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