Town of Winthrop : Record of Deaths 1939, Part 41

Author: Winthrop (Mass.)
Publication date: 1939
Publisher:
Number of Pages: 560


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 41


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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-11- 36. No. 9080-g


17


Informant


From hospital records


(Address)


John Y Trask Medical Dire


A TRUE COPY.


ATTEST:


George Harney


(Registrar of city or town where death occurred)


Inspector


Mar. 15, 1:39


DATE FILED 19-


MEDICAL CERTIFICATE OF DEATHI


18 DATE OF


DEATH


March 14, 1939


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


Mar. 10,


1,39


to


19


Mar. 14,


39


I last saw h


1 malive on.


Mar. .. 14


19 39


death Is said


to have occurred on the date stated above, at


12: 15P.M.


The principal cause of death and related causes of importance in order of


onset were as follows:


Cirrhosis of liver


vears


Daleofonset


AGE


Years


10


If less than 1 day


Hours


. Minutes


OCCUPATION


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...


Ship Keeper


9 Industry or business In which work was done, as silk mill, saw mill, bank, etc. Merchant .... Marine


10 Date deceased last worked at


11 Total time (years)


this occupation (month and


spent in this


occupation.


year)


12 BIRTHPLACE (City)


Cambridge


(State or country)


Mass.


13 NAME OF


FATHER


Roland Litchfield


14 BIRTHPLACE OF


FATHER (City)


Cambridge


(State or country)


Mass


15 MAIDEN NAME


OF MOTHER


Elizabeth Staples


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Maine


Relation, if any


DATE OF BURIAL


CUNDERTAKER


J. S. Waterman & Son


ADDRESS


Boston


Received and filed ..


March 15, 1939


19


(Registrar of City or Town where deceased resided)


1


PLACE OF DEATH


Suffolk (County)


Chelsea (City or Town)


No. U. S. Marine Hospital


St.,


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Chel sea


(City or town making return)


Registered No.


174


97


(If death occurred in a hospital or institution,


.Ward


give its NAME instead of street and number)


2 FULL NAME


Frank W. Litchfield


(If deceased is a married, widowed or divorced woman, give also maiden name.)


220 Court Rd.


St.


Ward,


Winthrop Lass.


(If nonresident, give city or town and state)


mos. days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


male


4 COLOR OR RACE


white


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


married


(write the word)


5a If married, widowed, or divorced


HUSBAND of


Adelaide V. Moore


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


Contributory causes of importance not related to principal cause;


Pulmonary edema


3/10/39


Bronchial ... pneumonia


3/13/39


Name of operation


Date of


What test confirmed diagnosis?


autopsy


clinical&


Was there an autopsy?Yes


20 Was disease or injury in any way related to occupation of deceased?


no


If so, specify.


(Signed)


Howard T. White


(Address) .US ... Marine .... Hosp ..


Date .3 .14 1939


21


Lakeside Cem., Wakefield, Ma.s.


Place of Burial, Cremation or Remoyal.


Mar.


16,


city or Town)


19


M. D.


Baileyville


PARENTS


7


70


7


Months


Days


mos.


(If U. S.


War Veteran,


specify WAR)


(a) Residence. No ...


(Usual place of abode)


Length of residence in city or town where death occurred


yrs.


days.4 How long in U. S., if of foreign birth?


утв.


R-302


MAY 161939 AM


ROPIN


W


0


?! !


1


RECEIVED


1 R-302


1


cis brans Hosp


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


BOSTON (City or town making return) 4067 93


Registered No (If death occurred in a hospital or institution,


give its NAME instead of street and number)


Finostone


2 FULL NAME


(If deceased is a m


ied, wridgwed or divorced woman, give also maiden name.)


St.,


........


Ward,


(If nonresident, give city or town and state)


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX M


4 COLOR OR RACE


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


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 AGE Years Months Days


Of less than 1 day


Hours Minutes


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ....


9 Industry or business în 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.


12 BIRTHPLACE (City)


Boston


(State or country)


13 NAME OFJoseph Finestone FATHER


14 BIRTHPLACE OF


FATHER (City)


Scotland


(State or country)


15 MAIDEN NAME Norma E Kleingless OF MOTHER


16 BIRTHPLACE OF


MOTHER (City) ..


Boston


(State or country)


17 Informant (Address)


r&ertiga if any (


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Kar 15/39


(Month) (Day)


(Year)


3/15/39


19 I HEREBY CERTIFY, That I, attended deceased from


3/15/39


19 ...


to.


19


....


I last sawiii:2


3/15/39


to have occurred on the date stated above,


m.


The principal cause of death and related causes of importance in order of onset were as follows:


Dateofonset


tracheo esophageal stricture


Contributory causes of importance not related to principal cause:


inperforate anus-atelectasis


Name of operation Ophagoal anestenosis Date of 3/15/39


What test confirmed diagnosis? Was there an autopsyz/OS


20 Was disease or injury in any way related to occupation of deceased? If so, specify.


(Signed)


R.R .... Thito


M. D.


(Address on Longwood Ave


Date


19


21


Beth Josoph-Woburn


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


3/17/39


19


22 NAME OF


Stanetsky


UNDERTAKER


ADDRESS.


Boston


3/18/39


Received and filed


19


(Registrar of City or Town where deceased resided)


50m-11-36. No. 9080-g


OCCUPATION 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 PARENTS important.


PLACE OF DEATH


SUFFOLK BOSTON


No.


St.,


....... Ward


(L U. S. War Veteran,


Wifech WAR)


(a) Residence. No.


(Usual place of abode)


Length of residence in city or town where death occurred


yrs.


mos.


days. How long in U. S., if of foreign birth?


....


alive on ...


19


death is said


MAY 121939 AM


٢٠ ١٠


1


Meaay


1 R-302


SUFFOLK BOSTON


(CityHÅ Home


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


BOSTON (City or town making return) 99 2941


Registered No. (If death occurred in a hospital or institution,


St.,


Ward


give its NAME instead of street and number)


Evelyn J Gallagher


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


31 Palmyra St Winthrop Massst.,


Ward,


(If nonresident, give city or town and state)


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Female


4 COLOR OR RACE


White


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


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 34


AGE


Years Months Days


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .. Bookkeeper


9 Industry or business In which work was done, as silk mill,


saw mill, bank, etc. Dept.Store


10 Date deceased last worked at


11 Total time (years)


this occupation (month and


Jan!38


year).


spent in this occupation .... 18


12 BIRTHPLACE (City)


Hoboken ... Now ... Jersey.


(State or country)


13 NAME OF


FATHER


Daniel F Gallagher


PARENTS


15 MAIDEN NAME


OF MOTHER


Johanna Murphy


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Hoboken New Jersey


17


Relation, if any


Mrs J Gallagher Mother


Informant (Address) 31 Palmyra St Winthrop


A TRUE COPY.


ATTEST:


James Q. Burke


(Registrar of city or town where death occurred)


DATE FILED 19


18 DATE OF


DEATH


March 24,1939


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


March 1


39.


March 24


193.9


to


I last savetf. alive on ... March24 1939 ... , death Is said


to have occurred on the date stated above


.. m.


The principal cause of death and related causes of importance in order of onset were as follows:


Daleofonset .137


Contributory causes of importance not related to principal cause: Laryngoal.tuberculosis Nov.138 ..


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) .Carey ... M.Poters


M. D.


(Address).101.Boacon St- Brookline -3-24 1939 ...


21


Winthrop Cem Winthrop


ty or Town)


Place of Burial. Cremation or Removat.


DATE OF BURMAeh -27-1939


19


22 NAME OF


UNDERTAKER


R ... C .... Kirby


ADDRESS


EastBoston Mass


Received and filed


March 28,1939


19


(Registrar of City or Town where deceased resided)


50m-11.'36. No. 9080-g


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 OCCUPATION


important.


1


PLACE OF DEATH


No.


(If U. S. War Veteran, specify WAR)


(a)


Residence.


No ...


(Usual place of abode)


Length of residence in city or town where death occurred


yTs.


mos.


days. How long in U. S., if of foreign birth?


угз.


(write the word)


14 BIRTHPLACE OF


FATHER (City)


Brooklyn .. Now.York


(State or country)


If less than 1 day .. Hours. .Minutes Pulmonary ... Tuberculosis Dec


RECEIVED


140


W


SSI


RI


MAY 121939 All


A R-305


PLACE OF DEATH


LSUFFOLK (County) BOSTON


(City or Town)


No.


Boston .. City ... Hosp


St.,


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


(City or town making return)


Registered No


3090. 00


(If death occurred in a hospital or institution,


-


Ward


give its NAME instead of street and number)


2 FULL NAME


Kerry ... Gillis


(It deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No .... 729 Winthrop


(Usual place of abode)~


Length of residence in city or town where death occurred


St.,


Ward,


(If nantesidebt,give city or town and state)


.... dayı.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


(write the word)


Worried


5a If married, widowed, or divorced


HUSBAND of


(Give maldef fame d \fe ttai)


(or) WIFE ..


(Husband's name in full)


6 IF STILLBORN, enter that fact hare.


7 AGE 6.6 Years ... 8 Months .5 .Days


If less than 1 day .Hours Minutas


OCCUPATION


8 Trada, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..... clerk


9 Industry or business in which


work was dona, as silk mill,


saw mill, bank, etc ....


store


10 Date deceased last worked at


this occupation (month and


year)


11 Total time (years)


spant in this


occupation.


12 BIRTHPLACE (City)


(State or country)


Charlottotom PEI


13 NAME OF


FATHER


14 BIRTHPLACE OFexander Gillis


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Pr Edw Island


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


17


Informant


(Address)


Relation, if any


(


wife


A TRUE COPY.


ATTEST:


"(Registrar of city or town where death occurred)


DATE FILED 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


War 29/39


(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)


Cirrhosis of liver alcoholism


20 If death was due to external causes (VIOLENCE) fili in the following:


Accident,


Suicide or


Homicide?


Date of Injury


.19


Where did Injury occur?


(City or town and State)


Manner of


Injury


Nature of


Injury


Was there an autopsy?


21 Was disease or injury in any way ralated to occupation of deceased? If so, specify


M. D.


(Signed)


T Leary


Data .. .. 19 ...


Boston


3/20/30


22


Place of Burial. Cremation prtRemoval intheropor Town)


DATE OF BURIAL


18


5/31/39


28 NAME OF


UNDERTAKER


RHThito


ADDRESS


Winthrop


Receivad and filed


1/1/39


19


(Registrar of City or Town where deceased resided)


25m.11.'36. No. 9080-h


1


PARENTS


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


days. How long in U. S., if of foreign birth?


(If U. S.


War Veteran,


specify WAR)


Spanish


........... .......


(Addrass)


RECEIVED


11


..


12


3


33


THROP


MAY 121939 AM


R-302


PLACE OF DEATH


SUFFOLK BOSTON


(CBy.orOpwalemorial Hosp


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


BOSTON


(City or town making return) 3177


Registered No ....


(If death occurred in a hospital or institution, give its NAME instead of street and number)


Annie E Fowler


2 FULL NAME


(Ifgdeceased is a married, widowed or divorced woman, give also maiden name.)


.St.


Ward,


(If nonresident, give city or town and state)


days. How long in U. S., if of foreign birth?


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


5 SINGLE


(write the word)


MARRIED


WIDOWED


Widowed


or DIVORCED


5a If married, widowed, or divorced HUSBAND of Daniol (Give midenhame of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


77


7 AGE


Years


Months


Days


If less than 1 day Hours .. Minutes


8 Trade, profession, or particular at home 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


11 Total time (years)


spent in this


occupation.


12 BIRTHPLACE (City)


Nova Scotia


(State or country)


13 NAME OF


FATHERJohn Layte


14 BIRTHPLACE OF


FATHER (City) ...


"Nova Scotia


(State or country)


15 MAIDEN NAMEusan


OF MOTHER


Thomas


16 BIRTHPLACE OF


MOTHER (City)


Turland


(State or country)


17


Informant (Address)


A TRUE COPY.


ATTEST:


James Q. Burke


(Registrar of city or town where death occurred)


DATE FILED 19


183/5G/PREBY CERTIFY AUht A attended deceased from


I last saw h


alive on


19


death Is said


3802


to have occurred on the date stated above, at.


m.


The principal canse of death and related causes of importance in order of onset were as follows: Dateofonset


Lymphoblastona


....


Contributory causes of importance not related to principal cause:


...


pulmicdona


biopsy


3/21/39


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 ..


G-L Swan Jr


(Signed)


:204 Beacon St


(Address)


19


Winthrop-Winthrop


21


Place of Burial, Cremation of Removal.


(City or Town)


muito


22 NAME OF


UNDERTAKER


Winthrop


ADDRESS.


4/1/39


Received and filed 19


(Registrar of City or Town where deceased resided)


50m-11-36. No. 9080-g


OCCUPATION 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 PARENTS important.


1


No.


.St.,


Ward


(I U. S.


War Veteran,


wesify WAR)


Winthrop


(a)


Residence. No.


(Usual place of abode)


Length of residence in city or town where death occurred


yrs.


mos.


Apr 1/39


18 DATE OF


DEATH


(Month)


(Day)


(Year)


31931/39


19


17


this occupation (month and


year)


Date:


$/1/39


.... , M. D.


Relation, if any DATE OF BURIAL 19


MAY 121339 AM


١١٠



١١١


RECENTES


R-302


OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS


important.


50m-11-'36. No. 9080-g


17 Mrs. Julia Winston


Relation


Informant


( Address) 109 Banks St. Winthrop


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


/


Apr. 15, 1939


.19


MEDICAL CERTIFICATE OF DEATH


3 SEX


M


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


Married


18 DATE OF


Apr. 13,1939


DEATH


(Month)


(Day)


(Year)


5a If married, widowesultad Theresa Donovan


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


64


26


If less than 1 day .Hours Minutes


OCCUPATION


8 Trade, profession, or particular kind of work done, as spinner. sawyer, bookkeeper, etc


Proprietor


9 Industry or business In which


work was done, as silk mill,


saw mill, bank, etc.


Lunch Room


10 Date deceased last worked at


11 Total time (years)


this occupation (month a 1930


year)


Contributory causes of importance not related to principal cause:


.......... Cerobralhemorrhage


unknown


... 2 ..... Nephrosclerosis


unknown


Name of operation


Date of


none


What test confirmed diagnosis?


clinical %


there an autopsy ?. es


20 Was disease or injury in any wautop S upation of deceased? no


If so, specify.


(Signed)


V.E. artens,Lt. (jg)


(MC) , USN


(Address)


USN Hosp. Chelsea


21


Holy Cross Malden, Mass


Place of Burial, Cremation or Removal.


Town)


DATE OF BURIAL Apr. 17, 1939


19


22 NAME OF


UNDERTAKER


Richard Kirby


.


ADDRESS


17 Bennington St.E Boston


Received and filed 19


(Registrar of City or Town where deceased resided)


1


(City ofU.S. Naval Hospital


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Chelsea


100


(City or town making rete 2


Registered No.


(If death occurred in a hospital or institution,


St.,


.....


Ward


give its NAME instead of street and number)


James Bernard Winston


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


specify WAR)


(a) Residence. No.


(Usual place of abode)


Length of residence in city or town where death occurred


109 Bank


St.,


Ward,


Winthrop


(If nonresident, give city or town and state)


Oyra.


1


mos.


days .


How long in U. S., if of foreign birth?


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


(write the word)


19


I HEREBY CERTIFY, That I attended deceased from


Mar.9.


19.39, to.


Apr .. 13


19


3.9


1 last saw h .. Amm .. alive on .....


Apr .13


19 ..... 39death Is said


to have occurred on the date stated above2.12 Pm.M. The principal cause of death and related causes of Importance in order of onset were as follows: Dateofonset Arteriosclerotic heart disease unlmown


spent in this0 yrs. occupation


12 BIRTHPLACE (City)


(State or country)


Boston, Mass.


13 NAME OF


FATHER


James


14 BIRTHPLACE OF


FATHER (City)


Ireland


(State or country)


15 MAIDEN NAME


OF MOTHER


Celia Lyons


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


Suffolk


PLACE OF DEATH


Chodsea


No.


(If U. S.


Spanish


AGE


Years


Months


Days



3


3


1


3


Kli


MAY 161939 AM


RECEIVED


-301A


1


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No.


18 Tewksbury


The Commonwealth of Alassachusetts 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. 103


Registered No. S (If death occurred in a hospital or institution,


St., Ward ( give its NAME instead of street and number)


2 FULL NAME


Harriette Elizabeth (Looker) Nourse


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence.


No.


18 Tewksbury


(Usual place of abode)


St.,


Ward,


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred


15


years


months


days.


How long in U.S., if of foreign birth?


years


months


days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Married


5a If married, widowed, or divorced HUSBAND of


(or) WIFE of


Charymaiden name of wife in full)


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7


85


AGE


Years


6


Months


22 Days


If less than 1 day


Hours.


.....


.. Minutes


8 Trade, profession, or particular


kindofwork done, as spinner,


sawyer, bookkeeper, etc ..


House work


9 Industry or business in which


work was done, as silk mill,


saw mill, bank, etc. Own home


10 Date deceased last worked at


11 Total time (years)


this occupation (month and pril 1939 spent in this


50


year)


occupation.


12 BIRTHPLACE (City)


Elizabeth


(State or country)


New Jersey


13 NAME OF


FATHER


Thomas J. Looker


14 BIRTHPLACE OF


FATHER (City)


Unable to obtain


(State or country)


15 MAIDEN NAME


Susan Price


OF MOTHER


16 BIRTHPLACE OF


MOTHER (City)


Unable to obtain


(State or country)


17


Charles Nourse


Informant


(Address)


18 Tewksbury St 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 drept of Board of Health of the)


Health Officer /5/2/39


(Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATHI


18 DATE OF


DEATH


May


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That i attended deceased from


May


1938, to May 1


19 39


I last saw her


allve on May 1


19 .. 39, death Is sald


to have occurred on the date stated above, at & P.


.. m.


The principal cause of death and related causes of Importance in order of onset were as follows:


Pato of Ontet IMPORTANT


arterio Ocebrosio


1924


chronic myocarditis


1934


Contributory causes of importance not related to principai cause:


Name of operation.


nous


Date of.


What test confirmed diagnosis ?.


clinical


Was there an autopsy? .... D ....


20 Was disease or injury in any way related to occupation of deceased?


120


if so, specify


Buscotis W. pickingou


(Signed)


M. D.


(Address) 89 Somecool Avz. Date May 2 1939.


2St . Peters Cemetery New Brunswick


Place of Burial, Cremation or Removal.


(City or Town) N. J


19


Relation, if any


husband


DATE OF BURIALMay 4 1939


22 NAME OF


UNDERTAKER


Charles R. Bennison


ADDRESS


Winthrop Mass


Received and filed .... 19


.......


MAY 2 1939


(Registrar)


100m 11.36. No. 9080-F


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


(If U. S.


War Veteran


specify WAR)


1939


GOVERNING THE


Statement of occupation. - l'recisc statement of occupation is very important, so that the relative healthfulness of various pur- suns 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 deccased 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 husiness, 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 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 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 causc, name other important diseases.


Example


The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis


Dste 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 scen alive by the physician or officer and the late of his death. . . GEN. LAWS, CHAP. 46, SEC. 9.




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