Town of Winthrop : Record of Deaths 1931, Part 37

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

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 37

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information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state

12 BIRTHPLACE (City)

Past Boston

(write the word)

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

married

If less than 1 day

Hours

Minutes

Retinidt

night superintendent

Any Foodo

11 Total time (years)

spent in this

occupation .

2.6

13 NAME OF

FATHER

andrew Webster

15 MAIDEN NAME

OF MOTHER

Susanah Mc hay

Scotland

17 nun Eliza E. Webster

Informant

(Addr 212 Neodide and Hunterazo

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

(Signature of Agent of Board of Health or other) e aitle Schicke 5 21 31

(Official Designation)

(Date of Issue of Permit) /

St.,

Ward

(If U. S.

specify WAR)

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

. .

. . . . , M. D.

Contributory causes of importance not related to principal cause:

nar 20 9,9

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, soup 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

1021

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.

.... 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-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County Suffolk

Domevill

notified

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Mass.

(City or town) Registered No. 93

City or Town

Winthrop

No.

Station Hospital Ft. Banks, Mass.

St.

Ward

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

2FULL NAME

Florida M.

Tardiff

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

(a) Residence. No.

6 Highland Ave, Sommerville, Ma sst

Ward

(If non-resident give city or town and state)

Length of residence in city or town where death occurred

years

months

days.

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

years

months

days.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

White

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

5 ª If married, widowed or divorced

HUSBAND Of

(or) WIFE of

Delphis Tardiff

Years

Months

Days

IF LESS than 1 day, ........ hrs. or ........ min.

IF STILLBORN, enter that fact here

7 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

Housewife

Sanford,

Maine

9 NAME OF FATHER Paul Labboy

:10 BIRTHPLACE OF FATHER (City) (State or country)

Canada

1 1 MAIDEN NAME OF MOTHER Olive Gagneire

12 BIRTHPLACE OF MOTHER (City) (State or country) Canada

13 William D. Tardive

Informant (Address) First Banks what

14.

Filed

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

May

(Month)

(Day)

(Year)

| HEREBY CERTIFY , That I attended deceased from

April 25,

31 May 21,

1931

that I last saw h_Or

alive on

May 21

19. 31

and that death occurred, on the date stated above, at

10:55 A.M.

The CAUSE OF DEATH was as follows: (State fully)

Salpingitis and pelvis abscess.

Feb. 1971.

(duration)

_yrs

mos. ds.

CONTRIBUTORY (Secondary)

(duration).

yrs

mos. ds.

Where was disease contracted

if not at place of death

Did an operation precede death Yes For whatSalpingooophor-

Date of operation

May 20,1931.

ectomy.

Was there an autopsy

No.

What test confirmed diagnosis

Or Cubren

(Signed)

M. D.

(Address)

Oscar T. Kirksey, Major, M.C.

Date

Fort Banks ,Mass. Lay 21 ,1931.

18 PLACE OF BURIAL, CREMATION, OR REMOVAL

Graniteville Mass. (Cemetery) (City or town)

DATE OF BURIAL

5/25/31

(19 UNDERTAKER

· 1

ADDRESS

20 1 HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued Womit ildres 4.8

Official position.

Health Officer

Date of issue 28 1831

Permit No.

5/23/3) 1

200.000. 9-26. NO. 6373

3 SEX Fomalo 6 AGE 18 PARENTS -Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms; so that it may be properly classified. 8 BIRTHPLACE (City) (State or country)

: (Usual place of abode)

ina

İt

: Operation

1931

State

REVISED UNITEDSTATESSTANDARD CERTIFICATE OF DEATH

(Approved by U. S. Census and American Public Health Association)

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irre- spective of age. For many occupations a single word or term on the first lino will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Fore- man," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer-Coal mine, etc. Women at home, who are engaged in the duties of the household ony (not paid Housekeepers who receive a definite salary), may be entered as House- wife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupa- tion at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.) .. For persons who have no occupation whatever, write None. 1 1

Statement of cause of death .- Name, first, the Discase Causing Death (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symp- tomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.)

Bronchopneumonia: If primary cause, write the word "primary" ; if secondary, givo primary cause. - 1

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, menin- gitis, miscarriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

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 registra- tion a standard certificate of death, stating to the best of his knowl- edge 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, or from one cemetery to another, until he has received a permit from the board of health of 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 satisfactory 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 certi- ficate 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 ob- tained 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 certi- ficate 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 statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician 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 cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46. G. L., as amended.

PLACE OF DEATH

(County) Withus (City or Town) 385 Revere St No ..

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

To be filed for burial permit with Board of Health or its Agent. Registered No 94

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

2 FULL NAME

George Rouillard

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

specify WAR)

(a)

Residence.

No ....

385 Bernese

St.,.

Ward,

(Usual place of abode)

Length of residence in city or town where death occurred 10 yTS. mos.

days.

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

yTs.

mos. days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

(write the word)

5 SINGLE

MARRIED

WIDOWED

or DIVORCED / / wwwvient

5a If married, widowed, or divorced

HUSBAND of C 22312 a

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 89

Years Months

Days

If less than 1 day Hours Minutes

OCCUPATION

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) ..

1922

11 Total time (years) spent in this occupation

12 BIRTHPLACE (City)

erton

(State or country) mass

13 NAME OF

FATHER

frederick

14 BIRTHPLACE OF

FATHER (City)

Pikperil

(State or country) mars

15 MAIDEN NAME

OF MOTHER

Sarah 1 otter

Concord

16 BIRTHPLACE OF MOTHER (City) . (State or country) 7.720

17 Informant (Address) 385 Twee At Winther

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

(Signature of, Agent of Board ( Heath or other) Health Officer 5 /25/31

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

(Month)

(Day)

1931

(Year)

19 I HEREBY CERTIFY, That I attended deceased from

192 7, to

Lucy ×3, 1931

I last saw h can alive on Luan 22 19 31 death is said

to have occurred on the date stated above, at & am. The principal cause of death and related causes of importance in order of onset were as follows:

Date of Onset

angina Pestoria

lesiniciones Caramary arrière,

Contributory causes of importance not related to principal cause: asterio- necesario

14 21

Name of operation.

200mg

What test confirmed diagnosis? Chical

Was there an autopsy? - we

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

If so, specify ......

(Signed)

(Address) [ Gulli

Date 2 25 1951

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Coton

(City or town)

DATE OF BURIAL

22 NAME OF

Hatten T White

UNDERTAKER A

ADDRESS

15/ 1 Pensant It Winther

Received and filed 1931 19

(Registrar)

100m-0-'30. No. 9954.

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

is very important. See instructions and extracts from the laws on back of certificate.

information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state ..

R-301A

PARENTS

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

Market Man.

23-31

Date of.

M. D.

(Cemetery)

2.5

19 31

Mywith Echwards

St.,

.Ward

(If U. S. War Veteran,

(If nonresident, give city or town and state)

AGE

Revised United States Standard Certificate of Death May 23, 1931

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.

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Town of Winthrop : Record of Deaths 1931, Part 37

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

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