USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 7
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No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a down, 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
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.
or complication which causes death, not the mode of dying, e. g., heart\ \which can be obtained as to the deceased, or as to the manner or cause
FORM R-301
1
PLACE OF DEATH
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
16
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Herbert L
11/12 1) 11
(If deceased is a married, widowed pr divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
20 yrs.
.St.,
2
Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mal
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married.
5a If married, widowed, or divorced
HUSBAND of
Clara
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
58
Years
5
.Months
21 Days
If less than 1 day
Hours ....
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Salesman
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ..
Bonds IC.
10 Date deceased last worked at this occupation (month and year) Jany 14/31
11 Total time (years) spent in this occupation. 20 years
12 BIRTHPLACE (City)
Charlotte
(State or country)
Maine.
13 NAME OF
FATHER
Chen Luan
PARENTS
14 BIRTHPLACE OF
FATHER (City)
lekaptatte
(State or country) yVaine
15 MAIDEN NAME
OF MOTHER
Martha hee-
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Wifie ...
Informant (Address) 230 Pleasant It Winetruof Warz
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with, me BEFORE the burial or trapsit permit was issued: William D Childress (Signature of, Agent of Board of Health or other) H. O. January 23/1931
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
(Month)
18 DATE OF
DEATH
Jan
21
1931
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
19
.. , to
19
I Lest saw h.w .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:
Dateofonset
Minutes nature Came
Probably -
1/18/31
1921
Contributory causes of importance not related to principal cause:
Name of operation
no
Date of What test confirmed dateienmed hevert, was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed)
Writing Board of health, M. D.
(Address)
Date 1/2/ 1931
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winehook fem Winthrop
(Cemetery)/
(City or town)
19
DATE OF BURIAL
Jamy 23 - 14/31
22 NAME OF
Walter ! White
UNDERTAKER
ADDRESS
Winthrop
Mars
Received and filed
......
19 ..
A TRUE COPY, ATTEST: (Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
MARGIN RESERVED FOR BINDING
is very important. See instructions and extracts from the laws on back of certificate.
200M-11-'29. No. 7180-a
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
(City or Town) 230. Pleasantst. No.
St.,
Ward
(If U. S. War Veteran, specify WAR)
2 FULL NAME
230 Pleasehat It
mos.
days. How long in U. S., if of foreign birth? yrs.
TheoBrunswick
Jan. 21. 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, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury 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 contri- butory causes of importance not related to principal cause, name other important diseases or injuries.
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: Fracture of arm
Automobile accident
May 3, 1927
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.
State cause for which surgical operation was undertaken.
Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death : Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
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
1
BROOKLINE
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BROOKLINE
17
(City or town making return)
Registered No ..
34
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
DANIEL E.
AHERN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence.
No.
116 QUINCY AVE
St.,
Ward,
WINTHROP
MASS
(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
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
JANUARY
23
1931
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
Geneva.
Bolles
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
64
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.
Cashier
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc .....
Boston Globe
10 Date deceased last worked at
this occupation (month and
year)
Jan/31
11 Total time (years) spent in this occupation
42
Boston
Massachusetts
13 NAME OF
FATHER
(Unknown ( Ahern
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Unknown
15 MAIDEN NAME
OF MOTHER
Unknown
Cotting
Boston
16 BIRTHPLACE OF MOTHER (City) (State or country) Massachusetts
17
Wife
Informant (Address) #116 Quincy Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent af Board of Health or other)
Town Clerk January/23/1931
(Official Designation) (Date of Issue of Permit)
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
George W ........ Morse
M. D.
(Address) 475 Com wealth Ave.
Date
1/23 1931
Boston
22 PLACE OF BURIAL
CREMATION OR REMOVAL
Calvary.
(Cemetery)
Boston
(City or town)
DATE OF BURIAL
January
26
19 ..
3.1
22 NAME OF
UNDERTAKER
John F .... O. Maley
ADDRESS
7/79 Atlantic St.
Winthrop
Received and filed
January 23 redivixcuivisor 19 31
A TRUE COPY, ATTEST: (Registrar)
important.
50M-11-'29. No. 7180-b
PLACE OF DEATH
NORFOLK (County)
(City or Town) No. BROOKS HOSPITAL
...... St .;...
Ward
(If U. S. War Veteran,
3 SEX
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
(write the word)
Male
19 I HEREBY CERTIFY, That I attended deceased from January. 19 ,19 31 to January 23 19 31
1 last saw h.
.Lin .. alive on
January ... 23.
19.3.1 ... ,
death is said
to have occurred on the date stated above, at 4.0.5p.m.
The principal cause of death and related causes of importance in order of onset were as follows: Double Broncho Pneumonia
1/1881
Diabetes
?
Contributory causes of importance not related to principal cause:
Name of operation
None
Date of
What test confirmed diagnosis?
Clinical
Was there an autopsy?
no
12 BIRTHPLACE (City)
(State or country)
PARENTS
MARGIN RESERVED FOR BINDING
(Usual place of abode)
tan. 23, 1931.
ORM R-301A
MARGIN RESERVED FOR BINDING
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 (doubty) Winthrop (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permil with Board of Health or its Agent. 18
Registered: No.
(If death occurred in a hospitalor in sitution; . . give its NAME instead of samet ande 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? JT8.
mos. .
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX 7 termale
4 COLOR OR RACE
Mute
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Warned
5a If married, widowed, or divorced HUSBAND of Auching To Pilato
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 2
Years
.Months
.Days
If less than 1 day Hours Minutes
OCCUPATION|
8 frade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Housewife
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 2 mo occupation
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
DE Salvatore Auditore
14 BIRTHPLACE OF
FATHER (City)
Italy
(State or country)
15 MAIDEN NAME
OF MOTHER
EN Lace Pinade
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17 A. P. Pelata Informant (Address) 586 Washington Ut Biber
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William W. Childress
(Signature of Agent of Board of Health or other)
Cegine- 1/25/31
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
25
(Month) (Day)
1931 (Year)
19 I HEREBY CERTIFY
That I attended deceased from
Jan 22
193 .. ... , to
19 3 .1.
I last saw h. E.Y alive on
24
19 3 .( ... , 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:
Dateofonset
Endocardite .
10yes
nutrat regurgitate
Contributory causes of importance not related to principal cause: Passing Congestion
Name of operation
What test confirmed diagnosis?
Cheap Way there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
,
M. D.
(Address)
193 ..!
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross, Melden Cemetery L
Jan (2)
(City or town) 3
DATE OF BURIAL
22 MME OF Fiedby A Magnaft UNDERTAKER . 64 mundial ADDRESS
Received and filed
Jan. 27 , 1931.
ம
(Registrar)
1
No. Community Hospital
Ward
2 FULL NAME Fehleni Pelati
(If deceased is married, widowed or divorced war an, give also maiden name: 586 Warking.
(a)
Residence. No
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
M
Buntline
...... Date of
Jan. 25 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.
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