USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 63
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important.
(Signature of Agent of Board of Health or other)
aug 21- 1931
(Official Designation)
(Date of Issue of Permit)
50M-11-'29. No. 7180-b
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-
(State or country)
Pritom mars
(write the word)
Single
aug 21,1931
1 2 FULL NAME 5a If married, w HUSBAND of (or) WIFE of AGE 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS OCCUPATION! 16 BIRTHPLACE OF MOTHER (City) (State or country) Informant (Address) 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 100m-0-'30. No. 9954. 8. 2. 4726zł& : &MI1161, WITTE UNPADING DLAVA INIS TRO D A PERMANENT RECORD. Every item of (State or country)
PLACE OF DEATH
(County)
(City or Town) 1. FC 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.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth? yTs.
mes.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
3 SEX May White
5 SINGLE MARRIED WIDOWED or DIVORCED
(write the word) Married
radicis Fanning (Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 38 Years Months
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 ..... .
Type Preter Machine
Aug 28
11 Total time (years) spent in this occupation ..
10 Date deceased last worked at this occupation (month and year) .. 19.81 bethel Vermont
Salavare, Chardoni
Italy
any Carrasco
17 Branch Standen
33 Machaut Are Centrale 2 NAME OF
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with +4EBEFORE the Itial for transit permit was issued:
(Signatureof Age of Board of Health or other)
(Official Designation HALTH CURI, (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH Aug 28 /31 (Month) (Year) (Day)
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 1
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
(Signed) (Address)
M. D.
Date 19
21 PLACE OF BURIAL, CREMATION OR REMOVAL New Calvary Baton (Cemetery) (City or town)
DATE OF BURIAL Aug 31 .19
31
UNDERTAKER
Denges
ADDRESS
istinmass
Received and filed 19
AUG 3-1 1931
(Registrar)
1
(a)
Residence.
No ...
(Usual place of abode)
Length of residence ia city or town where death occurred
yrs.
mos.
St.,
Ward
Philip Achardon.
3 Salientove Manage
100
Days
.....
If less than 1 day
Hours
Minutes
Salesman
1
1
M R-301A
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
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 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.
STATE OF NEW YORK
No .. 2.1.02.8 DEPARTMENT OF HEALTH OF THE CITY OF NEW YORK This Certificate with the Paster below must be detached and pasted to the Box. TRANSIT LABEL
I hereby certify that the accompanying dead body of, Phillip Jo
Chardon
If a minor give parents' name also.)
who died in the City or Town pf-
New
Ink
County of
New York
State of New York,
on_ august 28th 1931, consigned to Biston Mass
has been prepared under my direction for transportation, in conformity with Rule No. 2 of the rules printed with this permil;
and that I hold Undertaker's License No ..
3794
, issued by the Board of Embalming Examiners of the State of New York.
Name of Escort. amsterdam Funeral Home Las Shipping Undertaker.
Embalmer's License No ..
5768
1625 amsterdam.les
__ Place of Business.
Permit Issued.
august 28th
19.3 /,
County of
New Ink
State of New York.
1
PASTER.
The Railroad or other Transportation Agent must enter hereon a description of the ticket held by the passenger in charge of the corpse, the exact route, and VIA WHAT JUNCTIONAL POINTS it read.
SPECIAL INSTRUCTIONS-A burial case containing a corpse must not be received for transportation unless the person in charge presents a permit from the local Board of Health, and an undertaker's certificate that the body has been prepared for shipment in accordance with the Laws of the State; nor will je bo received even then Il any fluids or offensive .odors are escaping from the case.
From- 125th 35
LA Listalo of New York, to.
No. of Escort's Ticket.
24220
No. of Corpse Ticket. 2671
Form No. of Escort's Ticket.
Form No. of Corpse Ticket.
Via
To.
Vi
To
Via
Tos
Vi
To.
Vi
To.
Name of Passenger in charge
IO de Place of Residence.
Signed.
Shipping Agent.
we think
25-2068-29-B, Form 7 H
19
State of_
TRANSPORTATION OF DECEASED PERSONS
TO TRANSPORTATION AGENTS CONCERNED:
You will in no case receive a corpse for transportation unless accompanied by a board of health transit permit, also a transit label that the body has been prepared for burial and shipment in accordance with the rules of the State Department of Health; nor will you receive it even with such certificates if fluids are escaping from the case or it has become offensive in any degree. One full first-class limited or unlimited ticket will be required for the transportation of a corpse, without regard to age of the deceased, and a corpse will not be taken for transportation except there is a passenger with it change. The word "Corpse" should be plainly written on the face of a local and each coupon of a coupon ticket. A record must be made of a'l bordes shipped and carried, on the back of your station and trip reports, giving name of deceased and destination.
It will be the duty of Agents and Baggage Agents to see that each burial case is properly marked on "Paster," giving date and at what station shipped, point of destination, "State," number and form of ticket, name of passenger in charge and place of residence, with name of Agent. If the corpse is destined to a point beyond the initial line, the initials of each road over which it passes must be written on the paster; also the terminal points of each road at which transfer is made with connecting line, as shown on the coupons of the ticket.
You will see that the "Transit Label" is properly filled out by the undertaker, and the transit label is properly filled out by yourself, and is securely pasted to the coffin box before it is put into the car, and the permit remaining you will hand to the passenger in charge of the corpse.
All this information is necessary to insure the prompt and correct transportation of the corpse.
TRANSIT AND BURIAL PERMIT
No. 21038
STATE OF NEW YORK DEPARTMENT OF HEALTH OF THE CITY OF NEW YORK
This Permit must be properly signed and presented, with Undertaker's Certificate, to the Railroad, Express or other Transportation Agent, before a body can be shipped.
New York,.
28
The Certificate of Death, having been furnished to me, as required by the Laws of this State, permission Is hereby granted to Quiste dan Fund af rore we -
holder of Undertaker's License No .. To. 379 4
for the removal and shipment for burial at how Calvas Cemetery at Basta
cremation -
Crematory
State of_ quaes. the body of.
Phillip
(When obtainable) F Chardon who died in
the Borough of. Tran. County of
91.4 N. Y., on. aug #13/, at 6:00A. M. 20-18
M
( !__ color, the cause of death being
Aged. 38 years months dáýs sex appendicitis
inte Gangrena
which necessitates shipment under Rule No. _of the Rules of the New York State Department of Health for the Transportation of the Dead, as printed on the back of this Permit.
Unsterdam Funeral Home Luc, Sign
Que. Signed
(Signature of Undertaker)
Ass't Registrar
This Permit must be detached and delivered to the Person in charge of the Corpse
aug 28. 19 31
NEW YORK STATE DEPARTMENT OF HEALTH ALBANY
SPECIAL ADMINISTRATIVE RULES RELATING TO THE TRANSPORTATION OF DEAD BODIES BY COMMON CARRIERS
[In effect throughout the State of New York, except in the City of New York, on August 1, 1915.]
RULE 1. A transit permit and transit label issued by the local registrar of vital statistics must accompany each dead body transported by a common carrier.
The transit permit shall state the date of issuance, the name, sex, race and age of the deceased, and the cause and date of death. The transit permit shall also state the date and route of shipment, the point of shipment and destination, the method of preparation of the body, and shall bear the signature of the undertaker and the signature and official title of the officer issuing the permit.
The transit label shall state the date of issuance, the name of the deceased, the place and date of death, the name of the escort or consignee, the point of shipment and destination; and shall bear the signature and official title of the officer who issued the transit permit. The transit label shall be attached to the outer box or case.
RULE 2. The transportation by common carriers of bodies dead of any diseases other than those mentioned in Rule 3 shall be permitted only under the following conditions:
(a) The coffin or casket shall be encased in a strong outer box made of good sound lumber, not less than ¿ of an inch thick. All joints shall be securely put together and the box tightly closed. Either the coffin or casket, or the outer box or case, shall be watertight.
(b) When the destination cannot be reached within 60 hours after death, all body orifices shall be closed with absorbent cotton, and the body placed at once in a coffin or casket which shall be immediately closed and the coffin or casket shall be encased in a strong outer box made of good sound lumber not less than { of an inch thick. All joints must be securely put together and the box tightly closed and either the coffin or casket, or outer box or case, shall be watertight.
RULE 3. The transportation by common carrier of bodies dead of smallpox, plague, Asiatic cholera, typhus fever, diphtheria (membranous croup, diphtheritic sore throat), scarlet fever (scarlet rash, scarlatina), shall be permitted only under the following conditions:
All body orifices shall be closed with absorbent cotton, the body shall be enveloped in a sheet saturated with an effective disinfecting fluid and shall be placed at once in a coffin which shall be immediately and permanently closed. The coffin or casket shall be encased in a strong outer box made of good sound lumber, not less than ? of an inch thick, all joints of which shall be securely put together and the box shall be tightly and permanently closed. Either the coffin or casket, or the outer box or case, shall be watertight.
RULE 4. No dead body shall be disinterred for transportation by common carrier without the previous consent of authorities having jurisdiction at the place of disinterment. The transit permit and transit label shall be required as provided in Rule 1, and Paragraph (a) of Rule 2 shall apply.
RULE 5. Every outside case holding any dead body offered for transportation by common carrier shall bear at least four handles and when over 5 feet 6 inches in length, shall bear six handles.
PROMULGATED BY STATE COMMISSIONER OF HEALTH AT ALBANY, JUNE 25, 1915.
.
R-302
PLACE OF DEATH
Middlesex (County)
Cambridge (City or Town)
No Holy Ghost Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Cambridge (City or town making return)
Registered No ..
1103
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Walter Thomas Milton
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence.
No. 24 Beacon St.
St.,
Ward, Winthrop
(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?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
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 7.6 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.
Salesman
(retired
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
Wholesale leather
10 Date deceased last worked at
this occupation (month and
year)
1905
Boston
11 Total time (years)
spent in this
20yrs
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Thomas Milton
14 BIRTHPLACE OF FATHER (City) (State or country)
Marthas Vinyard
Mass.
15 MAIDEN NAME
OF MOTHER
Emily A Turner
16 BIRTHPLACE OF MOTHER (City) (State or country)
Boston
Mass .
17 Miss Hattie Turner
Informant
(Address)
75 Lincoln Ave Quincy
A TRUE COPY. Frederick H. Burke
ATTEST:
Aug 18 1931
(Registrar of city or town where death occurred)
DATE FILED
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Aug 15 1931
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Aug 1
19 31 to Aug 14
19.31
I last saw h
1m
alive on
Aug 14
19.3.1.,
death is said
to have occurred on the date stated above, at. 10.10₽
The principal cause of death and related causes of importance in order of
onset were as follows:
Coronary Sclerosis
1913
Date ofonset
1
Arterio Sclerosis
19.18
Cerebral Hemorrhage
1/11/1931
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy ?. n.O.
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
John R Sennott
M. D.
(Address)
384 Broadway
Date 8./ 16 .19.31
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Forest Hills
Boston
(Cemetery)
(City or town)
DATE OF BURIAL
August 18
1931
19
22 NAME OF
UNDERTAKER
Waldo B Pay
ADDRESS
8 Old Colony Ave Quincy
Received and filed
OCT 8 1931
19
{Registrar of City or Tow Town where where deceased resided)
1
1
-
PARENTS
50m-2-'30. No. 7997-
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.
1
St.,
Ward
(IF U. S.
War Veteran,
165
(If nonresident, give city or town and state)
(write the word)
aug. 15, 1931
R-301 A
PLACE OF DEATH
(County)
(City or Townd 31 Clearas Park Road No
Dowchy: Van Want
(If deceased is a married, widowed or divorced woman, give also maiden name.)
30 Clean Park 1
Ward,
(If nonresident, give city or town and state)
How long in U. S., if of foreign birth? yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Linjer
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
If less than 1 day Hours Minutes
11 Total time (years) spent in this occupation.
13 NAME OF
FATHER
Charles, Holman Von Wart
mon
OF MOTHER 15 MAIDEN NAME Era .. . Raynard
U.S./
Chu. H. Van. Mark tracker
17 Informant (Address) 31 Pleasant Park Rd .
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: MM. D. Childress
(Signature of Agent of Board of Health or other)
17:0 Sept 2/1931
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Setila
1
1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from august 2 1931, to ammt31, 1921
I last saw him alive on
august 21, 1931, 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
Claronic Broncho per
3-1931
Contributory causes of importance not related to principal cause:
nome
X-Day
Date of.
Was there an autopsy ?.........
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify.
Sunde gately
(Signed)
(Address)
. M. D.
The Birth Date 9-1 1931
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Waclaw fungo Tutte
DATE OF BURIAL
Left und d/195,
19
(City or town)
22 NAME OF
UNDERTAKER
ADDRESS
Received and filed
SEP
19
(Registrar)
---
100m-9-'30. No. 9954.
1 2 FULL NAME 3 SEX 4 COLOR OR RACE White temale. (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here 7 AGE Years. 11 Months /3 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 ailk mill, saw mill, bank, etc. 10 Date deceased last worked at this occupation (month and OCCUPATIONI 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) Chelun (State or country) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state year) Штор 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.
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