USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 73
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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 ouly 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.
IM R-302
PLACE OF DEATH
Middlesex
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Melrose
(City or town making return)
Registered No.
,55
(If death occurred in a hospital or institution,
St.,
..... Ward give its NAME instead of street and number) - (If U. S. War Veteran, specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No
146 Pauline
St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
1 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
Sept. 18, 1933
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Sept. 17/33
19
to
Sept ...... 18, ..... 193,39
I last saw h ... Ar ... alive on
Sept .18/33
19
... , death is said
Dateofonset to have occurred on the date stated above, at. 11:30 P. M. The principal cause of death and related causes of importance in order of onset were as follows: Premature -- 5 mo. old fetus
---
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy ?.... no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
R. W. Layton
(Address)
Boston Mass.
Date.9/19/33
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
St. Patrick's Stoneham
(Cemetery)
(City or towa)
DATE OF BURIAL.
Sept.20 1933
19
22 NAME OF
UNDERTAKER
John W. Gately
ADDRESS
Melrose Mass.
Received and filed SEP 2 1 1933
19
DATE FILED
Sept. 10, 1933
19
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
(Give maiden name of wife in full)
(Husband's name in full)
7 AGE Years Months 1 Days
If less than 1 day Hours Minutes
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
Melrose.
Mass.
13 NAME OF
FATHER
Winfield T. Nickerson
14 BIRTHPLACE OF
FATHER (City)
Winthrop
Ida M. Morin
16 BIRTHPLACE OF
MOTHER (City)
NewBedford
(State or country)
Mass.
17 Winfield T. Nickerson
Informant (Address) 146 Pauline St., Winthrop
(Registrar of city or town where death occurred)
(Registrar of City or Town where deceased resided)
1 Melrose (City or Town) 3 SEX 4 COLOR OR RACE White Female 5a If married, widowed, or divorced HUSBAND of (or) WIFE of 6 IF STILLBORN, enter that fact here. 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) (State or country) 15 MAIDEN NAME OF MOTHER PARENTS OCCUPATION A TRUE COPY. - ATTEST: important. 50m-2-'30. No. 7997-đ N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE (State or country) Mass
No. Melrose Hospital
2 FULL NAME
Betty Ann Nickerson
RM R-301A
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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 75m-5-'32. No. 5469 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No.
Winthrop Community Hosp.
St.,
To be filed for burial permit with Board of Health or its Agent.
Registered No.
186
(If death occurred in a hospital or institution,
Ward give its NAME instead of street and number)
2 FULL NAME
John Freerick Harney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ...
7.8.Ingleside Ave
(Usual place of abode)
Length of residence in city or town where death occurred
7
yTs.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of
Margaret Pratt
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here
7
35
AGE
Years
Months Days
.Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Radio Announcer
9 Industry or business in which
work was done, as silk mill,
Studio
saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
this occupation (monthaav 1933
4
spent in this
occupation.
year) ..
12 BIRTHPLACE (City)
Revere
Mass
(State or country)
13 NAME OF FATHER Edward Harney
14 BIRTHPLACE OF
FATHER (City)
Halifax
(State or country) Nova Scotia
15 MAIDEN NAME
OF MOTHER
Catherine Corbett
16 BIRTHPLACE OF
MOTHER (City)
Webster
(State or country)
Mass.
17 Informant, Catherine Harney (Address) 78 Ingleside Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial pr transit permit was issued:
ildress (Signature of Agent of Board of Health or other) Health Mx u
(Date of Issue of Permit) 10/2/33
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
tut
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
Aug 21
19
! last saw h- alive on
, 19 -.-. , death is said
to have occurred on the date stated above, at 60200m. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
Contributory causes 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? 0
If so, specify.
(Signed)
(Address)
M. D.
Date:
:19 ...
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Cemetery W
(Cemetery)
(City or town)
DATE OF BURIA
September 27,1933
19
22 NAME OF
UNDERTAKER
michael J. Gnella
ADDRESS
10 North Bennet St. Boston
Received and filed
SEP 20 1933
19
(Ofacial Designation)
(Registrar)
1
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(L U. S.
War Veteran,
specify WAR)
St.,
Ward,
(If nonresident, give city or town and state)
(write the word)
17
If less than 1 day
Hours
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, 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
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.
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 physician. board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending 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. - Chap. 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 .... 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
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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 200M-11-'29. No. 7180-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
(County) muchas (City or Town) 15 Welchen DL No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Vanxol, Jarrison Eldende, SR
(If deceased is a married, widowed or divorced woman, give also maiden name.)
15 Belchen St.
St.,
Ward,
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Max
4 COLOR OR RACE
While
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Manuel
5a If married, widowed or divorced HUSBAND of Mallia, Elizabet Youry (Give maiden name of wife in fall)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
7
52
Years
10
Months
Days
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.
Lugalas
10 Date deceased last worked at this occupation (month and Sex/ 24 year)
11 Total time (years)
spent in this occupation ..
27 years
12 BIRTHPLACE (City) (State or country)
13 NAME OF
FATHER
Malta S. t. Exanalys
14 BIRTHPLACE OF
FATHER (City)
(State of country) Och Pal Lias
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Informant Ler- Hatt
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Chil dress (Signature of Agent of Board of Health or other),
He with apure / (Official Designation) (Date of Issue of Permit)
9/26/33
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept
2 4
1933
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
19. ...... , to.
19
I last saw h
.. alive on
Sept 24
19.3.3 .... , death is said
to have occurred on the date stated above, at/ 6. 45 Pm.
The principal cause of death and related causes of importance in order of
onset were as follows:
Dateofonset
SchT 3 1933.
-
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis? have hat Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify B Vanku
(Signed)
... , M. D.
(Address WithT
Brand of Health Data pt 25 1933.
21 PLACE OF BURIAL, CREMATION OR REMOVAL
DATE OF BURIAL
(Cemetery) (City or town) 1933
22 NAME OF
UNDERTAKER
O.K.O.
-
1
ADDRESS
Received and filed
19
SEP 28 1933
A TRUE COPY, ATTEST: (Registrar)
-
-
1
X days. How long in U. S., if of foreign birth? yrs.
If U. S. War Veteran, specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of residence in city or town where death occurred
mos.
St., Ward
2 FULL NAME
Suffolk
1
1
If less than 1 day
Hours.
Minutes
Partake an guix Putin
Jauria
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, 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, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contri- butory causes of importance not related to principal cause, name other important diseases or injuries.
Example
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onset
1915
Chronic interstitial nephritis
1921
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause : Fracture of arm
Automobile accident
May 3, 1927
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first. second, or third position. The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, 'Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by 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.
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