USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 56
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THIS CERTIFICATE CONSTITUTES SUCH PERMIT
RIR-301A
suffolk (County)
winthrop
(City or Town)
Winthrop Hospital
No.
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.
Registered No.
137
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
·
2 FULL NAME
Edward W. Keough
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
78 Waldemar Av.
St.,
....
Ward,
(If nonresident, give city or town and state)
Length of residence ia city or town where death occurred
16
yTs.
mos.
days.
How long in U. S., if of foreign birth?
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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
16
5
Months
Days
14
If less than 1 day
Hours
Minutes
OCCUPATION·
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
School
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. .
10 Date deceased last worked at
this occupation (month and
year) ..
11 Total time (years)
spent in this
occupation
Chelsea
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Henry Keough
14 BIRTHPLACE OF
FATHER (City)
Chelsea
Mass.
(State or country)
15 MAIDEN NAME
OF MOTHER
Grace Perkins
16 BIRTHPLACE OF MOTHER (City) (State or country) Mass.
17
Henry Keough (father)
Informant ... 78 Waldemar ave. Winthrop Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burfar or transit permit was issued: Www. D. Childrenet (Signature of Agent of Board of Health or other) Health Officer 7/28/38 (Date of Issue of Permit)
(Official Designation)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
26 1938
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
26.
que 14
1938 to que
1938
1938
death is said
26
last saw h ..
.. alive on.
to have occurred on the date stated above, at 9:30 H m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
acute appendicitis
July 14 1938.
July 24 193.F
Contributory causes of importance not related to principal cause:
Name of operation of pendente
Date of July 15 1938
What test confirmed diagnosis: Guration
Was there an autopsy? /Va
20 Was disease or injury in any way related to occupation of deceased ?.
N.
If so, specify
(Signed)
writing man ...
Date 27 1938
(Address)
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
July 28
DATE OF BURIAL,
(Cemetery)
(City or town)
1938
22 NAME OF
UNDERTAKER
Richard 16 Heute
ADDRESS
1147
Winthrop St. Winthrop
Received and filed
July ...... 28,
1938.
(Registrar)
WUDITE DIAINI V
75m-5.32. No. 5469
1
PLACE OF DEATH
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! ACKLINGWITHUS G.A.PERMANENT RECORD. Every item of D
PARENTS
Chelsea
(Address)
N
(If U. S.
War Veteran,
specify WAR)
(Usual place of abode)
.St.,
.........
.Ward
., M. D.
AGE
Years
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, soat 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.
GOVERNING TH
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 deccased 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 thercafter furnish for registration any other necessary information which can be obtained as to the deceased. or as to the manner or cause of the death. which the clerk or registrar may require. - Chap. 114, Sec. 45. G. L .. as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made ... . Chop. 114, Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
F301A
OCCUPATION N D. - WRITE PLAINLI, WITTT ONTAVING DLACA INA TITS W A TEMANUTI ALLURE, PARENTS
100m 11 '36. No 9080 F
I HEREBY CERTIFY that e satisfactory standard certificate of death was lifed with me BEFORE the burial or transit permit was issued: Www. D. Culdress (Signature of Agent of Board of Health or other)
Health Office 8/1/38
(Oficial Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
22
19.53.&, to ....
30, 1938
I last saw h.L.t .... allve on
Jul 30, 1939, death is said
to have occurred on the date stated above, at & P. m. The principal cause of death and related causes of Importance in order of onsat were as follows: Date of Onset IMPORTANT Chronic negociardeter
...
Cardiac DEcombusti arle rio sclerosis Uralmia
?
1 4th.
Contributory causes of Importance not related to principai cause: milch-
1
neve
Name of operetion
What test confirmed diagnosis ?.
Clinical
-
... Data of
Was there an autopsy? ?
20 Was disease or Injury in any way related to occupation of deceased? 200
if so, specify.
(Signed)
Enon E. Barros
.... M. D.
(Address) 290 Summer H. E. D. Bate Cevea1 1928%.
21. ST. Josephis, Boston
DATE OF BURIAL
(City of Town)
2
1938
22 NAME OF
UNDERTAKER
MOJ. Kelly
ADDRESS
11 meridian IST. 8. 13.
Received and filed. AUG - 5 1938
.19
(Registrar)
1
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.
Registered No.
138
f (If death occurred in a hospital or institution, Ward ( give its NAME instead of street and number)
Patrick Henry Corbett
(If U. S. War Veteran
specify WAR)
Ward, Boston
(Usual place of abode)
Length of residence in city or town where death occorred
years
booths /5 days.
How long in U.S., if of foreign birth?
years
months days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
Da If married, widowed, or divorced Christina Welch
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of (Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE ...
8 Trede, profession, or particular kindofwork done, as spinner sawyer, bookkeeper, etc ...
3. Retired Police Oficer
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ....
City of Boston
10 Date deceased last worked et
this occupation (month and
year)
11 Total time (yeers)
June 1910 spent in this occupation ..
33
12 BIRTHPLACE (City)
(State or country)
ras.
13 NAME OF
FATHER
Patrick Corbett
14 BIRTHPLACE OF
Go. Colare
FATHER (City)
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Mary Jane
16 BIRTHPLACE OF
MOTHER (City)
OGo. Glare
(State or country)
Ireland
17 Was. Daniel & Moriarty (daughter) Informant" 379 Pleasant Stf, While,
important. See instructions and extracts from the laws on back of certificate. in plain torms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very
No.
enthrone (City or Town) 379 Pleasant St.,
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
84 Fenway
St.
(If nonresident, give city or town and state)
30
1938
7 91 Years Months .Days
If less than 1 day Hours Minutes
Boaton
CALICE OF DEATH
DIVCICIANC .L . -. 11
Relation, if any Place of Burial Creination or Removal. August
Statement of occupation. - l'recise statement of occupation is very important, so that the relative healthfulness of various pur. suits 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 bus- iness, report the occupation prior to retirement. Children not gainfully employed may be returned as AT SCHOOL Of 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 whatever write NONE.
To be complete, an occupation return must state :
8 .- The tradc. 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 partic- ular kind of work donc and return that, as SPINNER, WEAVER, etc.
In stating the industry or business. avoid the use of such gen- eral terms as "store." "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as GROCERY STORE, SOAP FACTORY, COTTON MILL, ctc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles. as CIVIL ENGINEER, MECHANICAL ENGIN- EER. 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. 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. . Is related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. U'nder contributory causes of importance not related to principal causc, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Dste of Onset
Arteriosclerosis ....
1915
Chronic interstitial nephritis ...
1921
Cerebral hemorrhage
July 5. 1927
Contributory causes of importance not related to principal cause :
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a 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.
A physician or registered hospital medical officer shall forth- with, alter 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 sup- posed 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 dlate of his death. . GEN. LAWS. C'HAP. 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 hoard 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 nave been delivered to such board, agent or clerk. as the case may be, a satisfactory written statement con- taining 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 re- cuired by law, or in lieu thereof a certificate as hereinafter pro- vided. If there is no attending physician, or if, for sufficient rea- sons, his certificate cannot be obtained early enough for the pur- pose. 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 attend- ing physician. If death is caused by violence. the medical examiner If such a permit for the removal of a human body, not previously interred. from one town to an- shall make such certificate. other within the commonwealth 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 a removal shall constitute a permit for such removal: provided. that such body shall be returned to the town from which it was re- moved within thirty six hours after such removal. unless a permit ,in'the usual form for the removal of such body has been sooner If the death certificate contains a recital. as wennired 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 ap- pear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can he 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. (TER- CENTENARY 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 hoard 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 cemetery 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 ob- servance 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 unrelated to any form of injury, have died without recent medical attendance 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 septi- cemia), and hy 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.
-
Distinguish ante Obtained hereunder.
RI R-305
Middlesex
(County)
Cambridge (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Candri dge (City or town making return) 139
Registered No ....
(If death oceurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Manuel T Sylvia
(If deceased is a married, widowed or divoreed woman, give also maiden name.)
(a)
Residence. No .... 24 .... ChamberlainAve.
(Usual place of abode)
St.,
........
Ward,
.......
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
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