. R. alvo on February 24 1936 2., death is said to have occurred on the date stated above, at 6:30 p' m. The principal cause of death and related causes of Importance in order of onset were as follows:
Date of Onset
Carcinoma of Transverse Colon
1935
Contributory causes of importance not related to principal cause: General Carcinomatosis Strangulated inserial hernia
5/14/35
Hempolomy
Date of.
5/14/35
Name of operation exploratory
What test confirmed diagnosisalmedalx
Was there an autopsy? no
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
.M. D.
(Address) 562 Surley
St Dat
125.1936
21 PLACE OF BURIAL,
CREMATION OR REMOVALInthror
intircp
Cemetery,56.
(City or town) .19
22 NAME OF
Charles R. Bennison
UNDERTAKER
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Vive. L' Chudress IDe alte office ADDRESS inthrop Mass
Signature of Agent of Board of Health or other)
2/27/36
(Official Designation) (Date of Issue of Permit)
100m-12-'34. No. 2938-9
...
1
Winthrop
(City or Town)
37 Ilees int
No.
.....
2 FULL NAME
3 SEX
4 COLOR OR RACE
White
Female
6 IF STILLBORN, enter that fact here.
7
AGE
sawyer, bookkeeper, etc .......
saw mill, bank, etc.
OCCUPATION
(State or country)
England
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
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
, WIIn UNFADING BLACK INK-THIS IS A PERMANENT REGARD. Every item of
Years
3
Months
8 Days
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
rried
5a If married, widowed, or divorced
HUSBAND of
E I.(Give maiden name of wife in full)
(er) WIFE of
(Husband's name in full)
If less than 1 day
Hours
.Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
House work
9 Industry or business in which
work was done, as silk mill,
Om bore
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City)
Birmingham
this occupation (month and ?
year)
91 ..... 1035
45
18 NAME OF
FATHER
Robert G. Harris
15 MAIDEN NAME
OF MOTHER
Elizabeth S. Dutton
17 Edward H. Gillespie (husband Informant (Address) 87 Pleasant St Winthrop Mass
Relation, if any
DATE OF BURIAL
Feb.
27
no
Received and filed. 00
19
....
A TRUE COPY, ATTEST: (Registrar)
(L U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred £ 9
yrs.
mos.
St., ..................... Ward
Revised Unite-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
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1027
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MAS:CHUSETTS 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 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 appcar 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.)
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., (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-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
PLACE OF DEATH
(County)
Tinthrop
(City or Town)
No. .....
390 ... Tinthron .... St
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME LUCY A
Brown O'Connor
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ................. inthron .... St.
(Usual place of abode)
............ St., ................ Ward,
(If nonresident, give city or town and state)
Length of residence in city or towe where death occurred
mos.
days. How long in U. S., if of foreign birth?
yrs.
1.08.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
(Month)
(Day)
1986
(Year)
5a If married, widowed, or divorced HUSBAND of
(oz) WIFE of
(Give maiden name of wife in full)
Michael O connor
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
If less than 1 day
Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sswyer, bookkeeper, etc ....
Housewife
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
O:m Home
10 Date deceased last worked at
11 Total time (years)
this occupation (month and z
year)
1935
spent in this
occupation.
40
12 BIRTHPLACE (City)
(State or country)
New Brunswick
13 NAME OF
FATHER
Joseph Brown
14 BIRTHPLACE OF
FATHER (City)
New York
(State or country) N.Y.
15 MAIDEN NAME
OF MOTHER
Elizabeth Parks
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Brunswick
17
Relation, if any
Informant ...............
(Address)
Inthron
welfare win.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wiliam Cuadrefax. (Signature of Agent of Board of Health of other)
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