USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 28
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Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL March 27
1939
22 NAME OF
UNDERTAKER
ADDRESS
254 Beach LP
Revue
Received and fited. ........... MAR 2-7 1939 19
(Registrar)
1100m 11.36. No. 9080 F
1 3 SEX Male (or) WIFE of (State or country) FATHER (City) PARENTS OCCUPATION 16 BIRTHPLACE OF MOTHER (City) (State or country) important. See instructions and extracts from the law's on back of certificate. in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very (State or country)
7 AGE .. 52 Years .... .. 10 .. Months 13Days
If less than 1 dey Hours. .. Minutes
(Soldier) Pvt Hq Btry
8 Trade, profession, or particular
kindofwork done, as spinner, 9th C. A.
sawyer, bookkeeper, etc.
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
(U.S. ARMY) Fort Banks, Mass.
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
this occupation, month and1 939
yeer).
18
12 BIRTHPLACE (City).
Nashua, ... N. H.
13 NAME OF
FATHER
Unknown
14 BIRTHPLACE OF
Unknown
15 MAIDEN NAME
OF MOTHER
Unknown
Ur known
17 loformaat .. Registrar, Sta.Hosp ... Et ... Banks., ... ass ........ ) (Address)
I HEREBY CERTIFY that a satisfactory stendard certificate of death was flied with me BEFORE the burial or trensit permit was issued: William D, Childress
(Signature of Agent of Board of Health or other)
agent
mar, 26/39
(Official Designation) (Date of Issue of Permit)
(write the word)
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
OF DIVORCED Single
6a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
1939
19
........ to ..
-19 .....
-
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
PLACE OF DEATH
Revised United States Standard Certificate of Death
COMMONWEA
ALTH OF M GOVERNING THE
-
Statement of occupation. l'recise statement of occupation 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 change on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from bus. incss, 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 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. avoul the use of such indefinite terms as "employee" "worker," "operative," etc. Find out the partic. ular kind of work done and return that, as SPINNER, WEAVER, etc.
In stating the industry or business, avoid the use of such gens 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 engincers 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. 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 discase causing death. . As related causes, name carlier 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 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
1915
Chronic interstitial nepbritis
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.
RETURN OF CERTIFICATES OF DEATH
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 date of his death. . .. GEN. LAWS. CHAP. 46, SEC. 9.
No undertaker or other person shall hury 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 afoirsaid or from the clerk of the town where the body is buried. No such perinit 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. quired hy 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 shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- 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: provuled. 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 obtained hereunder. If the death certificate contains a recital. as required 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 eer- tifying the cause of death hall 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. (TER- CENTENARY EDITION.)
Medical examiners shall make examination upon the view of the dead bodies of only such persons as arc 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 peintits, 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 hurial 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 hy 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 hy traumatism (including resulting septi. cemia), and by the action of chemical (drugs or poisons ). thermal. or electrical agents, and deaths following ahortion. 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.
MASSACHUSETTS
301
1
PLACE OF DEATH
SUFFOLK (County)
WINTHROP (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
70
" (If death occurred in a hospital or institution.
Ward ( give its NAME instead of street and number)
2 FULL NAME
GEORGE H. FLANDERS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
Fort .. Banks., Mass
(Usual place of abode)
.St.
. Ward,
(If nonresident, give city or town and state)
Leogth of resideoce io city or town wbere deatb occurred
12 years
- mooths- days.
How long in U.S., if of foreign birtb?
years
months days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
18 DATE OF DEATH March 25th 1939
(Month)
(Day)
(Year)
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 fect here.
7 AGE .. .52 Years ... 10 .Months 12 ... Days
If less than 1 day .Hours ..
.Minutes
8 Trade, profession, or particula( Soldier) Pvt Hq Btry kind of work done, es spinner, 9th C sawyer, bookkeeper, etc .... 9 Industry or business In which( U.S. Army) Fort Banks, work was done, as silk mill,
saw mill, bank, etc .. Mass.
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ......
18
12 BIRTHPLACE (City)
Nashua. ... N .. H.
(State or country)
13 NAME OF
FATHER
Unknown
14 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
Unknown
(State or country)
Relation, if any
Informant (Address)
17 Registrar, Sta Hosp, Ft Banks 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)
(Official Designation)
(Date of Issue of Permit)
theory
A TRUE COPY ATTEST.
(Registiar)
CORRECTED CERTIFICATE: Josef eph Casper, Col, MC, Registrar. (a)
OCCUPATION important. See instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very PARENTS
100m.9.'37. No. 1859-h.
21 l'lace of Burial, Cremation or Removal. DATE OF BURIAL
CCity OF Town)
19
22 NAME OF FUNERAL DIRECTOR
ADDRESS
- .......
Received and filed.
Date of.
Name of operation
What test confirmed diagnosis?
.Was there an autopsy ?... Xes
20 Was disease or Injury in any way related to occupation of deceased? If so, specify
(Signed)
Joseph Rich, Capt, MC
M. D.
(Address)
Fort ... Banks., .... Mass.
Date
19
Date of Onset Unknown
Unknown
Coronary ... sclerosis
Contributory causes of Importance not related to principal cause: None
19 I HEREBY CERTIFY, That I attended deceased from
19. -
-19.
I last saw h ............ allve on.
death is said
to have occurred on the date stated above, at .. 4 .: 25Am. The principal cause of death and related causes of Importance in order of onset were as follows: Intimal ... atherosclerosis.
this occupation (month and
year) ... Maroh ... 25. ... 1.939
MEDICAL CERTIFICATE OF DEATH
(write the word)
(If U. S. War Veteran specify WAR)
No.Station Hospital ,Fort Banks ,Mass St.,
(City or town making; letur, }
.19.
Revised United States Standard Certificate of Death
Statement of occupation. - Precise 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 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 partic. ular kind of work done 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, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as CIVIL ENGINEER, MECHANICAL ENGIN- KER, 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 carher 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 werc as follows:
Date of Onset
Arteriosclerosis
1915
Chronic interstitial nephritis
1921
...
Cerebral hemorrhage
July 5. 1927
Contributory causes of importance not related to principal causc :
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 ahove example happens to be the second cause given.
COMMONWEALTH OF MA MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, aiter the death of a person whom he has attended during his fast 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 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 hody 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 hoard, 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 hoard. agent or clerk, ΓΆΒΊ the case may he, a satisfactory written statement con- taining the facts required by law to he returned and recorded. which shall he accompanied, in case of an original interment, by a satisfactory certificate of the attending physician. if any, as re. quired by law, or in lieu thereof a certificate as hereinafter pro. vided. If there is no attending physician, or if, for sufficient rca- sons, his certificate cannot be obtained early enough for the pur- pose, or is insufficient, a physician who is a member of the hoard of health. or employed hy 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 shall make such certificate. If such a permit for the removal of a human hody, not previously interred, from one town to an- 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 hody shall he 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 obtained hereunder. If the death certificate contains a recital. as required 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 hoard 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 be. ohtained 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 hy 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 hody 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 hoard, from the clerk of the town where the body is to he 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 carc 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 disahled 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. Thesc include not only deaths cansed directly or indirectly by traumatism (including resulting septi- cemia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following ahortion, 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.
(a) Corrected Entries: Cause of Death revised after review of case by Pathologist
Army Medical Museum.
.
-301A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No. 61 Johnson Ave
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.
S (If death occurred in a hospital or institution,
St.,
Ward { give its NAME instead of street and number)
2 FULL NAME
Anne I. Dwyer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
61 Johnson Ave
St.,
Ward,
(Usual place of abode)
Length of residence in city or town where death occurred 22 years
months
days.
How long in U.S., if of foreign birth?
(If nonresident, give city or town and state)
years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
march
27
1939
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John ..... J ...... Dwyer
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
84
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 ....
Housework
9 Industry or business In which
work was done, as silk mill,
Own Home
saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
Oct 1938
this occupation (month and
year)
occupation.
spent in this 60 yh SContributory causes of Importance not related to principal cause:
arterio nalesis
12 BIRTHPLACE (City)
Boston
(State or country)
Mass
13 NAME OF
FATHER
James McLaughlin
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unknown
17 MaryE.Kiernan
Relation, if any
(Daughter)
DATE OF BURIAL
March .... 29 1939
19
Informant
(Address)
61 Johnson 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 8, Childress
(Signature of Agent of Board of Health or other)
Cegent
mar. 29/39
(Official Designation)
(Date of Issue of Permit)
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