USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 72
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Julfolk
PLACE OF DEATH No.
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No. 182
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If decease) is a married, Widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
5/ Buchanan
.St.,
. Ward,
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sep T
13
1933
/(Year)
(Month)
(Day)
19 I HEREBY CERTIFY, That I attended deceased from
13
1933 to
LeAT 13.
19 2.3.
Ylast saw h ....... ... alive on. 19 death is said
to have occurred on the date stated above, at
6 Pm.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Still-bush
DeST 13 143
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)
Winthe
11 Total time (years
spent in this
occupation ..
12 BIRTHPLACE (City)
(State or country)
mars
13 NAME OF
FATHER
arthur S. Payne
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME OF MOTHER
Eva Parent
16 BIRTHPLACE OF MOTHER (City) (State or country)
mc
17 arthur S. Payne;
Informant (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
will im A, Children (Signature of Agent of Board of Health or other)
agent Seft- 15/33
(Official Designation) (Date of Isshe of Permit)
(write the word)
4 COLOR OR RACE Mule White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name a SAD)
Stillon
7
If less than 1. day
AGE Years Months Days
Hours. .Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis? manal There was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify! B Parka
(Signed)
., M. D.
Date SeAT 14 19 2. 3.
21 PLACE OF BURIAL, CREMATION OR REMOVAL
(Cemetery)
(City or town) 19
DATE OF BURIAL
Sek CR Bennes
UNDERTAKER
ADDRESS
SEP 18 1933
Received and filed
19
A TRUE COPY, ATTEST: (Registrar)
MARGIN RESERVED FOR BINDING
1
(City or Towy) 54 Buchanan Sf - Payus
St., Ward
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
6 IF STILLBORN, enter that fact here.
Caribou
Revised United States Standard Certificate of Death
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, 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
1931
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 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.
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, pyemia, septicemia, tetanus.
RM R-302
SUFFOLK
(County)
BOSTON
(City or Town)
No. Beth ... Israel ... Hospital
.St.,
Ward
give its NAME instead of street and number)
2 FULL NAME
Barnet
Silverman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No
7 ... Sea Foam Ave Winthrop.
.. St., ............... Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred yTs.
days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
(write the word)
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
18 DATE OF
DEATH
Sept
15
19.33
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
Bessie .... Brauer
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 5.7 Years Months .Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner. sawyer, bookkeeper, etc .. dry ... goods
OCCUPATION|
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)
2 ... mos ...
11 Total time (years) spent in this occupation. 15 yrs
12 BIRTHPLACE (City) (State or country)
Russia
13 NAME OF
FATHER
Samuel Silverman
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country) Russia
15 MAIDEN NAME
OF MOTHER
Rebecca -
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant
IJ Silverman
(Address)
30 Pemberton
A TRUE COPY.
Boston
ATTEST:
James J. Mulvey
.A .....
Received and filed
OCT 1 0 1933
19
(Registrar of city otown where death occurred
DATE FILED
Sept
18
19 ... 33
19 I HEREBY CERTIFY, That I attended deceased from
Åug
31
1933., to
Se.pt
15
, 19.33.
I last saw h .... ]malive on
Sept
15
19 ... 3.3., death is said
to have occurred on the date stated above, at12.04P.m.
The principal cause of death and related causes of importance in order of onset were as follows:
malignant .. lymphoblastoma .... of
peritoneum
inanition
March/33
Aug/33
Contributery causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosispathological was there an autopsy?
no
no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
A ... L ... Hermans on
M. D.
(Address)
Boston
Date
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Beth David
Woburn
(Cemetery)
(City or town)
DATE OF BURIAL
Sept
15
1933
22 NAME OF
UNDERTAKER
J ... H. Levine
ADDRESS
Dorchester
(Registrar of City or Town where deceased resided)
.........
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
important.
50m-2-'30. No. 7997-d
PLACE OF DEATH
1
Registered No.
7.725
(If death occurred in a hospital or institution,
(If U. S. War Veteran,
specify WAR)
(Usual place of abode)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
183
Dateofonset
(Give maiden name of wife in full)
IM R-301
N. B .- 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
PLACE OF DEATH
SUFFOLK
(County)
earthand the whole vid - 10-9.5 The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
184
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
BABY WING
52 Spring
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. esion-Hospital, Ft.Banks, Masss- fomen ! Ward, (Usual place of abode) Length of residence in city or town where death occurred yrs. mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here. Stillborn
7
If less than 1 day
AGE Years Months Days
.. 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)
Winthrop.,
(State or country)
Mass.
13 NAME OF
FATHER
CLARENCE ARTHUR WING
14 BIRTHPLACE OF
FATHER (City)
Portland,
(State or country) maine.
15 MAIDEN NAME
OF MOTHER
Sadie Lois Casswell
16 BIRTHPLACE OF
MOTHER (City)
East. .. Weymouth,
(State or country) Nass.
17 Informant Clarence ... Arthur ..... ing
(Address)
Portland, Maine,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
A.O.
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
16.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from 19 19 .. , to
I last saw h ............ alive on
19
death is said
to have occurred on the date stated above, at. Date of Onsøt m. The principal cause of death and related causes of importance in order of onset were as follows: Stillborn(pregnancy at.term)
Contributory causes of importance not related to principal cause: Congenital .syphilis
Name of operation. Accouchement
Date of 9/16/33
What test confirmed diagnosispositive Was there an autopsy?
wassekan in mother. 20 Was disease or injury in any way related to occupation of deceased?
Lise, specy ny lofor
(Signed) George Horsfall,Capt.US Army, M. D.
(Address) .Fort Banks Mass.
9/16/93
21 PLACE OF BURIAL.
Rest. Haven, Deer .... Island.,
(Cemetery)
(Cifno soyn)
DATE OF BURIAL
September
20
22 NAME OF
UNDERTAKER
ADDRESS
070
19
Received and filed
A TRUE COPY, ATTEST: SEP 2 0 1936
BAT )
1
WINTHROP
(City or Town) No.Station Hospital Fort Banks ,MassSt., - Ward
Registered No.
1
(If U. S. War Veteran, specify WAR)
-
Portland Me.
(If nonresident, give city or town and state)
1933
Female |
(Give maiden name of wife in full)
PARENTS
100m-12-'32. No. 7070-h
Im Lilhilders
(Signature of Agent of Board of Health or other)
text. 19/33.
19 ... 33
Revised Unite nited prates Jud
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 houscke per-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 car penter, 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, astlienia, 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
1015
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.
COMMUNIGALLI .. .....
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 che 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 such a permit for the removal of a human body, not previously interred from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired 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 statement 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. - Chop. 114, Sec. 45, G. L., as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
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 .... Chop. 114, Sec. 46, G. L. as amended.
RULES OF PRACTICE
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