USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 94
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Menthon. (City or town making return)
Registered No. 247
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
alice E. Winter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence.
No
(Usual place of abode)
15 Elliott St
St.,
Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE
Have R Winter
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
7 42 .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.
House Wife Home
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
year)
4 months
spent in this
occupation
19 ym
12 BIRTHPLACE (City)
Weister
mass
(State or country)
13 NAME OF
FATHER
Charles F grof
14 BIRTHPLACE OF
FATHER (City)
Dudley
mass
(State or country)
15 MAIDEN NAME
OF MOTHER
Margaret Shanley
16 BIRTHPLACE OF
MOTHER (City)
Deuden
(State or country)
mass
17 Harold R. Winter Informant (Address) 5 Elliott t Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: WMC. D. Childrens
(Signature of Agent of Board of Health or other)
12/26/31
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December 22 1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
December 12
1926 to
19.34
dec 22
I last saw her alive on december
22, 1931, death is said
to have occurred on the date stated above, at 130Am. The principal cause of death and related causes of importance in order of onset were as follows; Cerebral hemmorrhage Datosfonset 17/2/3
Contributory causes of importance not related to principal cause: arteriosclerosis
Hypertension
Chronic Interstitial Restantes
Name of operation
norge
Date of
What test confirmed diagnosis Clinical lab Was there an autopsy?
Two
20 Was disease or injury in any way related to occupation of deceased? If so, specify Jacob ataques
, M. D.
(Signed)
(Address) 562 L
Date 12/2/3/19
21 PLACE OF BURIAL,
CREMATION OR REMOVALALL taion
(Cemetery)
(City or town)
Went woh
DATE OF BURIAL
10c 26,
1931.
22 NAME OF
UNDERTAKER
Thank U. Welsh
ADDRESS
1721
broadway Chelsea
Received and filed
19
A TRUE COPY, ATTEST:
(Registrar)
No.
St.,
Ward
(If U. S.
How long in U. S., if of foreign birth?
JTs.
Length of residence in city or town where death occurred 9 mos.
(write the word)
1925 1926 1927
6. Hinter
Revised United States Standard Certificate of Death Ded. 22, 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 merchantere A penterr who selts whorts 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 Violente, The medical examiner shall make such certificate. If the death certnicate 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, pyemnia, septicemia, tetanus.
ORM R-302
Middlesex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Can bridge
048
(City or town making return)
Registered No .. 1650
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Zairan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
165 Grovers Ave,
St.,
Ward, ..... Winthrop
(If nonresident, give city or town and state)
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
er DIVORCED
Single
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
3tillborn
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 vilk 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)
Cambridge
Mass.
13 NAME OF
FATHER
John Pairman
England
Laura Ward
New York
17 Benjamin Temey
Informant
(Address)
271 Beacon St. Boater
A TRUE COPY.
Frederick H. Burke
ATTEST:
Dec 28 1931
(Registrar of city or town where death occurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
12 == 23 -- 1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
19
to
19
I last saw h
alive on
19
death is said
to have occurred on the date stated above, at ... .. m.
The principal cause of death and related causes of importance in order of onset were as follows:
Datosfonset
Stillborn
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)
Benjamin Inney Jr
M. D.
(Address) 271 Beacon st ...
Date:1.1 ........ 19 .... 7 ...
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mit Auburn Crematory
(Cemetery)
(City or town)
DATE OF BURIALDec 20 1931
19
22 NAME OF
UNDERTAKER
Benj F Wye th
ADDRESS
Cambridge
Received and filed
JAN-9 1932
19
(Registrar of City or Town where deceased resided)
MARGIN RESERVED FOR BINDING
8 SEX F. (or) WIFE of 7 AGE 0 Years OCCUPATION| (State or country) 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) important. 50m-2-'30. No. 7997 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 (State or country)
PLACE OF DEATH
(County)
Cambridge
(City or Town) No ...... 330 ... I.t .... Auburn St. Cambridge Hospital 2 FULL NAME
St.,
Ward
(M U. S. War Veteran, specify WAR)
(a)
Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrı.
MOB.
days.
How long in U. S., if of foreign birth?
yrı.
(write the word)
Months.
Days
(Fillbom) - airman Dev. 23, 1931
-
------
RM R-301 A
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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of See instructions and extracts from the laws on back of certificate.
is very important.
75m-2-'30. No. 7997-a
| HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mm D. Childress
(Signature of/Agent ef Board of Health or other) We althe Officer (Official Designationy (Date of Issue of Permit)
12/28/31
MEDICAL CERTIFICATE OF DEATH
4 COLOR OF RACE
3 SEX
Sale Mute
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single-
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 18 Years Months/6 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) (State or country)
13 NAME OF
FATHER
ER Inapril
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME OF MOTHER
Genova
(Address)
Date 12/201931
21 PLACE OF BURIAL, CREMATION OR REMOVAL
(Cemetery)
(Gity or town)
DATE OF BURIAL 2128
22 NAME OF UNDERTAKER Richard Party
19
1
(City or Town) No. 94 Luimoto
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.
2318
Registered N
(If death occurred in a hospital or institution, Ward | give its NAME instead of street and number) 249
mação
CHE U. S. War Veteran, specify WAR)
(If nonresident, give city of town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
18 DATE OF DEATH On
25
1931 (Year)
(Month)
(Day)
19 I HEREBY CERTIFY, That I attended deceased from
Den 23
19
7/
19 ..... to
l last saw h. Lalive on Un 25 1991 death is said
to have occurred on the date stated above, at
2 Pm.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Contribufery 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)
M. D.
16 BIRTHPLACE OF MOTHER (City). (State or country) 10000.
17 Informant IN South (Address)ALarenta
St.,
2 FULL NAME
Justin Edward
(If deceased is a married, widowed og divorced woman, give also maiden name.)
GHzincoti St., Ward,
(a) Residence.
No ...
(Usual place of abode)
Length of residence in city or town where death occurred 16 yes. mos. 16
days.
How long in U. S., if of foreign birth?
yrs.
PLACE OF DEATH
Suffolk. (County)
(Give maiden name of wife in full)
Received and filed
"DEC 2.8.19ffgistrar)
Revised United States Standard Certificate of Death Dec 25, 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, soup factory, cotton mill, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onset
1915
Chronic interstitial nephritis
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. Lamus, 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.
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