USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 39
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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 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 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.
FR-303 B
PLACE OF DEATH
(County) Winitioh
(City or Town)
No. 80 Sugarsite
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 97
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Margaret ihnen
Toland
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No
86 S'algumne Wurst,
(Usual place of abode)
Length of residence in city or town where death occurred
13 yrs.
days. How long in U. S., if of foreign birth? yri.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
(write the word)
Wcloud
5a If married, widowed, er divercid HUSBAND of
(or) WIFE of firel
(Give maiden name of wife in fud)
Minse (Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
7 50 Years. .Months Dày
If less than 1 day Hours .Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Suleslady
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc .......
Cualof Dresses
10 Date deceased last worked åt
11 Total time (years)
this occupation (month and may 6 31
year)
spent in this occupation 1>
12 BIRTHPLACE (City)
Baisley
(State or country) scotland .
13 NAME OF
FATHER
Fin . Teland ( Tol and
14 BIRTHPLACE OF
FATHER (City)
Заговор.
(State or country)
d'orient
15 MAIDEN NAME
OF MOTHER
Many Marche- Stuart
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Informant (Address) 86- Sugumore
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Wm-WChildress
(Signature of Agen gof Heard of Health or other)
10 may 28/01
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(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.)
Malarda camas jovana /
........
(See reverse side for description for unknown person)
20 IN WHAT CITY OR TOWN WAS INJURY SUSTAINED ?
(Signed)
., M. D.
(Address)
ate M/ 8/1991
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
May 28/1001
19
22 NAME OF
UNDERTAKER
ADDRESS
Received and filed.
May
......
29, 1938
(Registrar)
OCCUPATION N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-INIS IS A TEAMANENI ALLVAD. PARENTS
5m-2-30. No. 7997-c
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF MARGIN RESERVED FOR BINDING
1
2 FULL NAME
St.,. .Ward
(If U. S. War Veteran, specify WAR)
Ward,
(If nonresident give city or town and state)
MARRIED
WIDOWED
or DIVORCED
× 6
Willnot
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 regis- tration 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 con- tracted, 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 under- taker 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 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 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 statement 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.
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
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ;...- General 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; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
.. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfilment 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 unrelated to any form of injury, have died without recent medical attendance 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.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an : injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident. " "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorr- hage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
May 26, 1931
Margaret Konson
R-302
PLACE OF DEATH
NORFOLK
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BROOKLINE
(City or town making return)
Registered No.
191
98
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
MASS.
(If nonresident, give city or town and state)
Ios. days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
MAY
26
1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
May .. 10th
19.31 to May 26th
19.31
1 last saw her .... alive on
May 26th
19 31 .. , death is said
to have occurred on the date stated above, at10.55pm. The principal cause of death and related causes of importance in order of onset were as follows:
CompleteLaceration of Perineum
Dateofonset
12/29
Mucous Colitis
1925
Post Operative wound Sepsis 5/15/31
Contributory causes of importance not related to principal cause:
Name of operation
Complete Perineorr-
Date of 5/13/31
What test confirmed diagnosis?
haphy
Was there an autopsy? no
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Geo. V.Smith
M. D.
(Address).
Free Hosp.for Women ... Date
5/27
.19 .. 3.1
Brookline
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
May ...... 29
19 3.1.
22 NAME OF
UNDERTAKER
Walter ... I ..... White
ADDRESS
Winthrop ..... Mass
Received and filed
27 Sime 1/ 1931
(Registrar of City or Town where deceased resided)
MARVIN ALOLAYEU TON DINVINO
....
important.
50m-2-'30. No. 7997- 1
ATTEST:
(Registrar of city of town where death occurred)
May 27
19. 31
DATE FILED
(write the word)
Married
If less than 1 day Hours Minutes
Housewife
11 Total time (years) 5/1931
spent in this occupation ..
?
William A. Carstensen
Bessie G. Brown
No ... FREE .. HOSPITAL .. FOR .. WOMEN
Ward
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... 63 COTTAGE PARK ROAD
St., ............... Ward, ... WINTHROP.
18days.
How long in U. S., if of foreign birth?
yrs.
mos.
PERSONAL AND STATISTICAL PARTICULARS
1 BROOKLINE (City or Town) 2 FULL NAME SYBIL L. BROWN (Usual place of abode) Length of residence in city or town where death occurred yrs. 3 SEX 4 COLOR OR RACE 5 SINGLE MARRIED Female WIDOWED or DIVORCED White 5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full) (or) WIFE of Charles H ..... Brown (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 AGE 31 Years 2. . Months 2 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 .. Home 10 Date deceased last worked at this occupation (month and OCCUPATION| year) 12 BIRTHPLACE (City) East ... Boston Massachusetts (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF East ...... Boston FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) East ...... Boston (State or country) Massachusetts 17 Husband Informant (Address) Winthrop - Mass - A TRUE COPY. 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 (State or country) Massachusetts
Winthrop
may 26, 1931.
R-301A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 26 nevada
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.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Harris Peyser
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No 26 Nevada
(Usual place of abode)
Length of residence in city or town where death occurred
mos.
4
yrs.
days.
How long in U. S., if of foreign birth? 77
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Male White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
ED widowed
may
27
1931
(Month)
(Year)
(Day)
19
HEREBY CERTIFY, That I attended deceased from
December 15 1930 %
I last saw hun alive on
may 26
, 193 /, death is said
to have occurred on the date stated above, at .:
3:10 9.m.
The principal cause of death and related causes of importance in order of onset were as follows: Senility
Datpofonset 1930
Contributory causes of importance not related to principal cause:
arteriosclerosis
Clinic Interstral Replicate.
1929
1930
Name of operation
none
Date of
What test confirmed
clinical
Was there an autopsy? no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
(Add
21 PLACE OF BURIAL,
VILMATION OR REMOVAL Whaher shatom(ity or town)
(Cemetery)
DATE OF BURIAL
May 29,
1931
22 NAME OF
UNDERTAKER
Benjamin 7. Salomon
ADDRESS
korchester.
Received and filed
May
29
1938
(Registrar)
75m-2-'30. No. 7997-a
17
Juquish Leyseu
Informant
(Address) 26 Nevada Sk, Winthrop.
I HEREBY CERTIFY that a satisfactory standard certificate of death was
filed with me BEFORE the burial or transit permit was issued:
Um. W. Children
(Signature of Agent of Board of Health or other)
agent
La 28/31
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
5a If married, widowed, or divorced
HUSBAND of
faiseine nelson
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
merchant
9 Industry or business in which
saw mill, bank, etc. . . . .
silk Day goods + clothing
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation. 52
this occupation (month and
year)
1917
12 BIRTHPLACE (City).
(State or country)
Poland
13 NAME OF
FATHER
Isaac (Peyser)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Poland
PARENTS 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 OCCUPATION|
1
St.
Ward 1
(L U. S.
War Veteran,
specify WAR)
99
St.,
Ward,
(If nonresident, give city or town and state)
, M. D.
Date
5/27/31.
E. Bo
boston
May 27, 1931
7
90
Years
2
Months
Days
If less than 1 day Hours. Minutes
Revised United States Standard Certificate of Death may 27, 19/1.
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
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 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.
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