Town of Winthrop : Record of Deaths 1931, Part 32

Author: Winthrop (Mass.)
Publication date: 1931
Publisher:
Number of Pages: 540

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Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.

.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.

No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L. 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.

1915

01 R-301A

Suffolk

County) Hitlerok

(City or Town) 144 main

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

To be filed for burial permit with Board of Health or its Agent. 31- Registered No.

(If death occurred in a hospital or institution, - .Ward

give its NAME instead of street and number)

Dennis) } callahan

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

144 Juin

.. 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

(write the word) Lingue

(Give maiden name of wife in full)

If less than 1 day

Hours

Minutes

Iline Steward

11 Total time (years)

spent in this)

13 NAME OF FATHER John Callahan

15 MAIDEN NAME

OF MOTHER

Mary Sullivan

17 Informant (Address) 144 Thurn It teather

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:

Childrens [Signature of Agent of Board of Plealth or other)

Health Officer 4/21/31

(Official Designation)/ (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF DEATH april

19.31

(Month)

(Day)

(Year)

19 0I HEREBY CERTIF Sent 3 193.0, to. I last saw h .......... alive on april

That I attended deceased from

april 19 19.3.(

,19.3.1 death is said to have occurred on the date stated above, at 101. .. m.

The principal cause of death and related causes of importance in order of onset were as follows: Date of Onset 1939 Claronic mejorardete

Contributory causes of importance not related to principal cause:

Name of operation.

What test confirmed diagnosis thecure Was there an autopsy !!

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

(Signed)

(Address) 6 2h pur

Date 4-20

19.2.1.

21 PLACE OF BURIAL,

DATE OF BURIAL

(Cemetery)

[City or town)

abril 2ª

19 2 ...

22 NAME OF

UNDERTAKER

ADDRESS

Received and filed

(Registrar)

(If U. S. War Veteran, specify WAR

Spanish

(a) Residence.

No.

(Usual place of abode)

Length of residence in city or town where death occurred

10 m.

mos.

1 No. 2 FULL NAME 3 SEX 4 COLOR OR RACE Voule 5 SINGLE MARRIED WIDOWED or DIVORCED 5a If married, widowed, or divorced HUSBAND of (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 50 AGE Years Months Days 8 Trade, profession, or particular kind of work done, as spiner sawyer, bookkeeper, etc. 9 Industry or business in which work was done, as silk mill, Water saw mill, bank, etc .... 10 Date deceased last worked at this occupation (month and OCCUPATION year) .. 12 BIRTHPLACE (City) Lata (State or country) 14 BIRTHPLACE OF FATHER (City) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) Ireland is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-9-'30. No. 0954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANEN! KECURD. Every item VI (State or country) Ireland

PLACE OF DEATH

Date of.

, M. D.

Revised United States Standard Certificate of Death 21

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.

To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation.

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store, " "factory, "

"mill." etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.

Example

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

Date of onset

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.

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of, his death .... Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early 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 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 appear upon the permit. The board of health, or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, 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.

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.

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.

I R-301

PLACE OF DEATH

Suffolk (County)

Pülauch

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

(City or town making return)

Registered No. 78

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

2 FULL NAME

Leo

G. Bourassa

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

(a) Residence. No. So .Dalton Rd. Pittsfield, Massst.,

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

mos.

Ward,

(If nonresident, give city or town and state)

加0%. 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

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 AGE 21

Years Months Days

If less than 1 day

.Hours

Minutes

OCCUPATIONI

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

Soldier.

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

U.S.a.

10 Date deceased last worked at

11 Total time (years)

this occupation (month and

year)

occupation. 4 mos

12 BIRTHPLACE (City)

Adams,Maine

(State or country)

13 NAME OF FATHER Joseph Bourassa

14 BIRTHPLACE OF

FATHER (City)

(State or country)

Canada.

15 MAIDEN NAME OF MOTHER Laura Bauvais.

16 BIRTHPLACE OF

MOTHER (City)

Manchester.

(State or country)

new Hampshire.

17 Informant (Address) Putte wild

1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Burial oy transit permit was issued; Mm. S. Childress

(Signature of Agenter Board-of Health or other) 4/22/31

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

13 DATE OF

DEATH

April

21.

1931

(Month)

(Day)

(Year)

19 I HEREBY CERTIFY, That ! attended deceased from April 13, 31 April 21,1931 19 19.

I last saw h.

im alive on

April 21,

19.31

death is said

to have occurred on the date stated above, at.2 ... 50p .m.

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

Acute infectious endocarditis. Acute diffuse nephritis. Acute rheumatic fever.

3-20-31

3-5-31

Contributory causes of importance not related to principal cause: None.

Name of operation

None

Date of.

What test confirmed diagnosis?

Phys . Exam. Was there an autopsy? N.Q ..

20 Was disease or injury in any way related to occupation of deceased? No

If so, specify

Com

(Signed)

A.G. COMPTON, Major , M. C.

M. D.

(Address)

Fort Banks, Mass.

Date

4/21/32

21 PLACE OF BURIAL, CREMATION OR REMOVAL Pittsfield, Mass.

DATE OF BURIAL

april 25)

1931

(Cometery)

(City or town)

22 NAME OF

UNDERTAKER Charles V.T. VLeur vou

ADDRESS

Received and filed 1 1/2

A TRUE COPY. ATTEST: (Registrar)

Winthrop,Mass. (City or Town) NoStation Hospital Ft Banks Mass St.

Ward

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

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

is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 200 M-11-'29. No. 7180-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A TERMANEN! ALVUIL; PARENTS

Joseph Bourarea.

Dateofonset

(Give maiden name of wife in full)

apr. 59 193% Revised United States Standard Certificate of Death

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 statthg the industry or business, avoid the use of such general terms as "store, " "factory. "> mili," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter. painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants; A person who sells goods should be called a salesman and not a clerk.

Statement of cause of death .- Cause of death means the disease injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury 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 contri- butory causes of importance not related to principal cause, name other important diseases or injuries.

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 nephritis

1921

Cerebral hemorrhage

July 5, 1927

Contributory causes of importance not related to principal cause : Fracture of arm

Automobile accident

May 3. 1927

In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may 'appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

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 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 appear upon the permit. The board of health or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, 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.

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.

State cause for which surgical operation was undertaken.

Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death : Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

UM R-301A

1 2 FULL NAME 3 SEX (or) WIFE of 7 AGE OCCUPATION: 12 BIRTHPLACE (City). (State or country) (State or country) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 17 Informant (Address) 100m-9-'30. No. 9954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state saw mill, bank, etc ....

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Town of Winthrop : Record of Deaths 1931, Part 32

Author: Winthrop (Mass.) Publication date: 1931 Publisher: Number of Pages: 540

Author: Winthrop (Mass.)
Publication date: 1931
Publisher:
Number of Pages: 540