USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 59
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100m-12-'34. No. 2938-6
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bubal or transit permit was issued: compopulders ........
(Signature of Agent of Board of Health or other)
July 3136
(Official Designation)
(Date of Issue of Permit
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That [ attended deceased from
nem
19
19
to
I bast saw h mmm alve on
19
death Is said
Date of Onset to have occurred on the date stated above, at 0:30 PM The principal cause of death and related causes of Importance in order of onset were as follows: natural Causes Probably
July 30
1936
Contributory causes of importance not related to principal cause:
Name of operation
home
What test confirmed diagnosis ?.
Date of.
Was there an autopsy? I. a.
20 Was disease or injury in any way related to occupation of deceased? IV
If so, specify
(Signed)
(Address) Nittet Brandy Hent Date July 31 1936.
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVA
Mr. Cubus Curbude
(Cemetery)
DATE OF BURIAL
(City of town) 1936
22 NAME OF
UNDERTAKER
C. TR. Bunnen
ADDRESS,
Received and filed.
AUG 6 1936
19
A TRUE COPY, ATTEST:
(Registrar)
1
(If death occurred in a hospital or institution, five its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 19 Orlando Chas
.St., .Ward,
(If nonresident, give city or town and state)
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
m
4 COLOR OR RACE
10
5 SINGLE
MARRIED
WIDOWED
OL DIVORCED
(write the word)
Manuel
5a If married, widowed, or divorced HUSBAND of
red Madelin Me Cay
(Give maiden name of wife in full)
(ar) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
7
50
Years
Months
13
.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.
Customs Mari.
Broken Offuel
10 Date deceased last worked at this occupation (month and year) Washington
13
12 BIRTHPLACE (City).
(State or country)
N. C.
13 NAME OF
FATHER
William Lunsford
14 BIRTHPLACE OF
FATHER (City)
(State or country) Varqual
15 MAIDEN NAME
OF MOTHER
I like A Como
Baltimore,
16 BIRTHPLACE OF MOTHER (City) (State or country) Marchand
17 Madelin Junefry
Relation, if any
Informare (Address) 19 orlando alok
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Suffolk.
The Commomuralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making returna)
1
PLACE OF DEATH
(County) Winthrop
(City or Tern) 19º Orlando que „St.,.,
Ward
Marince Paul Lunsford
...
(If U. S. War Veteran, specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of residence in city er town where death occurred
yTs.
days. How long in U. S., if of foreign birth?
Registered No.
135
No ......
informations should be carefully supplied. AGE should be stated EXACTLY. I.YSICIANS should state
....
11 Totalome (years) &dl/ 34 3 & spent in this occupation.
PARENTS
30
1936
Revised United Sta
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 nonc.
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
1013
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 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.
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 ezhume 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, 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.
IM R-302
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town)
No.
.Boston.City .. Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No ..
.7245
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Lewis
E
Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No.
(Usual place of abode)
60 .. Bates .. Ave
St.,
Ward, ...
.Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred yrs.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August 13
193 6
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
July .... 5
13.6 .... , to
Aug ... 13
19.3 ... 6
19
death is said
I last saw h .. j.m ... alive on ..
Aug
to have occurred on the date stated above, at.
8.02P
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
perforated ... peptic ... ulcer ... with
general ... peritonitis
6.wks
Contributory causes of importance not related to principal cause:
broncho pneumonia
dys
Name of operation
Date of.
What test confirmed diagnosis?
Was there an autopsy?no ..
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
W O'Connell
M. D.
(Address)
Boston
Date .. . 8. 14/1936
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Mass
(Cemetery}
DATE OF BURIAL
(City or town)
19.3.6
22 NAME OF
UNDERTAKER
ADDRESS
Baston
Received and filed
...
SEP 151936 AL
J Co mally WICTHROPMASS
19
(Registrar of city or town where death occurred) Aug 18
DATE FILED 19.36
5 SINGLE
MARRIED
WIDOWED
er DIVORCED
(write the word)
married
5a If married, widowed, or divorced HUSBAND of
Sarah Mo Faddon
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
receiving clerk
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)
Jime 1.936
11 Total time (years)
spent in this
occupation
7 yrs
Nova Scotia
Daniel Smith
N S
15 MAIDEN NAME
OF MOTHER
Sarah Eliot
N S
Widow ..
ATTEST:
Neida Ofeditions Quirks
1 2 FULL NAME 3 SEX M (or) WIFE of 7 AGE 53 Years OCCUPATION 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 17 Informaat (Address) A TRUE COPY. important. 50m-9-'31. No. 3385-₪ 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 (State or country)
St.,
Ward
(If U. S.
War Veteran,
110
4 COLOR OR RACE
W
Months Days
(Registrar of City or Town where deceased resided)
2M 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
important.
ATTEST:
Neida Ofedition Quick
(Registrar of city or town where death occurred)
DATE FILED
Aug 24
19 .. 3.6
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August 19
1936
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Aug 17
93.6., to.
Aug ... 19
19 .. 3.6.
I last saw h
im alive on.
Aug 19
19.36
death is said
to have occurred on the date stated above, at.
1.104.
The principal cause of death and related causes of importance in order of onset were as follows:
Date ofonset
hypertension
1926
cerebral edema
8/18/
cirrhosis of liver
1933
Contributory causes of importance not related to principal cause:
broncho pneumonia (bilat)
dys
Name of operation
What test confirmed diagnosis?
Was there an autopsy ?..... yes
Date of
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
W.W Knowlton
M. D.
(Address)
Boston
Date
8/1919.3.6.
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Winthrop
Winthrop
Au Cemetery22
(City or towf)
DATE OF BURIAL
19.3.6.
22 NAME OF
UNDERTAKER
R.
ADDRESS
Last Boston
Received and filed
19
1
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.
7405
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
John ... J.
Bray.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
241 Washington Ave
St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
W
(write the word)
M
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(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.
Pres
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
McKie Lighter Co
10 Date deceased last worked at
this occupation (month and
year)
Aug 1936
11 Total time (years)
spent in this
occupation.
25
12 BIRTHPLACE (City)
(State or country)
Newfound land
13 NAME OF
FATHER
Peter J Bray
14 BIRTHPLACE OF
FATHER (City)
(State or country) NE
15 MAIDEN NAME
OF MOTHER
Catherine Blythe
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
N F
17 Informant (Address)
Wife-
50m-9-'31. No. 3385-g
PLACE OF DEATH
SUFFOLK (County)
No.
Peter Bent Brigham Hospital
.St.,
Ward
Į ( U. S.
War Veteran,
specify WAR)
(a)
Residence.
No
(Usual place of abode)
Length of residence in city or town where death occurred
mos.
days. How long in U. S., if of foreign birth?
yrs.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
PARENTS
A TRUE COPY.
SEP 151936 AM
(Registrat of City or Town where deceased resided)
A R-301A
7 OCCUPATION 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. D .- WRITE FLAINLI, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
Suffolk V (County)
The Commamuralth 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. 142
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... 180 Sonoet One St
.Ward,
Winthrop
(If nonresident, give city (or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred / 3 yrs.
.₪205
days. How long in U. S., if of foreign birth? yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female White
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
OF DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Ho(Give maiden name of wife in full) .
IM Cuales
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
75
Years ..
5
Months.
22 Days
If less than 1 day Hours. Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .....
Homewife
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. at Honk
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ....
this occupation (month and
year)
4/35
49
12 BIRTHPLACE (City)
Chebea
(State or country)
13 NAME OF
FATHER
George E. Leeper
14 BIRTHPLACE OF
FATHER (City)
Chelsea
(State or country) oss
15 MAIDEN NAME
OF MOTHER
Carolina Brooks
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 gustavo Curtis
Informant (Address) 21 Prescott At Win
500
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
de althe fficer 8/3/36
.
(Official Designation)
(Date of Issue of Permits
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Ďay)
(Year)
19 I HEREBY CERTIFY
That I attended deceased from
Dee
1924, to 8/2
1936
I last saw h.C ......... allve on
19.2.G, death is sald
to have occurred on the date stated above, at/ 0 G, m. The principal cause of death and related causes of Importance in order of onset were as follows:
Date of Onset IMPORTANT
Chimie my accidente
1931?
1925?
Name of operation.
Date of
What test confirmed diagnosis ?.
Was there an autopsy? 10
20 Was disease or injury in any way related to occupation of deceased? $200
If so, specify .....
Lay lu Tacion
(Signed)
M. D.
(Address)270 Concommich ters Date
8/2 1936
21 PLACE OF BURIAL,
Relation, if any
DATE OF BURIAL
augus
CREMATION OR REMOVAL
Woodlow
Engrett
(City or town)
1936
(Cemetery)
22 NAME OF
UNDERTAKER
424 Broadway Chelsea
bounce
ADDRESS
Received and filed. 19
AUG .11 1935
(Registrar)
1
(City or Town)
No 180 .... Som set Ones, ........ .Ward
nellie 7. Curtis
(If U. S. War Veteran, specify WAR)
1936
1
Contributory causes of importance not related to principal cause:
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, soup 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.
Examplo
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.
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