USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1932 > Part 28
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R-301A
Suppolia
(County) Withsok
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 66
(If death occurred in a hospital or institution, 5
give its NAME instead of street and number) -
Hilda Benson
(If deceased is a married, widowed or divorced woman, give also maiden name.) 15 Junset was
(a)
Residence. No ..
(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
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
19 Enson
(Give maiden name of wife in full)
If less than 1 day Hours .Minutes
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)
this occupation (month and
year) ..
spent in this
33 jrs
12 BIRTHPLACE (City)
(State or country)
Awsdan
13 NAME OF
HER Johann Berndtson
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME OF MOTHER Justina Not Nurmos
16 BIRTHPLACE OF
MOTHER (City)
Amadeu
(State or country)
17 Informant (Address) 15 Sunset Prace
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. L. Killdress
(Signature of Agent of Board of Health or other)
... (Official Designation) (Date of Issue of Permit) 5/20/32
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Abril 18
DEATH
1932
(Month)
(Day)
(Year)
19
I
HEREBY CERTIFY,
That I attended deceased from
aw.
8
19.32 to
April
18
19
3
I last/saw
h
alive on.
afaril
18
193 .... , death is said
12.35/m C.m.
Date of Onset 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 Endocarditis
19.3
arterio Selervia
-
Contributory causes of importance not related to principal cause:
Name of operation.
What test confirmed diagnosis?
Date of.
Was there an autopsy? IV. O
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Edward & Fraunger
M. D.
(Signed)
476 Stilling St.
(Address)
ORA 19/
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Glenwood Ovenett
DATE OF BURIAL
April 20
1932
22 NAME OF
UNDERTAKER
Fregh of , magra
ADDRESS
Cart Paraton
Received and filed
APR 22-1932
19
(Registrar)
100m-0-'30. No. 0054.
OCCUPATION 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 PARENTS
PLACE OF DEATH
1 No 2 FULL NAME 3 SEX 4 COLOR OPRACE tennale Meite 5a If married, widowed, or divorced HUSBAND of trust 6 IF STILLBORN, enter that fact here. 7 58 AGE Years Months Days 8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .. sivuia De stated EXACTLY. PHYSICIANS should state (or) WIFE of (Husband's name in full)
(City or Towa) 15 Sunset Roads
Ward
(If U. S. War Veteran, specify WAR)
Ward,
(If nonresident, give city or town and state)
(Comptery) (City or town)
Housewife
APR 18 1932
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, ete.
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., hcart 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.
COMMONWEALTH TH OF MASSACHUSE! 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 deccascd, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccased, 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 aforcsaid 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 certificatc, 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 funcral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
I R-301
o caicluny supplea. AUL should be stated EXACTLY. PHYSICIANS should state 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 -WRITE PLAINLY, WITH TINFADING RI ATU TATIF
100m-11-'30. No. 605-b
I HEREBY CERTIFY that a satisfactory standard certificate of death Was
filed with me BEFORE the burial or transit permit was issued:
Www. D. Couldres
(Signature of Agent of Bord Health or other)
Health Officer
4/20/32
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
(write the word) stengte
5a If married, widowed, or divorced HUSBAND ol
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here. 2
7 40
Years
3
Months.
140
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, baok, etc.
Clark
10 Date deceased last worked at this occupation (month ago141932 year) Manchester
11 Total time (years) spent in this occupation
12
12 BIRTHPLACE (City) (State or country)
13 NAME OF
FATHER
James. Hary Bencon
PARENTS
14 BIRTUPLACE OF
FATHER (City)
Vingrand
(State or country)
15 MAIDEN NAME
OF MOTHER
ME Flerena. Nohawell
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Marcuel .
Informant
(Address)
24 Sergant SL Wonchung
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
..
(City or town making return)
Registered No.
67
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Glace. Hannah, Benson
2 FULL NAME
(a) Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred 72
yrs.
mos.
days.
How long io U. S., if of foreign birth?
yrs.
mos.
days.
18 DATE OF
DEATH
Month)
(Day) /
(Year)
19 I HEREBY CERTIFY, That I attended deceased from april 13 1932 to.
a/ 18 1992
I last saw h ........ alive on ...... /8, 19.21, death is said to have occurred on the date stated above, at 6 pm. The principal canse ol death and related causes of, importance in order of onset were as follows: Date of Onsel Myomata 21 1 1 Wteras 1931
Several Peritonitis (1618)
Cootributory causes of importance not related to principal cause:
Name of operation ...
Hysterectomy
.Dale of UMr. 14.1932 What test confirmed diagnosis efetucale Was there an autopsy ?! 20 Was disease or injury in any way related to occupation of deceased? ...
If so, specify
Som Williams
(Signed)
....... , M. D.
(Address)
429 Bracmy
Date.
21 PLACE OF BURIAL,
CREMATION OR REMOVA
(Cemetery)
(City or town)
april 20%
19.3.4.
DATE OF BURIAL
22 NAME OF
UNDERTAKER
Des R Demmin
.
ADDRESS
19
Received and filed
APT
A TRUE COPY, ATTEST: (Registrar)
1
PLACE OF DEATH
(County)
(CHy or Town)
No
Ward
(II U. S. War Veteran, specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 146 Tallau Park &K Ward,
(If nonresident give city or town and state)
PERSONAL AND STATISTICAL PARTICULARS
18,1932
AGE
England
APR 18 1932
Statement of occupation .- Precise statement of occupation is ervy 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," ete. 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, ete. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Date of onset
Arteriosclerosis
1915
Chronic interstitial nephritis
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.
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 discase 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.
- ---
A R-301A
Lvery nem or
1
PLACE OF DEATH
(County)
Minithat (City or Town)
Community Has
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.
68
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Robert & Evans
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
86 Ingleside ave St.,
(Usual place of abode)
Length of residence in city or town where death occurred 30 ITS.
MOS.
days.
How long in U. S., if of foreign birth?
yrs.
MG8.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
male White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
trace Long
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
7
62
Years
6
Months
Days
If less than 1 day Hours .Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
·Floor manager
sawyer, bookkeeper, etc.
9 Industry or business in which work was done, as silk mill, saw mill, hank, etc.
Felines.
10 Date deceased last worked at
11 Total time (years)
this occupation (month and nav. 1932
year)
Bellows Falls
(State or country)
mas
12 BIRTHPLACE (City).
13 NAME OF
FATHER
Robert a levaris
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME
OF MOTHER
Mankann
16 BIRTHPLACE OF MOTHER (City) (State or country) unknown
17 Robert @ Evans Sv
Icformant (Address) 86 Ingleside Que Marithiel
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Nm. Fr. Childress
(Signature of Agent of Board of Health or other) Health suur 4/28/32
(Date of Issue of Pepmit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
4
(Month)
(Day)
19
32
(Year)
19 I HEREBY CERTIFY, That } attended deceased from
3/7
19.32, to
4/19
1932
1932
death is said
to have occurred on the date stated above, at.
18 The principal cause of death and related causes of importance in order of onset were as follows: Dateofonset acute N lattung Heart-
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