USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 47
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(If death occurred in a hospital or institution, give its NAME instead of strect and number)
Geo Q. Keit
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No 108 almout
(Usual place of abode)
Length of residence in city or town where death occurred 22
JTS.
mos.
-
St. 4 Ward,
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH Jeme
13
1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
19
to
19
| tact saw h.t ..... alive on
19
death is said
to have occurred on the date stated above, at ... m. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
Natural Causes. Probably angina pectoris
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased? If so, specify Ped Raymond B Parker
(Signed)
M. D. (Addre Cutting Brand of Health Date Jame 5 19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mit lubin Camb
DATE OF BURIAL
June 15/1931
(City or town) 19
22 NAME OF UNDERTAKER Walter S. White
ADDRESS
Vinchaud
JUN 1 6 1931
Received and filed 19
(Registrar)
100m-9-'30. No. 9954.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
William
D. Children
(Signature of Agent of Board of Health or other)
agent (Official Designation) (Date of Issue of Permit)
June 15 th 1931
--
5 SINGLE
1
(write the word)
Hanneil
5a If married, widowed, or divorced HUSBAND of ce Susan B. falloway
(Give maiden name of wife in full)
If less than 1 day
Hours.
.Minutes
Mater With Suchlier 1.6 11 Total time (years) spent in this occupation . 22
Otis L Rent
14 BIRTHPLACE OF
FATHER (City)
newbury Class
-
15 MAIDEN NAME
OF MOTHER
Emily March
andover
Marc
1 (City or Town) N 108 almout 2 FULL NAME 3 SEX 4 COLOR OR RACE MARRIED WIDOWED or DIVORCED Tuale (OF) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 58 AGE Years 5 Months 17 .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. ... 10 Date deceased last worked at this occupation (month and June 13/31 year) OCCUPATION: (State or country) 13 NAME OF FATHER (State or country) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 17 Informant (Address) information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 12 BIRTHPLACE (City) neuburg 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.
St.,
Ward
days.
How long in U. S., if of foreign birth?
yrs.
(If U. S.
War Veteran,
specify WAR)
122
June 13
1931
91
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 of 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 be 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 rertify 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.
ORM R-302
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE MARGIN RESERVED FOR BINDING
important.
50M-11-'29. No. 7180-b
AEC
(Signature of Agent of Board of Health or other)
6/15/31
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
June. 1.4.1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
5/23/31
19
tc6/14/31
19
I last saw h ... im alive on
6/14/31
19
death is said
to have occurred on the date stated above, at 3 :p. m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonsst
Benign prostatic hypertrophy
21 das
ago
Contributory causes of importance not related to principal cause:
Septicemia: type undetermired
6 das
Perivesical abscess
ago
Name of operation
Suprapubic cystotomyDate of 5/30/31
What test confirmed diagnosis?
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
W F Wood
Mass Gen Hosp
M. D.
(Address)
Date
19
E
Boston
21 PLACE OF BURIAL
CREMATION OR REMOVAL
(Cemetery)
6/16/31
Temple Ohabei
Shalom
(City or town)
DATE OF BURIAL
19
23 NAME OF
JSWaterman & Sons
Received and filed
6/18/31
19
A TRUE COPY, ATTEST:
(Registrar)'
1
Boston
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston
(City or town making return)
5463
Registered No.
(City or Town)
No.
Mass General Hospital
St.,
Baker Memorial Hospital
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No (Usual place of abode)
206 Washington Ave
.St.,.
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
5a If married, widowed, or divorced HUSBAND of Elizabeth Sarqui (Give maiden name of wife in full)
(or) WIFE of (Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 72 Year 1 Month Days
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinnerga lesman sawyer, bookkeeper, etc. .
9 Industry or business in which work was done, as silk mill, cigars saw mill, bank, etc.
10 Date deceased last worked at this occupation (month and year) ..
1920
11 Total time (years) spent in this occupation
40
12 BIRTHPLACE (City) (State or country) Toronto Can
PARENTS
14 BIRTHPLACE OF FATHER (City)
(State or country) Rus sia
15 MAIDEN NAME OF MOTHER Sarah Susan -
16 BIRTHPLACE OF MOTHER (City) (State or country) Holland
17
Granville Rogers
Informant (Address) 206 Washington Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: ADDRESS Boston
(If death occurred in a hospital or institution, - Ward
give its NAME instead of street and number)
Abraham Wingersky
(If U. S.
War Veteran,
specify WAR)
123
PLACE OF DEATH
Suffolk (County)
13 NAME OF FATHER Gabreial Wingersky
abraham Hangersky -June , 4, 1931.
RM R-301A
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 75m-2-'30. No. 7997-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) No. Whichinfo Community Verso
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.
124
Registered No.
(If death occurred in a hospital or in sitution, give its NAME instead of street and number)
Timothy Francie Dousran
(If U. S. War Veteran,
specify WAR)
(a)
Residence. No. 05 Quincy UNE
(Usual place of abode)
Length of residence in city or town where death occurred
yTs.
mos.
St.,
Ward,
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth? угб.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Dale White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Pingle
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
28 Years.
Months
Days
If less than 1 day
Hours
Minutes
OCCUPATION!
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.
Forman
4. the fo ty la
10 Date deceased last worked at
this occupation (month and
year) ..
7.1931
11 Total time (years) spent in this occupation .. 4
12 BIRTHPLACE
(ĆIty)
Caut Karton
(State or country) massacimento
13 NAME OF
FATHER
William VA.
14 BIRTHPLACE OF
FATHER (City)
(State or country) такийтив
15 MAIDEN NAME OF MOTHER Gertrude Baldwin
16 BIRTHPLACE OF MOTHER (City) (State or country)
East Karton
mars
17
Informant
(Address)
Waleumas era
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Um.S. Childress (Signature of Agent of Board of Health or other) Health Office
6/16/31
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
14
(13i
(Ycar)
19
I HEREBY CERTIFY, That I attended deceased from
Vlast saw h ..... zalive on
14, 19 3 /, death is said &P.m.
to have occurred on the date stated above, at
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Contributory causes of importance not related to principal cause:
What test confirmed diagnosis?
Was there an autopsy? ... )>
20 Was disease or injury in any way related to occupation of deceased? 50
If so, specify ...
(Signed) (Address) Le angha
, M. D.
Datdo (. 19
...
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Ently Cron
(Cemetery)
(City or town)
DATE OF BURIAL
June 17
19 J. ..
22 NAME OF
UNDERTAKER
John F. Orally
ADDRESS
JUN 16 1931/
Received and filed
19
(Registrar)
1
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Ward
Name of operation
afhandeling
Date
10/0,1.
, 1931, to hm14 1901
- ---
June 14, 1931. 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 nephritis
1021
Cerebral hemorrhage
July 5, 1937
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.
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