USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 65
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Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .-- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onset
1915
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. .. Chap. 114, Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
IRM 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
17 Annie Riley
Informant
(Address)
Winthorp, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
R
(Signature of Agent of Board of Health or other) Sept. 8, 1931
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
8,
1931
(Month)
(Day)
(Year)
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 70
AGE
Years Months Days
If less than 1 day
Hours
.Minutes
OCCUPATIONI
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Cigar Mkr.
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. ..
Own Business
10 Date deceased last worked at this occupation (month and year)
1926
11 Total time (years) spent in this occupation
50 yrs . Contributory causes of importance not related to principal cause:
Caecostomy
August. 26, 1931
Name of ope Resection of splenic flexpre & colost What test confirmed diagnos@my - 9/1/31 Was there an autopsy? Yes
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
C L Clay,
M. D.
(Address)Peter B. Brigham Hosp Date 9/8/ ...
19 .3.1
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
September 10 ,19 31
22 NAME OF
UNDERTAKER
J F McGlinchey
ADDRESS
Chelsea, Mass.
Received and filed.
September ........ 10,
19
31
GALTRUE 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)
Registered No.
7614
(If death occurred in a hospital or institution,
No.
(City or Town) Peter Bent Brigham Hospital
St.,
Ward {
give its NAME instead of street and number)
169
~
(If U. S.
War Veteran,
2 FULL NAME
James H. Riley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. No ..
(Usual place of abode)
93 ... Court .. Road
.St.,.
.....
Ward,
Winthrop,
Mas.s ..
(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
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
Male
White
Annie Mccarthy
19 I HEREBY CERTIFY, That I attended deceased from August 2.6 1931, to September 8, 19 31 I last saw h ... i.m. .. alive on .... September ........... 8.,, 19 .... 3.], death is said to have occurred on the date stated above, at 12:20Amn. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Carcinoma of colon
?
1 yr.
Lobar Pneumonia (rt.)
dys ..
12 BIRTHPLACE (City)
Chelsea, Mass.
(State or country)
13 NAME OF
FATHER
John Riley
14 BIRTHPLACE OF
FATHER (City)
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Fannie Dolan
16 BIRTHPLACE OF
MOTHER (City)
(State or country) Ireland
PARENTS
PLACE OF DEATH
Suffolk
(County)
Sept. 8, 193
M R-301A
Suffolk
(County)
(Gity or Town) No. 194 Maine
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
27.500
To be filed for burial permit with Board of Health or its Agent. Registered No.
170
(If death occurred in a hospital or institution, Ward { give its NAME instead of street and number)
Edward Parker Hodie
(If deceased is a married, widowed or divorced woman, give also maiden name.)
194 Illusie
St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
30
yTs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Male White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
Frances Harrell
(Give maiden name of wife in full)
(er) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
91
Years
5
Months.
10
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.
La leaptuin
and Thiner
10 Date deceased last worked at
this occupation (month and
year) ..
30years
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
Provinciiin
IHave
(State or country)
John Hove
14 BIRTHPLACE OF
FATHER (City) .
Provincetown
Mars
15 MAIDEN NAME
OF MOTHER
Emaline Thenn
16 BIRTHPLACE OF
MOTHER (City)
Sandwich
(State or country) Mass
17 Sarah R. Sturgis
Informant
(Address)
194 Main Lt
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Im. D. Cinidress (Signature of Agent of Board of Health of other) Health Much
9/12/3 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Soft.
10,
1981.
(Year)
(Month)
(Day)
19 I HEREBY CERTIFY, That I attended deceased from nom, st. to test, 10 19. . I last saw h. Joanlalive on ... 19.3./ ... , death is said to have occurred on the date stated above, at 2-20,2 m. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset f 1
Chronic Iostalitia vito jan. 1, purulent cystitis et 1931.
Contributory causes of importance not related to principal cause:
Left 4 99%
Name of operation ....
2 one.
".Date of.
What test confirmed diagnosis? Urinalysis Was there an autopsy? 20
200.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
(Address).
M. D.
Date Metis 1981
21 PLACE OF BURIAL,
CREMATION OR R
'(City or town)
(Cemetery)
Ti let.
13
1931
22 NAME OF
UNDERTAKER
Walter J. Ilhvite
ADDRESS
2Vinttuof
Received and filed
SEP 1 5 1931
19
(Registrar)
1
1
:
-
(If U. S. War Veteran, specify WAR)
(a)
Residence.
No
(Usual place of abode)
Lf St.,
PLACE OF DEATH
1 2 FULL NAME 3 SEX AGE 13 NAME OF FATHER PARENTS OCCUPATION 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 100m-9-'30. No. 9954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)
DATE OF BURIAL
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:
Date of onset
Arteriosclerosis
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.
-
I R-301 A
PLACE OF DEATH
Suffolk .County) Winthrop (City or Towy 62 Temple are St., Ward {
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.
171
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
Peter andrew O'Grady
(If deceased ig a married, widowed or divorced woman, give also maiden name.)
62 Lemple UVE
St.,
. Ward,
(a)
Residence. No
(Usual place of abode)
Length of residence in city or town where death occurred
yrı.
mos.
days. How long in U. S., if of foreign birth? yrs.
108. days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
(Give maiden name of wife in full)
(Husband's name in full)
If less than 1 day Hours Minutes
Drug Check
Cartera & my Co
10 Date deceased fast worked at
11 Total time years)
spent in this
occupation.
12 BIRTHPLACE (City) Ireland
13 NAME OF
FATHER
michael
14 BIRTHPLACE OF
FATHER (City)
Ireland
15 MAIDEN NAME
OF MOTHER
mary Itolan
16 BIRTHPLACE OF MOTHER (City) (State or country) Пилов.
17 Informant (Address) 62 Tempere Og
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mm. A. Childrens (Signature gRAgent of Board of Health or other) Sept 11/31.
J.D.
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept 10
(Month)
(Day)
143/ (Year)
19 I HEREBY CERTIFY, That I attended deceased from
19 3/
I last saw h.
Lalive on
5,300 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:
Cate of Onset t 1
mappadito
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)
M. D.
(Address)
Cunha In Date 9/1/ 198
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
It Soluces Clinton
DATE OF BURIAL
Defet 12
or town) 19.3.1.
22 NAME OF UNDERTAKER John t. O maker
ADDRESS
Received and filed SID 15 BY
19
(Registrar)
1
,19. 3 Le J 20 1931, death is said
1
100m-9-'30. No. 9954.
1 No 2 FULL NAME 3 SEX 4 COLOR OR RACE White 5a If married, widowed, or divorced HUSBAND of (or) WIFE of 6 IF STILLBORN, enter that fact here 7 68 Years Months Days AGE 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. OCCUPATIONI (State or country) (State or country) PARENTS 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 year) 20000 1931
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and státe)
Revised United States Standard Certificate of Death Sept. 10, 1931
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