USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 87
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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
I021
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, atter 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 re,;istration 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 atten .. ing 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.
RM R-301 A
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 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
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial og transit permit was issued:
Health
(Signature of Agent of Board of Health or other) 12/1/31
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
20
19 31
(Month)
(Day)
(Year)
18 I HEREBY CERTIFY, That i attended deceased from
Un. 29, 1931 death is said I last saw h 10 alive on to have occurred on the date stated above, at 12, 20 Am
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
AGE
7 421 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.
at Home
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ..
Housewife
10 Date deceased last worked
at
this occupation (month and 2011929
year) ..
Brotes
11 Total time (years) spent in this occupation
12 BIRTHPLACE (City) (State or country)
13 NAME OF
FATHER
RF John Burke
PARENTS
(State or country)
15 MAIDEN NAME OF MOTHER annie Hawkes
Dewmarket
16 BIRTHPLACE OF MOTHER (City) (State or country) n. J.
75m-2-'30. No. 7997-a
PLACE OF DEATH
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.
2378
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
anna E. G. nicholas
(If deceased if a married, widowed or divorced wo.nan, give also maiden name.)
(a) Residence.
No ..
30 Underhall
St., .: ..... Ward,
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth? yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 PEX
4 COLOR OR RACE
Stret
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
5a If married, widowed, or divorced HUSBAND of nathx miete the full sichals (or) WIFE of (Husband's name in full)
6 IF STILLBORN, enter that fact here.
.......
....
Contributory causes of importance not related to principal cause:
Name of operation
Date of.
What test confirmed diagnosis?
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
4 Linhas In Date
., M. D.
(Address)
12/11931
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Inf. Benedicto
Cemetery)
(City or town)
DATE OF BURIAL
DEU 2, 1931.
19
1052 NAME OF
UNDERTAKER
Auchark Curly
ADDRESS
Received and filed
DECI
(Registrar)
1
19
1
(City or Town) 30 Underhill Stantherato No.
Ward
(If U. S. War Veteran, specify WAR)
227
(Usual place of abode) Lengt'a of residence in city or town where death occurred 2 moc
nathaniel I Pacchialy
17 Informant (Address) 30 Underhill 25
14 BIRTHPLACE OF
FATHER (City)
Ireland
19 www.30 19 .5.1
to ...
chile
nr . 30, 193!
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 " worker, " "operative," etc. Find out the parti- cular land 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. " 1." etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.
1
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 salesmen 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 carlier 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.
2., marion
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
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, Scc. 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 dicd 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.
:
ORM R-305
Suffolk
(County) Boston
(City or Town) Children's Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Boston
'City or town making return)
Registered No.
8364
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
JohnW. Pappos
(Ir deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
5 Coral Ave
.St.
Ward,
Winthrop,
Mass.
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yTs.
mos.
days.
How long in U. S., if of foreign birth?
yTs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
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 Years 11Months 15 Days
If less than 1 day . Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year. ..
11 Total time (years)
spent in this
occupation ..
12 BIRTHPLACE (City)
Winthrop, .... Mas.s.
(State or country)
13 NAME OF
FATHER
James J. Pappos
PARENTS,
14 BIRTHPLACE OF
FATHER (City)
Greece
(State or country)
15 MAIDEN NAME
OF MOTHER
Thresa Kaleris
16 BIRTHPLACE OF MOTHER (City) (State or country)
Greece
17 William J. Pappos
Informant (Address) Winthrop, Mas.s.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
J ... W .M. (Signature of Agent of Board of Health or other) Oct 3 1931
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
2,
1931
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
etanus consequent on incised wound on the leg caused by an accidental fall on broken glass.
20 If death was due to external causes (VIOLENCE) fill in the following :
Accident,
Suicide os
Homteide ?
Where did
injury occur ?
Winthrop, Mass.
Manner of
Injury
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
G B Magrath
Boston, Mass.
(Address)
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mt. Hope
Boston
DATE OF BURIAL
23 NAME OF
UNDERTAKER
C R Bennison
Winthrop,
Mass.
ADDRESS
Received and filed.
.O.c.t ...
3:
A TRUE COPY, ATȚEST:
JANIT
(Registrar) (
MARGIN RESERVED FOR BINDING
# 25M-11-'29. No. 7180-d
1
PLACE OF DEATH
St.,
Ward
1
(LE U. S.
War Veteran,
specify WAR)
22%
(Cemetery)
oct.
4,
(City or town)
31
19
Date
10/2%M.D3
Date of injury.
19
(City or town and State)
Och. 2, 1931
ORM R-302
Middlesex
PLACE OF DEATH
(County) Tewksbury, Mass. (City or Town) No. State Infirmary
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
State Infirmary Tewksbury, Mass. (City or town making return)
Registered No. 443 229
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
William E. Fraser
(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. 4
mos. 2] days. How long in U. S., if of foreign birth? yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widower
5a If married, widowed, or divorced HUSBAND of
Helen Lawlor
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 73 Years 2 Months 17 Days
If less than 1 day
Hours
Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Diver
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.
12 BIRTHPLACE (City)
(State or country)
Not learned
Nova Scotia
13 NAME OF
FATHER
Alex Fraser
14 BIRTHPLACE OF
FATHER (City)
Not learned
(State or country) Nova Scotia
15 MAIDEN NAME
OF MOTHER
Charlotte Houghty
16 BIRTHPLACE OF MOTHER (City)
Not learned
(State or country) Nova Scotia
17 Hospital Records
Informant
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
John H. Nichols, Supt (Signature of Agent of Board of Health or other) October 4, 1931
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October 4
19.31
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from May 13
,19 to
19
31
I last saw h .. ]m.alive on
October
4.
, 19 3.1., death is said
to have occurred on the date stated above, 12 .. 40 P.m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Chronic Myocarditis
Not learned
Contributory causes of importance not related to principal cause:
1
Arteriosclerosis
Not learned
Name of operation
None
Date of
What test confirmed diagnosis? linical Was there an autopsy? No.
20 Was disease or injury in any way related to occupation of deceased? No
If so, specify.
(Signed)
Justin L. Anderson
M. D.
(Addres
State Infirmary
Date 10/4. 19 .3.1
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross
Malden
DATE OF BURIAL
(Cemetery)
October
7
(City or town)
19
31
22 NAME OF
UNDERTAKER
John F. O'Maley
ADDRESS
Winthrop, Mass
Received and filed October 4,
19.31
John H.
Nichols hols Sept
A TRUE COPY, ATTEST:
gistrar)
will. 32
1
important.
50M-11-'29. No. 7180-b
PARENTS
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
1
St.,
Ward
(If U. S. War Veteran, specify WAR)
.St.,.
Ward,
Winthrop
(If nonresident, give city or town and state)
31 October 4
William G. tracer Det. H. 1931
RM 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
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
Boston
(City or town making return)
1
Bo ston
CERTIFICATE OF DEATH
Registered No.
8644
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No
(Usual place of abode)
3 Woodside Pk.
.St., ..
. Ward,
Winthrop, Lass.
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