USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1932 > Part 39
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5/31/32
Health Giver (Official Designation) (Date of Issue of Permit)
1
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) ..
ligar-factory 11 Toal time (years) spent in this
45
12 BIRTHPLACE (City).
(State or country)
Holland
13 NAME OF
FATHER
abraham ttaalma
14 BIRTHPLACE OF
FATHER (City)
PARENTS
(State or country)
Holland
15 MAIDEN NAME
OF MOTHER
ChristinaVon Der Woude
16 BIRTHPLACE OD
MOTHER (City)
(State or country)
thecond
17 Informant niscilla gorgels thealma 25 futter , Winthrop
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 WALLI UNNI AVING DLACA INA-THIS IS A PERMANENT RECORD. Every item of MARGIN RESERVED FOR BINDING
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ......
If less than 1 day Hours Minutes
AGE
7 67 . Years Months Days
Give maiden name
5a If married, widowed, or divorced HUSBAND of Priscilla
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here
MEDICAL CERTIFICATE OF DEATHI
January 30
28.
..... , to
May 29
69:
m.
(If U. S. War Veteran, specify WAR)
.St.,.
Ward,
(If nonresident, give city cr town and state)
St.,
Ward
Revised United States Standard Certificate of Death May(30) 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 prio 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 onset
1015
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.
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 ease 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.
RM R-301 A
PLACE OF DEATH
Suffolk Winthrop County)
The Commonwealth of Massachusettsa 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.
93
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a mamed, howved or divorced woman, sve also maiden name.)
(a)
Residence.
No
(Usual place of abode)
17
Length of residence in city or town where death occurred y.s.
mos.
days. How long in U. S., if of foreign birth? yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced HUSBAND of
lemie l'King
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 56 .. Years 9 Months X 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 .....
Cabinet Maker Screen Maker
10 Date deceased last worked at
11 Total Xme (years)
year) nature 1927
spent in this occupation
35
12 BIRTHPLACE (City)
(State or country)
Max
13 NAME OF
FATHER
Patrick King
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
anne Connolly
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
75m-2-'30. No. 7997-a
17
(Address) ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE, the burial or transit permit was issued: Childress
(Signature of Agent of Board. of Health or other) Heaute officer (Official Designation) (Date of Issue of Permit)
19/2/32
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
/
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
19
.. , to
19
Jast saw h ............ alive on
82
death is said
to have occurred on the date stated above, at 4 A
.m.
The principal cause of death and related causes of importance in order of onset were as follows: Natural Causes, Probable Datecfonset
Chimie Myocardeth
1927
Contributory canses of importance not related to principal cause:
Name of operation
home
What test confirmed diagnosis? moretogain
Date of
Was there an autopsy? No
20 Was disease or injury in any way related to occupation of deceased? No
If so, specify Kay
Raymond B Parker
(Signed)
, M. D.
Writing Brand of Health
Date Ance 2 1932
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
Holo Cenos Malden
(City or town)
DATE OF BURIAL : fund 3rd 1932
Gym calle
22 NAME OF UNDERTAKER 91 Mellett Colis
Received and filed 19
JUN 3
(Registrar)
MARGIN RESERVED FOR DINDINO ..
· PARENTS 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 WIIn UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of OCCUPATIONI
1
(City or Town)
No. 17
Vine ave St. Michael & King
.Ward
(If U. S. War Veteran, specify WAR)
Ward,
(If nonresident, give city or town and state)
1932
ADDRESS
Bretin
race Revised United States Standard Certificate of Death
June 41932
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 deccased 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, ete. For a person who had no occupation what- ever write none.
To be complete, an occupation return must state:
S .- 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 "caployee, " "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 gencral terms as "store, " "factory,' "mill. " 1," 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 engincer, 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 .-- Cattse 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 diseascs.
..
Example
The principal cause of death and related eauses 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:
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 deccased, 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 scen 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 elerk 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.
.... Hc 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 thercof 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, Scc. 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-301A
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.
94
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Gangart In Com
(If deceased is a married, wid Red of divorced woman, give als) maiden name.)
136 @lmwoods
Ward
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth? 40 yrs. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
1932
(Month)
(Day) )
(Year)
19 I HEREBY CERTIFY,That I attended deceased from March 1 1932, to. JUNE 1 1932
I last saw helalive on
JUNE 1
19 32, death is said
5-P. m.
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:
Date of Onset
Sarcomte
2-1.32
Name of operation
What test confirmed diagnosis?
Date of
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D.
(Address)
474.
stuck, Date 6-2-1932
21 PLACE OF BURIAL CREMATION OR REMOVAL Splank Bootro Cemetery) DATE OF BURIAL (City or town) 19 32
22 NAME OF UNDERTAKER
ADDRESS 11409 Stark
Tal Boten
19
HO
Frame 3,1932 (Official Désignation) // (Date of Issue of Permit)
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state MARGIN RESERVED FOR PINPINIA
N. D .- 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
PLACE OF DEATH
1
(City or Town) 36 Elmwood Les St., No.
Ward
(If U. S. War Veteran,
specify WAR)
(a)
Residence.
No.
(Usual place of abode)
Length of residence in city or town wbere death occurred
10 yrs.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) lideune
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wise in full)
(or) WIFE of
(Husband's name in fall)
6 IF STILLBORN enter that fact here.
7
AGE
.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. ... 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Housewife
On Home
10 Date deceased last worked at 11 Total time (years) spent in this occupation 3.5gm
this occurs
year) ..
12 Rive 25-1932
12 BIRTHPLACE (City).
(State or country)
Teland
13 NAME OF
FATHER
Maurice Gafler
14 BIRTHPLACE OF FATHER (City)
(State or country)
Shiland
Gattini Sluta
15 MAIDEN NAME OF MOTHER
16 BIRTHPLACE OF MOTHER (City) Cheland (State or country)
17 Thomas Gaming
Informant (Address) 3686 mwood afc
100m-0 -* 30. No. 0054.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or. transit permit was issued:
(Signature of Agent of Board of Health or other)
mos.
Registered No.
2 FULL NAME
3 SEX
4 COLOR OR KACE
Lesalo Muita
PARENTS
Contributory causes of importance not related to principal cause:
Received and filed JUN 1.0-1900strar)
Revised United States Standard Certificate oy pe
Annel 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.
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