Town of Winthrop : Record of Deaths 1931, Part 92

Author: Winthrop (Mass.)
Publication date: 1931
Publisher:
Number of Pages: 540

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M R-301A

Juffach

PLACE OF DEATH

(County)

(City or Towp)

No. 61 Conversor

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 3 42)

.St.,

Ward {

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

William George (Addis

(If deceased is a married, widowed og divorced woman, give also maiden name.)

(a) Residence.

61 Comersoit Kdl

St.,

2 Ward,

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

mos. days. How long in U. S., if of foreign birth? yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

Married

5a If married, widowed, or divorced Quang H. HUSBAND of

Stina

(Give maiden name of wife in full)

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

AGE

Years ..

Months

.Days

If less than 1 day .Hours Minutes

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.

Civil Engineer for State of 41 ans

10 Date deceased last worked at Nec3/31 this occupation (month and year) .. Kristal

11 Total time (years) spent in this occupation. 4.5

Congland

13 NAME OF

FATHER

Edwin & Rdluis

Higland

$0 Elizabeth Duimmer

160

England-

17 Wife Winshop Was

I HEREBY CERTIFY that a satisfactory standard dertificate of death was filed with me BEFORE the burial or transit permit was issued: Wim.D. Childress

(Signature of Agent of Board of Health or other) Wealth Manicer · 12/19/31

(Official Designation) (Date of Issue of Permit) (

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

(Month)

(Day)

1931

(Year)

19 I HEREBY CERTIFY

That I attended deceased from

I last saw h.A.mx1 ... alive on

to have occurred on the date stated above, The principal cause of death and related causes of importance in order of onset were as follows: Chronic myocarditis Date of Onset

Chronic Nelhutis

Naugs 1991

Contributory causes of importance not related to principal cause:

Name of operation.

None

What test confirmed diagnosis?

clinical

ate of.

Was there an autopsy? NO

20 Was disease or injury in any way related to occupation of deceased? If so, specify. Squelie w ichtenlow (Signed) M. D. (Address) mintha, mas Data Del 18, 1931

21 PLACE OF BURIAL.

CREMATION OR REMOVAL

una Lerne Northampton

(Cemetery) IS

DATE OF BURIAL

(City or town) 19.3. J

22 NAME OF

UNDERTAKER

Walter J. Il frite

ADDRESS

Received and filed

DEC 2₺ 1931

(Registrar)

1 2 FULL NAME 3 SEX Tuale (or) WIFE of 7 OCCUPATIONI 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) Informant (Address) 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 is very important. See instructions and extracts from the laws on back of certificate. 100m-9-'30. No. 9954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)

(If U. S. War Veteran, specify WAR)

(If nonresident, give city or town and state)

1911, to face

141

... , 19.3.1

16, 1931, death is said 12,150m.

Revised United States Standard Certificate of Death

Dev. 17, 1931

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.

To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation.

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee," "worker." "operative. " ' etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store," "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.

Example

The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis

Date of ouset

1015

Chronic interstitial nephritis

1921

Cerebral hemorrhage

July 5, 1027

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.

M R-302

Suffolk

(County)

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

Chelsea

(City or town making return)

Registered No. 243

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

2 FULL NAME

Patrick J. Coakley

(If deceased is a married, widowed or divorced woman, give also maiden name.)

.St.,.

........

Ward,

Winthrop

(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

Dec. 17, 1.931

DEATH

(Month)

(Day)

(Year)

19 I HEREBY CERTIFY, That Lattended deceased from Dec .

I last saw h ..

.. alive on

,19 .......

Dec: 17

death is said

3,50 P.

to have occurred on the date stated above, at.

The principal cause of death and related causes of importance in order of onset were as follows:

Pulmonary tuberculosis

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, spechtis D. Anderson

(Signed)

U.S.M Fine dosy.

Daté-

12/18

19 1

21 PLACE OF BURIAL,

Holy Cross, Malden

CREMATION OR REMOVAL

DeCemeteryg,

(City or town

DATE OF BURIAL

22 NAME OF

M.J. Kelly

UNDERTAKER

11 Meridian St . E. Boston

ADDRESS

Received and filed 19

(Registrar of city or town where death occurred)

De.c ....... 18.,

19 31

St.,

Ward

(If U. S. War Veteran, specify WAR)

4 Waldemar Av.

(write the word)

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

single

5a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

If less than 1 day .Hours Minutes

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ... Seaman

10 Date deceased last worked at

11 Total time (years)

spent in this

occupation ..

(State or country) Mus3.

16 BIRTHPLACE OF MOTHER (City) (State or country) Ireland

17 U.S.Marine Hospital records

M. D.

(Address).

to ..

19.

Dateofonset

Manictens of City or Town where deceased resided)

1 Chelsea (City or Town) N .. S.Marine Hosp. (a) Residence. No. (Usual place of abode) 3 SEX male 4 COLOR OR RACE white (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 51 AGE Years Months Days 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc .... this occupation (month and OCCUPATION| year) 12 BIRTHPLACE (City) Boston 13 NAME OF FATHER Charles 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER Honora Kane PARENTS Informant (Address) A TRUE COPY. ATTEST: tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. DATE FILED 50m-2-'30. No. 7997- N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country) Ireland

PLACE OF DEATH

1 Patrick. Hra kelly Dec 17, 193Kl

M R-301 A

Suffolk Conty)

Winthrop (City or Town Sa

The Oo monwealth 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)

(a)

Residence.

No.

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

85 Saga

Come, Ward,

Utinthen

(If nonresident, give city er town a .d state)

mos.

days. How long in U. S., if of foreign birth? JTs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE

MARRIED

WIDOWED

(write the word) ED yanied

5a If married, widowed, or divorced HUSBAND of

(Give maiden name of wife in full)

marie

(Husband's name in full)

6 IF STILLBORN, enter that fact here

AGE 0 Years Months Days

If less than 1 day Hours Minutes

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.

9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.

10 Date deceased last worked at 11 Total time (years) spent in this occupation ..... ......

12 BIRTHPLACE (City)

(State or country)

Russia

13 NAME OF

FATHER

Harry M. Band

14 BIRTHPLACE OF

FATHER (City)

Russia

Rebecca Sherr

Russia

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William S. Childrens (Signature of Agent of Board of Health or other)

agent Dec. 20/31

(Officiel Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

(Month)

(Day) 18

1931 (Year)

19 I HEREBY CERTIFY, 1930 to December 18 . 193/ That I attended deceased from January 18

1 last saw h&L. alive on december 18, 1931, death is said to have occurred on the date stated above, at 9 P. m. The principal cause of death and related causes of importance in order of onset were as follows: Coronary thrombosis

Date of Onset 1931

Contributary causes of importance not related to principal cause: arteriosclerosis Chronic Myocardial Degeneration 1930

1929

Name of operation .

none

Date of

What test confirmed diagnosis? Chincinex

Was there an autopsy?

20 Was disease or injury in any way related to occupation of deceased? If so, specify Jacob beayes (Signed) (Address 1562 Smiley Pr

., M. D.

Date 12/19/ 1931

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Jacob & Wiemy (Cemetery) (City or town) 19

DATE OF BURIAL

22 NAME OF Manuel Stantsky UNDERTAKER

ADDRESS

63 €

DET 2 2 1931

Received and filed 19

(Registrar)

1 No. 2 FULL NAME 3 SEX (or) WIFE of 7 15 MAIDEN NAME OF MOTHER PARENTS OCCUPATION· 16 BIRTHPLACE OF MOTHER (City) (State or country) 17 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-9-'30. No. 9954 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)

PLACE OF DEATH

more asap Chesma Lourie

.Ward

(If deceased is a married, widowedor divorced woman, give also maiden name.)

Firmale white

or DIVORCED

Housewife at Home

this occupation (monthand 30

year) ...

Keena 0

Revised United States Standard Certificate of Death Dec. 18, 1931

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. " 4 mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soup factory, cotton mill, etc.

Example

The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis

Date of onset

1015

Chronic interstitial nephritis

1021

Cerebral hemorrhage

July 5, 1927

Contributory causes of importance not related to principal cause:

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH

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.

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Town of Winthrop : Record of Deaths 1931, Part 92

Author: Winthrop (Mass.) Publication date: 1931 Publisher: Number of Pages: 540

Author: Winthrop (Mass.)
Publication date: 1931
Publisher:
Number of Pages: 540