USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 82
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5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Sing.
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 2.7 Years 4 Months 18Days
If less than 1 day
Hours.
Minutes
OCCUPATION
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ....
Actress
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
Theatre
10 Date deceased last worked at
this occupation (month and
year) .
11/36
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City)
East Boston
(State or country)
Mass.
PARENTS.
13 NAME OF
FATHER
Charles Kenrick
14 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country) Nass,
15 MAIDEN NAME
OF MOTHER
Mary Anderson
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Norwe.v
25m-2-'30. No. 7997-e
17
Informant
Ers, Mary A. Kenrick (Mother)
(Address)
155 Pleasant St. . Winthrop
A TRUE COPY
OF Heida Ofeditions Juink
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
10/8/36
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October 5/36
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
Septicemia.
Pyemi &
Septic uterus. Manner to be
determined.
XX
20 If death was due to external causes (VIOLENCE) fill in the following :
Accident,
Suicide or
Homicide ?
Date of injury.
19
Where did
injury occur ?
Not ... known now
Manner of
Injury
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
W .J.Brickley
M. D.
(Address)
Boston
Date10/5/ 19.36
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Mass
(Cemetery)
(City or town)
DATE OF BURIAL
Oct 7
19.36
23 NAME OF
UNDERTAKER
R H White
ADDRESS
Winthrop
Received and filed.
nor
3,
19 36
(Registrar of City or Town where deceased resided)
specify WAR)
(If U. S.
War Veteran,
192
mos.
days.
How long in U. S., if of foreign birth?
JTs.
St.,
Ward
(City or town and State)
RECEIV.
OF
TOWN
OFFICE
11 12
10.
CLERK
3
8
4
1
5
6
TH
P MASS
NOV-31936 AM
TA R-301
OCCUPATION 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 100m-12-'34. No. 2938 -- N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
...
(County)
1
int ron
(City or Town)
No ........
. Junwww ide Avecour
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.
JOSEPH JAMES CYR
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ....
Zt Sunnyside avenue
.. St., ..
....
.. Ward,
(If nonresident, give city or town and state)
IROS.
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
of DIVORCED Married
18 DATE OF
DEATH
Cent
11
1936
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
a Poquett
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
.. Years.
.. Months.
Days
If less than 1 day
.. Hours.
.. Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
Retired
9 Industry or business in which
work was done, as silk mill,R . R. Engineer
saw mill, bank, etc ....
10 Date deceased last worked at
11 Total time (years)
spent in this 53
occupation.
12 BIRTHPLACE (City)
(State or country)
Canada
13 NAME OF
FATHER
Edward
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF MOTHER (City) (State or country) Canada
17
Francis Cyr
Informant ...
(Address)
Sunnysia Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
William 9. Childress
(Signature of Agent of Board of Health or other)
agent Get 18/36
(Official Designation) (Date of Issue of Permit)
20 Was disease or injury in any way related to occupation of deceased?
No
If so, specify.
(Signed)
M. D.
(Address) Warthing man
Dataet 12 1936
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
HoMiro: Winthrop
(Çemetery)
Actol.
(City or town)
19
22 NAME OF
UNDERTAKER
John F. O Maley
ADDRESS
Received and filed ... OCT 20 1936 .19.
-
A TRUE COPY, ATTEST:
(Registrar)
19 I HEREBY CERTIFY, That I attended deceased from
Sept 11
1936, to Cent
11
1936
I last saw h ............ alive on Cent 10 1936 death is said to have occurred on the date stated above, at & A ... m.
The principal cause of death and related causes of Importance in order of onset were as follows:
Date of Onset
aug 1936
Contributory causes of importance not related to principal cause:
Name of operation.
Date of
What test confirmed diagnosis play + blant Was there an autopsy? No
Relation, if any DATE OF BURIAL
5-
St., ..................... .Ward
(If U. S.
War Veteran,
specify WAR)
....
(Usual place of abode)
Length of residence in city or tewn where death occurred
Jrs.
days. How long in U. S., if of foreign birth?
yrs.
MEDICAL CERTIFICATE OF DEATH
(write the word)
7
79
this occupation. (month.
year)
T, granth and 1 928
Revised United States Standard Certificate of Death
EXTRACTS FROM THE L OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
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 onseè
1919
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.
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthe' 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 sconer obtained hereunder. If the death certificate contains a recital, as re- quirett 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, cr as to the manner or cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45, G. L., (T'ercentenary 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.
1 R-301 A
PLACE OF DEATH
Suffolk
The Commonwealth 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.
191
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Austin Eugene Carpenter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
183 Winthrop
.St.,
........
.Ward,
(If nonresident, give city or town and state)
37
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
Carrie Edda Pierce
(Give maiden name of wife in full)
If less than 1 day
Hours
Minutes
Relevo
11 Total time (years)
spent in this
occupation.
(State or country)
Massachusetts
13 NAME OF FATHER Fontenelle Eugene Carpenter
Fitchburg Ciubum. Mas Massachusetts
15 MAIDEN NAME Mary Jane Haskins OF MOTHER
fitchburg
16 BIRTHPLACE OF MOTHER (City) (State or country) Maso
17 Phyllis C.Stone (daughter)
Winthrop Mass
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)
(Date of Issue of Permit) ?? 10/14/36
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
11
1936
(Month)
(Day)
(Year)
October 3
19 I HEREBY
CERTIFY, That I attended deceased from
1936 to October 11,
36
. 19.
I last saw h.M.M ..... alive on
.
October 10 1936
,death is said
9 a. m.
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:
Date of Onset IMPORTANT
Hypertensive Heart Disease Chronic nephritis
1130
1932
Contributory causes of importance not related to principal cause:
none
.. Dale of
Was there an autopsy? 200
20 Was disease or injury in any way related to occupation of deceased? If so, specify Le digo, Risculbu M. D.
(Address).
(Signed)
8) Somerset Www. Withro
Date Oct 13. 19 36.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Forest Hilly ,Fitchburg
(Cemetery)
(City or town)
36
DATE OF BURIAL
October 14
19
22 NAME OF
Charles R. Bennison
UNDERTAKER
ADDRESS
Winthrop Mass
Received and filed OCT 25 1994
19
(Registrar)
(County) 1 Winthrop (City or Town) No .. 183 ..... Winthrop (a) Residence. No (Usual place of abode) Length of residence in city or town where death occurred 3 SEX 4 COLOR OR RACE White Male (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 AGE. 6.6 .Years 5 Months 17 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 ailk mill, saw mill, bank, etc. 10 Date deceased last worked at this occupation (month and OCCUPATION year) 1927 14 BIRTHPLACE OF FATHER (City) (State or country) PARENTS Informant (Address) 17 Buchanan St Healthe fficer (Official Designation) 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 100m-9-'33. No. 9321-a' N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item or 12 BIRTHPLACE (City) Fitchburg
St.,
.....
Ward
(If U. S.
War Veteran,
specify WAR)
Name of operation.
What test confirmed diagnosis ?..
Clinical
Fullled 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 & 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
IOIS
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1027
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first. second, or third position. The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LA 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 erough 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 i 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.
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