USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 2
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Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
made Névre
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
er DIVORCED.
(write the word)
Single
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
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 ...
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
occupation.
22-2020
13 NAME OF
FATHER
James Placet:
15 MAIDEN NAME
OF MOTHER
elsie
17 no James Hailett
Infor mant
(Address)
4 + Cottage Parte Road Halluc1
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of health of other)
Healthe Prices 1/8/36
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
6
1930
(Year)
(Month)
(Day)
19
I HEREBY CERTIFY, That ! attended deceased from
19
to
19
! last saw h ...
......
alive on
19
death is said
to have occurred on the date stated above, at. m. The principal cause of death and related causes of importanoe in order of onset were as follows:
Date of Onset
Still born (7 months)
Contributory causes of importance not related to principal cause:
Name of operation.
What test confirmed diagnosiflanced
Date of.
Was there an autopsy
20 Was disease or injury in any way related to occupation of deceased?
If so, specify A
(Signed)
Jacob Dahaup
(Address) 562 Htruggy 1
Date
1/8/20
., M. D.
21 PLACE OF BURIA Cocalata CREMATION OR REMOVAL de devo (Cemetery)
DATE OF BURIAL
1
(City or town)
1936
22 NAME OF
UNDERTAKER
Charles A few 2022
ADDRESS
424 Biway Chelsea mass
Received and filed 19
JAN
(Registrar)
A TRUE COPY, ATTEST:
(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.
days. How long in U. S., if of foreign birth? утв.
munity costruita
.Ward
1 (or) WIFE of 7 AGE OCCUPATION: 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATHi in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information shoulder carefully supplied. AGE should be stated EXACTLY. PHYSICIHA'S should state 100m-9-'31. No. 3385-f N. B .- WRITE PLAINLY, TH UNFADING BLACK INK-THIS IS A PERMANENT RECORTA Every item of (State or country)
Revised Ur": " 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
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,
EXTRACTS FROM THILLAWS 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 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.
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
FORM R-901
MARGIN RESERVED FOR BINDING
Temale or WIFE of . ACE SO OCCUPATION PARENTS 100m-12-'34. No. 2038- N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK THIS IS A PERMANENT RECU:1A. Every item of is very important. Sem 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 showid be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state yaz: -
Suffolk
(County)
Winthrop
(City or Town) 19 Lowell Road
Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Registered No.
(Ii desth occurred in a hospital or institution, Give its NAME instead of street and member)
2 FULL NAME LA&
(Picker) Eintre
(If deceased is g_married, wido wed ce divorced troman, give also maiden same.)
(a) Residence. No. 20 Ela llevo Una St.
(Usual piace of abode)
Length of residence in city er towrz where death pocasred.
.Ward,
(If pourasident, give city or town and state)
days
How long in U. S., # di fareiga hissk'
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
6
1936
19 I HEREBY CERTIFY, Thal | affected deceased Ta
19 35, to Deciwany 6
13 36
I last ser ware
unary ~ , 1936, death is
to have occurred as the date sizied shove, at 4 45
The principal cause of death and reisted casses al importance ja arder of cas
were as follows:
Isteri Accesorio
1925
Senility
1936 Cerebral 26 emorzuandge faut. "
Contribubery cames of importance not related to principal cause:
Name of operation name
Date of
What test confirmed diagnosis? Clinices
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed
Asdress
Date June 19 3
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Winthrop Winthrop
DATE OF BURIAL
22 NAME OF
UNDERTAKER
Charles R. Benniscn
ADDRESS
Hinthrop Kass
Received and filed
A TRUE COPY, ATTEST: JAN- TO
Des maticc)
(Date of Isoe of Fez,
--
8 Trase. professor, or particular
9 Industry or business in which
at home
10 Date depasses last wanted zt
Dec 2350
11 Total time (years)
60
12 BIRTHPLACE City
North Lebanon
Laine
18 MAKE CF FATHER Charles Ricker
14 BIRTHPLACE OF
FATHER (CT)
(State or country)
15 MAIDEN NAMEMary OF MOTHER
16 BIRTHPLACE OF MOTEER (CAST Beach Lebanon
l'rs an N. Tells daughter finthrop 2888
1 HERESY CERTIFY that a satisfactory stampani cert fonte :' ceath was
PLACE OF DEATH
No.
4 COLOR OR RACE
white
5 SINGLE
(write the wordy
MARRIED
Widowed
er DIVORCED
5z li married, willowad, er Everced
Otte John dintre
6 IF STILLBORN, enter that fact pere.
if less than i day
Years Months
19
Day'S
Minutes
Ward
M.U. S. War Veteran,
(City or tow=)
January 8
Revised Un": 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, 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 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
1921
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
EXTRACTS FROM TI. ' AWS OF THE COMMONWEALTH OFHE ASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... . .
Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the common- wealth cannot be obtained 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.)
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. Lows, Chop. 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 a3 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 Hosulting from injury or infection related to occupation, the
ORM R-301
1
PLACE OF DEATH
Lu fock. (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
2/8/36
(City or town making return)
5
Registered No.
(If death occurred in a hospital or institution,
Ward
give its NAME instead of street and number)
Isabelle Cameron
(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.
/ / days!
How long in U. S., if of foreign birth? yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Femace White
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Manuel
5a If married, widowed, or divorced
HUSBAND of
alexander Cameron
(Give maiden name of whe in full)
(or) WIFE of
AHusband's name in Ifly
6 IF STILLBORN, enter that fact here.
AGE
7 59 .Years 1 Months. 4 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.
at home
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
Scotland
(State or country)
13 NAME OF
FATHER
? Angus.
PARENTS
14 BIRTHPLACE OF FATHER (City) ... Scotland (State or country)
15 MAIDEN NAME OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country) Unknown
17 alexander
Informant
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or; transit permit was issued:
(Signature of Agent of Board of Health or other) Health Murcia 1/7/36
(Official Designation,
(Date of Issue of Permit )/
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
7
1736 (Year)
19 ) HEREBY CERTIFY, That I attended deceased from an 5 1955, to tam7 19:36
last saw h M alive on franco 193-6 death is said
to have occurred on the date stated above,' 3.308 m.
The principal cause of death and related causes of importance in order of onset were as follows: Date of Onset Comen of color with obstruction
Contributory causes of importance not related to principal cause:
Name of operation.
What test confirmed diagnosis? Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
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