USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 79
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BOSTON
(City or town making return)
Registered No.
3407
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Euge e Rowel Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred
54 Highland Av.
St.,
Ward, Winthrop
(If nonresident, give city or town and state)
IOS.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September 28/36
(Month)
(Day) (Year)
19 I HEREBY CERTIFY, That I attended deceased from
19
9. 18/36
.. 19
18/28/36
I last saw h.
imalive on9/28/36
19
., death is said
to have occurred on the date stated above, at1.O .: 30am. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
General arteriosclerosis
chronic myocarditis
unk
uk
Contributory causes of importance not related to principal cause:
.Psychosis.with.cerebral arterio ..
sclerosis
Aug .. 1936
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
(Signed)
H. F. Norton
M. D.
(Address)
Boston
Date 9/28/19.36.
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Winthrop.
(Cemetery}
Winthrop .. O(City/ or town)
19.36
22 NAME OF
UNDERTAKER
C ... R. Bennison
ADDRESS
Winthrop
A TRUE COPY ..
ATTEST:
Hilda Hedstrom Seink
(Registrar of city or town where death occurred) .... Received and filed
DATE FILED
10/1/36
19
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Marr.
5a If married, widowed, or divorced
HUSBAND of
Clara H. Symonds
(Give maiden name of wife in full)
(Husband's name in full)
7 AGE 79 Years 8 Months 15 Days
If less than 1 day
Hours.
.Minutes
Conductor
B. &. M.R. R.
/17
11 Total time (years)
spent in this
occupation
25
12 BIRTHPLACE (City)
Nashua
(State or country)
N. H.
13 NAME OF
FATHER
Jerome Smith
14 BIRTHPLACE OF
FATHER (City)
Londonderry
Amanda Rowel
16 BIRTHPLACE OF
MOTHER (City)
Hardwich
yrs.
mos.
St.,
Ward
(If U. S.
specify WAR)
185
days. How long in U. S., if of foreign birth?
утв.
1
(City or Town)
3 SEX
M
4 COLOR OR RACE
W
(or) WIFE of
6 IF STILLBORN, enter that fact here.
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)
OCCUPATION!
15 MAIDEN NAME
OF MOTHER
PARENTS
(State or country)
Vt.
17
Wife
Informant
(Address)
tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important.
50m-9-'31. No. 3385=f
N. B .- WRITE MAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD \Every item of informa-
(State or country)
Vt.
SEVN
1.
DATE OF BURIAL
RM 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
.....
......
(County)
... inthrow
(City or Town)
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 John Edmura Halli an
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 Belcher St
.St., ..
.. Ward,
(If nonresident, give city or town and state)
.₪03
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
OF DIVORCEDarried
5a lí married, widowed, or divorced
HUSBAND of
ar arat Mccarthy
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
56
Years Months .. Days
if less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ........
Merchant
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc ..
Leather
10 Date deceased last worked at
this occupation.(month andz
year)
11 Total time (years)
spent in this z 5
occupation
12 BIRTHPLACE (City)
East Boston
(State or country) Mass
13 NAME OF
FATHER
Edmond Halligan
14 BIRTHPLACE OF
FATHER (City)
Deat Boston
(State or country) Mass
15 MAIDEN NAME
OF MOTHER
Ann Maquillao
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17
Information Hallisan
(Address)
40 Beicker St
Relation, if any
(
Son
100m-12-'34. No. 2938-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE/the burial or transit peront was issued: . D. Cundress (Signature of Agent of Board of Health or other Health Much 30/36 (Official Designation) (Date of Issue of Bermit)
MEDICAL, CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
28
(Day)
1436
(Year)
19 I HEREBY CERTIFY, That , attended daceascd from
Just 26
1956, 10.
Want 25, 1936.
I last saw h .... A.A .... alive on x. 28 1936, death Is said to have occurred on the date stated above, at 6:00pm The principal cause of death and related causes of Importance In order of onset were as follows: Data cf Onset Central Mente 026
Contributory causes of importance not related to principal cause:
Name of operation.
Date of
What test confirmed diagnosis?
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
(Address) Cuanto 20
Data -7
1916
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Winthrop
(City of town)
DATE OF BURIAL
(Cemetery)
Oct. I 1936
19
22 NAME OF
UNDERTAKER
ADDRESS
Winthrop
Received and filed. 1995
19
A TRUE COPY, ATTEST:
(Registrer)
1
PLACE OF DEATH
No. Winthrop Community Hospivs
.Ward
(If U. S.
War Veteran,
186
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of residence in city or tows where death occurred
YT8.
days. How long in U. S., if of foreign birth?
FTs.
(write the word)
PARENTS
M. D.
Revised United State
andard Certificate of Death
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHI GOVERNING THE
TTS
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.
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 ...
I021
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.
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 dicd, 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 carly 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 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.
HI R-301
SUFFOLK
PLACE OF DEATH
(City or Town)
No Station Hospital, Fort Banks,
St.,
Ward 1
Cambridge notified 10/23/36 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 JOHN A PORTEOUS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
279 Pearl Street.
St.,.
......
Ward,
Cambridge, Mass.
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
82 days. How long in U. S., if of foreign birth?
Jrs.
MOB.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
28
(Month)
( Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from August ..... 7. 19 ... 3.6 to .... September 28 19 36
I last saw him ...... alive on. September 28, 19.3.6 ... , death is said
10: 16P
to have occurred on the date stated above, at. The principal cause of death and related causes of importance in order of onset were as follows: Goiter, exophthalmic, severe
Thyrotoxicosis, .post-operativo
Date of Onsat .Unimown 9/28/2.6
Contributory causes of importance not related to principal cause:
Name of operation ..
Thyroidectomy
.... Date of 9/28/36
What test confirmed diagnosis ?....
Operation ... Was there an autopsy ?.... NO
1
20 Was disease or injury in any way related to occupation of deceased? 4.0
if so, specify.
(Signed)
.. , M. D.
(Address)
Fort Banks, Mass.
... Date.So.pt299.36
21 PLACE OF BURIAL.
CREMATION OR REMOVAL Mt. BEREdect
Boston
(Cemetery)
(City or town)
DATE OF BURIAL
Oct.1.1936
19
22 NAME OF
Murray a Hurry
UNDERTAKER
ADDRESS
254
1935 Rever
Hearthe Life ces VOfficial Designation.,
(write the word)
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
(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.
C C C
9 Industry or business in which work was done, aş silk_mill, saw mill, bank, etc.CivilianConservationCorps ..
10 Date deceased last worked at 11 Total time (years) this occupation (month and spent in this occupation.
year) August .8.1936
12 BIRTHPLACE (City) (State or country) Massachusetts
V Adam Porteous
Fall River Mass.
Mary & Ryan.
Boston
(State or country) ması.
17 Informant .Registrar ..... Sta.Hosp .... Ft .... Banks. Mass ...
I HEREBY CERTIFY that a satisfactory standard certificate of death was Wed with me BEFORE the burial or transit permit was issued:
Signature of Agent of Board of Health or other
(Date of Issue of Period; 2/30/26 Received and filed OCT 1 19
A TRUE COPY, ATTEST: (Registrar)
(County) 1 WINTHROP (Usual place of abode) LUKD. cvery iteiff vl 3 SEX Kals 5a If married, widowed, or divorced HUSBAND of (or) WIFE of 7 AGE 28 13 NAME OF FATHER 14 BIRTHPLACE OF N FATHER (City) . 15 MAIDEN NAME OF MOTHER OCCUPATION PARENTS 16 BIRTHPLACE OF MOTHER (City, (Address) information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLANLY, WITH UNFADING BLACK INK-THIS IS A PERMANEN! 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 (State or country ) K 100m-12-'32. No. 7070-1
(If U. S. War Veteran, specify WAR)
1036
Kovised United Stas
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, y." "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
1915
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 LAWS C HE 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
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