USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 35
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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,a or complication which causes death, not the mode of dying, e. g., heart" failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Date of onset
Arteriosclerosis
1915
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1027
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.
.... 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.
R-302
PLACE OF DEATH
Bristol (County)
Taunton
(City or Town)
No. State Hospital
St., 8 Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
87
2 FULL NAME
Rebecca E ...
Bleeker
(If deceased is a married, widowed or divorced woman, give also maiden name.)
255 Pleasant
St., ............... Ward,
Winthrop Center, ass.
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
22 yrs. I mos.
30 days.
How long in U. S., if of foreign birth? __ yrs. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
9
1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Feb. 15
19
2% May 9
19
31
I last saw h.@ ...... alive on.
Lay 9
19 ... 3.1,
death is Said
to have occurred on the date stated above, at.
10.1G. P. M.
The principal cause of death and related causes of importance in order of onset were as follows:
Date ofonset
Broncho ... pneumonia .. 5-4-31
.
Contributory causes of importance not related to principal cause:
General Arteriosclerosis.
(Cannot be learned
Name of operation
Date of
What test confirmed diagnosis linical
Was there an autopsy?
0
20 Was disease or injury in any way related to occupation of deceased? 1.0
If so, specify
(Signed)
H. Sinclair Tait
M. D.
(Address) State Hospitallaunten 5.19 31
21 PLACE OF BURIAL,
Oak Hill, ellfleetTass
(Cemetery)
(City or town) 19. 31
DATE OF BURIAL
May 11
22 NAME OF
UNDERTAKER
Milton HI. Farley
ADDRESS
Taunton, ass.
Received and filed .:
19
"Registrar of City or Town where deceased resided)
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
3 SEX
4 COLOR OR RACE
Female
white
(or) WIFE of
6 IF STILLBORN, enter that fact here.
7
AGE
77
Years .........
Months
-..... Days
8 Trade, profession, or particular
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.
this occupation (month and
OCCUPATION|
year)
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Zachena Knowles
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Mary Garrett
PARENTS
Informant
A TRUE COPY.
ATTEST:
important.
50m-2-'30. No. 7997- '
N. B .- WRITE PLAINLY, WITH UNFADING INK-1NIS IS A FERMARLI! ALVIN.
(State or country)
Mass.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
J. A.Bleeker
(Husband's name in full)
If less than 1 day
Hours .........
.Minutes
Housewife
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
Truro
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
Quebec
17
State Hospital Records
(Address)
aunt n. a.s.
Edirne A. LEctora
(Registrar of city or town where death occurred)
DATE FILED May 11, 19349
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
.nl n
(City or town making return)
1
Registered No.
(If U. S.
War Veteran,
specify WAR)
(a)
Residence. No ..
(Usual place of abode)
Steken 6. 1 lecker
May 9, 19 31.
80
R-302
PLACE OF DEATH
(County)
1
(City or To
No.
2 FULL NAME
(
(a) Residence. No ... (Usual place of abo Length of residence in city or town
PERSONAL AND S
3 SEX
4 COLOR OR RAC
5a If married, widowed, or divorced HUSBAND of
(Give m
(or) WIFE of
(Husbar
6 IF STILLBORN, enter that fact he
7 AGE
Years Mo
OCCUPATION
8 Trade, profession, or particu kind of work done, as spinn sawyer, bookkeeper, etc ..... 9 Industry or business in whi work was done, as silk m saw mill, bank, etc .....
10 Date deceased last worked this occupation (month al year)
12 BIRTHPLACE (City) (State or country)
13 NAME OF FATHER
PARENTS
14 BIRTHPLACE OF FATHER (City)
(State or country)
15 MAIDEN NAME OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country)
17
Informant (Address)
A TRUE COPY.
ATTEST:
(Registrar of d
DATE FILED
Name,
Annie M. Belcher
Place of Death,
Nashua, N.H
No.
46 Lock
Street
Ward,
Village,
How long a resident,
4 mos
Previous residence,
St.Petersburg,Fla ..
If death occurred at an institution give name of same gn birth?
(City or town making return)
Registered No ..
88
death occurred in a hospital or institution, : its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
Jrs.
mos.
days.
ERTIFICATE OF DEATH
may 13, 1932 (Year) (Day)
)
ERTIFY, That I attended deceased from
,19 ..
..... , to.
19
19
death is said
stated above, at.
........
.m.
nd related causes of importance in order of
Dateofonset
Sex, .. F.
. Color,.
.w ....
Widowed or
W.id
Divorced
Occupation,
At Home
Cause of Death,
Cerebral hemorr ..
hage
Duration,
Contributing Cause, Duration,
Date of
Was there an autopsy?
vay related to occupation of deceased?
Name of Father,
Thomas .. Madden
Maiden Name of Mother,
Nora Kane
Birthplace of Father,
Ireland
Birthplace of Mother,
=
Occupation of Father,
[Record continued over.]
12699
19
may 25, 19 31
r Town where deceased resided)
important.
50m-2-'30. No. 7997-đ
N. B .- WRITE PLAINLY, WITH UNFADING INK-INIS IS A PERMANENT! 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
How long an inmate,
Where from,
Winthrop. Mass
Date of Death: Year,
1931
Monthyiay ... Day,.
13
Age: Years,.
69
Months,.
9
Days,
21
Place of Birth,
Troy, N. Y.
Date of Birth: Year, -. 96 .- MonthJuly. Day,. 21 ..
Married, Single,
nce not related to principal cause:
M. D.
Date
19
(Cemetery)
(City or town)
19
annie m. Belcher Элау/ 3,1932
M R-301A
Every item or
1
PLACE OF DEATH
Suffolk Monty) Whittrop (City or Town) 252 Shirley
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. 89
Registered No.
(If death occurred in a hospital or institution, 1
give its NAME instead of street and number) .St.,
2 FULL NAME
Sarah Gordon
(If deceased is a marred, proowed or divorced woman, give also maiden name.)
(a) Residence. No ...
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
St.,
Ward,
With
(If nonresident, give city or town and state)
maos. days.
PERSONAL AND STATISTICAL PARTICULARS
3. SEX
Female white
4 COLOR OR RACE
(write the word)
Mamed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Victor
(Husband's name in full
Gordon
6 IF STILLBORN, enter that fact here.
7 AGE 60 Years Months Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular 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
this occupation (month and
year)
11 Total time (years) spent in this occupation
12 BIRTHPLACE (City)
Russia
(State or country)
13 NAME OF
FATHER
Simon Pildus
14 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
15 MAIDEN NAME
OF MOTHER
Sophie Cannotby
16 BIRTHPLACE OF MOTHER (City) (State or country) Russia
17 Victor Gordon
Gord
Informant
(Address)
252 Sliter 3d
| HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued: Wm. D. Chil dress
(Signature of Agent of Board Health or other) Ilike officer 5/17/31
(Official Designation) (Date of Issue of Permit)'
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
may
16,
1931
(Month)
(Day)
(Year)
19 I HEREBY
CERTIFY, That I attended deceased from
may
13,
1931, to may 16,
.19.3 /
I last saw Par alive on
may 16,
, 1931, death is said
to have occurred on the date stated above, at.
7p.m.
The principal cause of death and related causes of importance in order of onset were as follows: Chronic Myocarditis Datsofonset
Coronary Thrombosis
7921
Contributory causes of importance not related to principal causa:
Lenbral Hemorrhage
Name of operation
.
many
What test confirmed diagnosis hal Drog.
Date of
Was there an autopsy Mo
20 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
viaul
(Address)
316 Simpleyst.
. . Date
mayles 31
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
weert leural len tus
(Cemetery
(Cty or toFit)
DATE OF BURIAL
may 17"
193
22 NAME OF
UNDERTAKER
manuel Stanctoles
ADDRESS
119 Eatory f) Busty
Y 35
Received and filed 19
(Registrar)
OCCUPATION| 75m-2-'30. No. 7997-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. PARENTS
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
No.
252 Shirley
Lyos.
Ward
(If U. S. War Veteran, specify WAR)
days. How long in U. S., if of foreign birth?
yrs.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(Give faiden name of wife in full)
Homework at Home
yes.
team
(Signed)
Samuel B. Goldberg
, M. D.
-
-
Revised United States Standard Certificate of Death
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 nephri'is
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 be ief 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.
... 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.
R-301A
N. B .- WRITE PLAINLY, WITH UNFAVING DLALA INN-ILID 1 A information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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
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