USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1932 > Part 49
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(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
I last saw h.
alive on
13th of July
32
to have occurred on the date stated above, at G.m. The principal canse of death and related causes of importance in order of onset were as follows:
Oate of Onset
tpoplesy of the L th
Contributory canses of importance not related to principal cause:
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)
(Address)
U.S. St. Louis
Date .....
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross Malden
(City or town)
(Cemetery)
July
1932
DATE OF BURIAL
22 NAME OF
UNDERTAKER
falmi Ji@haley.
ADDRESS
Winthrop
Received and filed.
JUL ... 2.2 1932
19
A TRUE COPY, ATTEST: (Registrar)
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 WIIM 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.
100m-11-'30. No. 605-b
1
(City or Town)
S.S.
No.
St. Louis - a desa:
Ward
(If U. S.
War Veteran,
specify WAR)
1345
1934
19
... to.
19
19
death is said
M. D.
year) .... y
13 NAME OF
FATHER
John
Revised United States Standard Certificate of De Deatu
July 13,1932
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." 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, 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, painler, 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.
FROM THE E 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 exhumc 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-301A
PLACE OF DEATH
(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. Registered No
2318
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. 119
(If deceased is a married, widowed or divorced woman, give also maiden name.)
.. St.
Ward,
(If nonresident, give city of town and state)
days. How long in U. S., if of foreign birth? 4 yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
18
32
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
5-4
193.( .... to
7-18
1952
I last saw halive on.
7-18
193.2, death is said
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
Cara
9 tures
Contribatory causes of importance not related to principal cause:
Several arteni Salevais
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)
Haver a
(Address)
cufille
., M. D.
Date :7/19 1932
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mandy ( Mev 11 alden
(Cemetery)
(City or town)
DATE OF BURIAL
19 32
22 NAME OF
UNDERTAKER
fe thard ( fairly
Received and filed
AUG 2
19
193
(Registrar)
1
[City or Town)
1945
Le 21
No. ....
2 FULL NAME
22 a re 21
(a)
Residence.
No ..
89 4 therey
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED
Demald White
5a If married, widowed, or divorced
HUSBAND of
Still
(Give maiden name of wife in full)"
.ct
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
Days
AGE
70
Years
Months
If less than 1 day
Hours
.Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
year) .
spent in this
occupation
OCCUPATION.
12 BIRTHPLACE (City)
(State or country)
Hana dertig
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Diana sentía
17
Informant
(Address)
E94Shortcut Santos
I HEREBY CERTIFY that a satisfactory standard certificate of death was
filed with me BEFORE the burial or transit permit was issued:
Man. D. Childress &.
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.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
(Signature of Agent of Board of Health or other)
Health Officer
7/19/32
(Official Designation)
(Date of Issue of Permity
100m-0-30. No. 0054.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
(State or country)
Klara scala
St.,
Ward
LL722 mee 2 3 4 War Veteran,
specify WAR)
Cummings
7Am.
0.
Revised United States Standard Vertuitaly
July18, 1932
FROM
COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
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;
Date of onset
Arteriosclerosis
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.
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-301
PLACE OF DEATH
Suffolk
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
120
(If death occurred in a hospital or institution, give its NAME instead of street and number)
No. Station Hospital Ft Banks Mass. St. Women! s Ward ( Cron)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
72.Atlantic
St.,
Ward,
Atlantic .... Mass ..
(If nonresident, give city or town and state)
mos.
16
deys.
PERSONAL AND STATISTICAL PARTICULARS
1
Winthrop
(City or Town)
2 FULL NAME
Katharina Mason
(Usual place of abode)
Length of residence in city or town where death occurred
3 SEX
Female
4 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John ... Paul ... Mason
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
31
Years
8
Months
11
.Days
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
Housewife
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc ..
Home
OCCUPATION
year)
12 BIRTHPLACE (City)
Coblenz
(State or country)
Germany
13 NAME OF
FATHER
A. Cron,
14 BIRTHPLACE OF
FATHER (City)
Coblenz,
15 MAIDEN NAME
OF MOTHER
Not known.
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
Valendar,
(State or country)
Germany
17
Informant
John Paul Mason,
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-11-20. No. 605-b
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
(State or country)
Germany
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D. Childress (Signature of Agent of Board of Health or other) Health Officer 7/21/32
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July .... 19,
1.932
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
July 12,
1932, to July 19,
19 ... 3.2.
I last saw h.er. .... alive on.
July .... 19,
, 19 ... 3.2., death is said
to have occurred on the date stated above, atZ .: 45 Pm. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
1. Pregnancy, at term. 2. Delivery of living male child by cesarean section, July 15, 1932. 3.Peritoni- tis, acute, suppurative, generali- zed, severe.
Contributory causes of importance not related to principal cause: Septicaemia, generalized, due to NO ... 3 ..
Name of operation Cesarean section
What test confirmed diagnosis?
... --
Was there an autopsy ?... No.
20 Was disease or injury in any way related to occupation of deseased?
.No ......
If so, specify
(Signed)
..... W. ...... KENNER , Major ,M.C .USA ...... , M. D.
(Address)
Ft .. Banks , Mass.
Date
7/20,19 32.
CREMATION OR REMOVAL
21 PLACE OF BURIAL,
Winthrop Cemetery Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
July ... 21
19.32.
22 NAME OF
UNDERTAKER
Chas. R. Bennison,
ADDRESS
159 Winthrop St. ,Winthrop,lass,
Received and filed
AUG 2
1932
19
A TRUE COPY, ATTEST: (Registrar)
£ U. S.
specify WAR)
6
yrs.
4
mos.
15 days.
How long in U. S., if of foreign birth?
9
т. 4
5 SINGLE
(write the word)
Married
If less than 1 day -- .. Hours ... ...... Minutes
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ..
9
(Address)
72 Atlantic St., Atlantic, Mass.
Date
July 15/32.
tacharven (
Revised United States Standard Certificate of Death July, 9, 1932
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