USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 57
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Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
M R-302
PLACE OF DEATH
Essex (County)
Dan vers (City of Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City J own thaking return)
Registered No.
11/8
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
William Henry Lehman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
(Usual place of abode)
1
3
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
4 COLOR OR RACE
white
5 SINGLE
(write the word)
married
5a If married, widowed, or divMed rtha H. Chambers
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE Years Months Days
If less than 1 day
Hours
.Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
Silversmith
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)
(Roxbury, )
Boston
11 Total time (years)
spent in this
occupation.
Mass.
Christopher Lehman
Bermany
Barbara Karakel,
Germany
17 Gertrude F. Smith,
Hethome
(Registrar of city or town where death occurred)
DATE FILED
7/27/31.
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
July 20, 1931.
DEATH
(Month)
(Day)
(Year)
19 1
SIFY, That
1 attended deceased
fram
31
I last saw h
alive on
5.357.
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; Myocarditis 1926 Dateofonset
Contributory causes of importance not related
Wren nared to principal cause:
Arteriosoler-
osis.
1926
Name of operation
Date of
What test confirmed diagnosis?
olin.
Was there an autopsy?
no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Henry A .Tadgell
(Signed)
Hathorno
7/04/51"
M. D.
(Address)
Date.
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery2/31 .
DATE OF BURIAL
C. D. Bennison,
19
22 NAME OF
UNDERTAKER
inthrop
ADDRESS
Received and filed
1931
19
(Registrar of City or Town where deceased resided)
(If U. S. War Veteran, specify WAR)
21 Adams
.St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
.
,19
20
20
,19
119 .. , death is said
MARRIED
WIDOWED
or DIVORCED
1 2 FULL NAME 3 SEX male (or) WIFE of OCCUPATION 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) Informant (Address) A TRUE COPY. ATTEST: 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 important. 50m-2-'30. No. 7997-đ N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country)
No Danvers State Hospital .. St., .... Ward
Forest HIII Boston
(City or towa)
William Henry Lehman July 20, 19 31
1
1 R-301A
PLACE OF DEATH
Suffalle. 7(County) grundhof (City or Town) Winthrop Come Hook. No ...
Revere pt 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)
Female Mmeuse
(If deceased is a married, widowed 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.
mos.
Ward,
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth? yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) stillto
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here
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
13 NAME OF
FATHER
Joseph Meuse
spain
Ofice & hangle
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
must
17 Informant (Address) 4, Bellingham Sve Parere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bunal or transit permit was issued: Wir D. Childress & (Signature of Agent of Board of health or other) Health Office 07/24/31
(Official Designation) (Date of Issue of Permit) /
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
21
(Month)
(Day)
1931
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
19
.. , to
19
I last saw h ..
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
Still born
Contributory causes of importance not related to principal cause:
Name of operation ...
What test confirmed diagnosis?
Date of.
Was there an autopsy
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Michael Litrich
(Signed)
M. D.
(Address)
114 Sturdy Cyc,
Riso
Date 7/22 1931
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
DATE OF BURIAL
(Cemetery)
(City or town)
24
19
3.
22 NAME OF UNDERTAKER CP. Tennison
ADDRESS
147 H mehrof ST Wuethiek
Received and filed
JUL
64 1971
.19
(Registrar)
1
1
St.,
Ward {
(If U. S.
War Veteran,
specify WAR)
1 2 FULL NAME 3 SEX Female (or) WIFE of 7 AGE Years OCCUPATIONI 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 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 CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION VEILLEUSELEU DLACE ALLTID DATENMANENT RECORD. EVERY ICH OF (State or country)
100m-9-'30. No. 9954.
6. Basta!
Huntrop
1
Revised United States Standard Certificate of Death July 21/1931
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
1015
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1029*
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 i 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 .... Chop. 114, Scc. 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.
M R-302
PLACE OF DEATH
Essex ....
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(cityVs Ftown making return)
Registered No.
150
(If death occurred in a hospital or institution,
No. Danvers State Hospital .St.
.......
Ward
give its NAME instead of street and number)
2 FULL NAME
Howard fastemart, divorced woman, give also maiden name.)
(L U. S.
War Veteran,
specify WAR)
(a)
Residence. No.
(Usual place of abode)
54 Lincoln
St.,
.........
Ward,
Anth
Igivatity or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
married
Gertrude 4 Meu
(Give maiden name of wife in fun)
If less than 1 day
Hours
Minutes
Linotype Operator
11 Total time (years) spent in this occupation
13 NAME OF
... . FATHER
Frank A. Stewart
New York
A TRUE COPY.
austin Chast
(Registrar of city or town where death occurred)
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH July 22 1931 (Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
JULY
.19
31
I last saw h
alive on
Jury 28,
19.32
...
death is said
to have occurred on the date stated above, at ........ 5.15.m. ... The principal cause of death and related causes of importance in order of onset were as follows:
General Paralysis of the Insane 1930
Dateofonset
Contributory causes of importance not related to principal cause:
-
Name of operation
Date of
What test confirmed diagnosis?11nica]
Was there an autopsy? no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Henry ............
Tadgoll
M. D.
(Address)
Ha thor adate 7/ 24 19.31
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Winthrop
DATE OF BURIAL
rul.y ...
24
19:31
22 NAME OF
UNDERTAKER
Walter T. White
ADDRESS
Winthrop ... Mass.
Received and filed
JUL 29 1931
19
(Registrar of City or Town where deceased resided)
1 Dayanan) ased is a matrie Length of residence in city or town where death occurred 3 SEX 4 COLOR OR RACE MARRIED white WIDOWED or DIVORCED 5a If married, widowed, or divorced HUSBAND of (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 AGE 45 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. 10 Date deceased last worked at OCCUPATION this occupation (month and year) 12 BIRTHPLACE (City) (State or country) New York 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER Inez Robert 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) 17 Informant Gertrude F. smith, (Address) Hathorne ATTEST: 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 important. DATE FILED 7/27/31 50m-2-'30. No. 7997-d N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country) New York
yTs.
mos.
2.5
days. How long in U. S., if of foreign birth?
yrs.
27
no.
Harvard . Stewart -July 22, 1931
Westfield notified
PLACE OF DEATH
No.
(City or Town) Huntrop anne Ttotel. St., .A.
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
della( Lee Van Dusen
(If U. S. War Veteran,
specify WAR)
(a)
Residence. No. 42 Could Hetfield Ward,
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth? yrı.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Finale
4 COLOR OR RACE
Milite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Workwed.
5a If married, widowed, or divorced1 .... HUSBAND of Thely
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
18 DATE OF DEATH July 24 1931.
(Month)
(Day)
(Year)
19 I HEREBY
CERTIFY, That I attended deseased from
July 17
19.3 /10 July 24/3/19
A last saw h en alive on July 24 19 ... 3/, death is said to have occurred on the date stated above, at 3:10pm. The principal cause of death and related causes of importance in order of onset were as follows: aceite entero colitis
Date of Onset July 1/1
Contribuory causes of importance not related to principal cause: Pernicious inemia ...
1929
Name of operation
none
Date of. What test confirmed diagnosis? Comment
... Was there an autopsy ?. Zio
20 Was disease or injury in any way related to occupation of deceased?
200
If so, specify
Jacob alano
(Signed)
9362 Stanley . Datter ly 241931
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Une Tiel Natura
(Cemetery)
DATE OF BURIAL July 27
(City of town) 19 .2 ... 1
22 NAME OF
UNDERTAKER
Standen & Treally
ADDRESS
Netfuld
mark 1
Received and filed
JUL 2 9 1931
19
Health Officer 7/ 244/31
(Official Designation) (Date of Issue of Permit)
100m-9-'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.
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country)
2.
15 MAIDEN NAME
OF MOTHER
Fusilla Spencer
Westfield.
16 BIRTHPLACE OF MOTHER (City) (State or country) mars.
m
17 Informant (Address) hout Is Nextfuld.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: 1 Www. D. Childrenz (Signature of Agent of Board of Health or other)
1 fore. Tour
OCCUPATIONI
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
11 Total time (years)
this occupation (ponth and
3
spent in this
occupation .. . 3
12 BIRTHPLACE (City)
(State or country)
Merfield
mate.
13 NAME OF
FATHER
7 70 Years Months Days
If less than 1 day
Hours. Minutes
6 IF STILLBORN, enter that fact here
AGE
I R-301 A
Suffolk
(County))
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.
1
-
-30
(Registrar)
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
(If deceased i a married, widowed or divorced woman, give also maiden name.)
(If nonresident, give city or town and state)
MEDICAL CERTIFICATE OF DEATH
Revised United States Standard Certificate of Death July 24
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,' er." "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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