USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 27
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1 8 SEX Tale (or) WIFE of 7 AGE 56 14 BIRTHPLACE OF FATHER (City) 16 BIRTHPLACE OF MOTHER (City) Informant is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION saw mill, bank, etc.
PLACE OF DEATH
(City or Town) No Winthrop Community HospitalSt,
Ward
(LE U. S.
War Veteran,
specify WAR).
St., ......
Ward,
(If nonresident, give city or town and state)
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
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, sont 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, 1927
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in 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. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thercof 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.
RM R-302
Suffolk
......
(County)
Chelsea
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
160
58
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Walter Edward DeLorey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No.
38 Madison Ave.
St.,
Ward,
Winthrop Mes
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred 2 yrs. 17 mes.
days. How long in U. S., if of foreign birth? yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
white
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of
Elizabeth Kelly
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
Years .
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Detired
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Real estate
10 Date deceased last worked at
11 Total time (years)
spent in this 1 5
this occupation (month and ]/] /1935
year)
occupation ...
12 BIRTHPLACE (City)
(State or country)
Cambridge
13 NAME OF
FATHER
Peter DeLorey
14 BIRTHPLACE OF FATHER (City)
(State or country) Nova Scotia
15 MAIDEN NAME
OF MOTHER
Theresa DeCosta
16 BIRTHPLACE OF MOTHER (City) (State or country) Nova Scotia
50m-9-'31. No. 3385-g
A TRUE COPY. Cacharel 9. Woher
ATTEST:
(Registrar of city of town where death occurred)
DATE FILED
March 21,1936
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
March 20,1956
DEATH
(Month)
(Day)
(Year)
19 -I HEREBY
CERTIFY, That I attended deceased from
36
January
3
19
to
March 20
19
36
I last saw h imalive on Horch ... 20 19. 36death is said to have occurred on the date stated abovela.55 The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: Syphilis cerebro-spinal 1/29/1936
Contributory causes of importance not related to principal cause: Asthma bronchial 19.20
Bronchitis chronic 1920
Paralysis,rt.diaphragm and rt
1930
Name of operation
Date of
What test confirmed diagnosis?
clinical
Was there an autopsy? I.O.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify ....
(Signed)
J. D. Yarbrough Lt. (Jg) (I.C), M. D.
(Address)
Date
.== 19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
St.Joseph's W.Roxbury
March 25.1936
(City or town)
19
22 NAME OF
C.R.Bennison
UNDERTAKER
Winthrop,Mass.
ADDRESS
Received and filed
APR.
19
36
(Registrar of City or Town where deceased resided)
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item 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
PLACE OF DEATH
1
(City or Town) U. S. Naval Hospital No
St.,
Ward
(L U. S.
War Veteran,
World War
(Usual place of abode)
important.
17
Joseph Delorey
brother
DATE OF BURIAL
Informant (Address) 33 Madison av. Winthrop Bass.
PARENTS
7 40 3 Months 3 Days
1
IM R-302
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item 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
PLACE OF DEATH
SUFFOLK (County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No ...... 2796
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Sarah .. F.
Holland
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
(Usual place of abode)
100 ... Marshall
St.,
Ward,
Winthrop.
(If nonresident, give city or town and state)
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
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
widowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Thomas (Harry.).Holland
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 51 Years .Months .Days
If less than 1 day .Hours Minutes
OCCUPATIONI
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
this occupation (month and
year)
11 Total time (years) spent in this occupation.
12 BIRTHPLACE (City).
East Boston Mass
(State or country)
13 NAME OF
FATHER
Daniel E Flaherty
14 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
15 MAIDEN NAME
OF MOTHER
Sarah Warner
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
17 Mary Holland (dau)
Informant (Address) above
A TRUE COPY.
Neida Sedation Quirks
ATTEST:
(Registrar of city or town where death occurred)
-19 35.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March 20 1936
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from March 20
19
to.
36
March 20
19 ... 36
! last saw h.Or ..... alive on
March 20
1936
death is said
to have occurred on the date stated above,
11.04 A.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
cardiac hypertrophy
hypertensive type
1 yr
Contributory causes of importance not related to principal cause:
cerebral.hemorrhage
2 mos
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy ?.... yes
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Address)
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Mass
(Cemetery)
(City or town)
DATE OF BURIAL
March 23 1936
22 NAME OF
UNDERTAKER
J.F .. .. O .! Maley
ADDRESS
Winthrop
.... Received and filed .. ...
1935
19.35
APR 8
(Registrar of City or Town where deceased resided)
important.
50m-9-'31. No. 3385-₥
1
No.
Mass ... General Hospital
St.,
Ward
(LE U. S.
War Veteran,
specify WAR)
59
F
(write the word)
PARENTS
DATE FILED March 24 1936
.M. D.
(Signed)
L V Ragsdale
Boston
3/22/ 19 36
Date
١/ ١٠
IR-301A
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
870 Shirley
The Commomeulth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Martha Sault MS Comiskey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
870
Shirley
.St., ................ Ward,
(If nonresident, give city or town and state)
days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
Married
If less than 1 day Hours. .Minutes
Housework
at Home
10 Date deceased last worked at 11 Total time (years) spent in this occupation. 60
13 NAME OF
FATHER
Cannot be learned
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17
James M: Comiskey (Husband)
Informant
(Address)
870 Shirley It Winthrop
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)
Hearthe Hacer 3/23/36
" (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Branch
21
1936
(Month)
(Day)
(Year)
1
19 I HEREBY CERTIFY That I attended deceased from Dc: 13 19:35 900 heard 21 0 09 36 .. ,
I last saw her alive on
march
21
, 1936 P. ., death is said to have occurred on the date stated above, at/ m.
1
The principal cause of death and related causes of Importance in order of onset were as follows: Date of Onsct IMPORTANT Quemna o livro
aug 1935
Contributory causes of importance not related to principal cause:
march 14.26. .
Name of operation
What test confirmed diagnosis?
Date of.
Was there an autopsy? V.
20 Was disease-or injury in any way related to occupation of deceased?
No
so, speo
Hay mond B Parker
(Signed)
(Address) Writtenof Mass
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Forest Hills
Rear 22 1936
Boston
DATE OF BURIAL.
March 24
(Cemetery)
(City or town)
1936
:
22 NAME OF
Lewis Jones + fin De.
UNDERTAKER
ADDRESS
50 La Grange St, Boston
Received and filed. 19
MAR 2
(Registrar)
1
(If U. S. War Veteran, specify WAR)
days. How long in U. S., if of foreign birth? 40 yra.
18 yra.
St., ..................
Ward
1
No.
(a) Residence.
No ..
(Usual place of abode)
Length of residence in city or town where death occurred
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or diverced
HUSBAND of
(Give maiden
James
.....
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
80
Years
Months
Days
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.
this occupation (month
year)
February 1936
OCCUPATION
12 BIRTHPLACE (City).
London
(State or country)
England
14 BIRTHPLACE OF
FATHER (City)
PARENTS
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
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
100m-12-'34. No. 2938-f
N. B .- WRITE PLAINET, WITH UNFADING BLACK INK -- THIS IS A PERMANENT RECORD. Every item of
(State or country)
England
Relation, if any
., M. D.
Revised United
tes 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
1021
Cerebral hemorrhage
July 5, 1927
...
...
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. "The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LAW" 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 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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