USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 94
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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.
DRM R-301 A
1 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 100m-9-'30. No. 9954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
(County) Winthrop City or Town) 162 Shirley No.
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 245 or its Agent. Registered No. 483 (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Catherine
erne
(If deteased is a married, widowed pr divorced woman, give also maiden name.)
St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
rt mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
5a If married, widowed, or divorced HUSBAND of ... sken
(Give maiden name of wife in full)
1, Mawel
(Husband's name in full)
1
6 IF STILLBORN, enter that fact here
7 68 Years 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 ....
at Home
une
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)
(State or country)
Rostan mask
13 NAME OF
FATHER
John Lythgoe
14 BIRTHPLACE OF FATHER (City)
England
(State or country)
15 MAIDEN NAME
OF MOTHER
mary G. Mahony
16 BIRTHPLACE OF MOTHER (City) (State or country) Ruland
17 Walter H. Jame el Informant (Address) 159 Manchester Rd Brookline
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) Health Officer 12/22/33
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
December.
21
1933
4
DEATH
(Month)
(Day)
(Year)
1
Dec. 11
19 3 .- 2, to ..
December. 21 1933
I last saw her
.alive on
December, 21, 1933, death is said
4,30 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
Broncho Pneumonia
Dec. 12:123 1
Contributory causes of Importance not related to principal cause: arteriosclerosis - Myocarditis - Chr. Nephritis-
Years -
Name of operation
What test confirmed diagnosis ?.
0
Was there an autopsy ?.... V .. D
Date of.
20 Was disease or injury in any way related to occupation of deceased? If so, specify (Signed) Edward ty tranger t.
M. D.
(Address).
476 Starter Set. 0
Date: Dec- 2/ 1933
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Nowyhard Brooklin
(Cemetery)
(City or town)
DATE OF BURIAL
Den 24
19 33
22 NAME OF
UNDERTAKER
ADDRESS
867 Read
Received and filed
19
0.1933
(Registrar)
212
(a) Residence.
(Usual place of abode)
No. 162 Shill
St.,
Ward {
(If U. S. War Veteran, specify WAR)
MARGIN RESERVED FOR DINDING
19 I HEREBY CERTIFY, That attended deceased from
(or) WIFE of
- - 0.
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
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 hannone to be the second pausa mina
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.
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,
RM R-302
SUFFOLK
(County) BOSTON
(City or Town) No. Maas General Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No ...
.10709
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
Jeremiah B
Walls
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No.
(Usual place of abode)
194 Washington.A
.St., ..
.. Ward,
Winthrop
(If nonresident, give city or town and state)
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
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of
Rosalie Dickerson Wella (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 52 Years Months Days
If less than 1 day Hours .Minutes
OCCUPATIONI
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Postal clerk US
10 Date deceased last worked at this occupation (month and year) Dec 21 1933
11 Total time (years)
spent in this
occupation
28
Cambridge
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF FATHER
Jeremiah
14 BIRTHPLACE OF FATHER (City)
Waterville
Me
(State or country)
15 MAIDEN NAME OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
17
Informant
(Address)
Rosealie Wells
A TRUE COPY.
ATTEST :.
(Registrar of city derown where death occurred
DATE FILED
Dea 27 .19.33
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec 22 1933
(Month)
(Day) (Year)
19 I HEREBY CERTIFY, That I attended deceased from
Dec
22
19 ... 33 to.
....... Dec
22 ..... , 19.33.
I last saw h ... 1m alive on.
Dec
22
19.33., death is said
to have occurred on the date stated above, at 3.11P.m. The principal cause of death and related causes of importance in order of onset were as follows:
duodenal ulcer with perforation peritonitis,general 24 hr.
Dateofonset 36.hr
Contributory causes of importance not related to principal cause:
Name of operation suture of duod ulcer Date 12/22/33 What test confirmed diagnosis? Was there an autopsy? yes
20 Was disease or injury in any way related to occupation of deceased? ...
.no
If so, specify.
(Signed)
M.J .... Rhees
M. D.
(Address)
Boston
Date 12/22.19 .33
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Winthrop
DATE OF BURIAL
Dec
(Cemetery)
24
19.33.
22 NAME OF
UNDERTAKER
JF. O Maley
ADDRESS
Winthrop
Received and filed
JAN 20 1354
19
(Registrar of City or Town where deceased resided)
important.
50m-2-'30. No. 7997-1
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 MARGIN RESERVED FOR BINDING
1
PLACE OF DEATH
St.,
.Ward
1
(If U. S. War Veteran,
246
(write the word)
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc .....
PARENTS
(City or town)
James J. Mulvey
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) Pinturah (City or Town)
The Commmuralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making retura) 247
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
riz self- muito
(If deceased is a married, widowed op divorcer woman, give also maiden name.)
No Summeret Faldson
Ward,
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Emal White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Niedaw
5a If married, widowed, or divorced HUSBAND of (Giye maideryname of wife in full) frank Twist
(er) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
63 Years 11
Months ...
5
.Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner Langeweile 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) (State or country) Пиццасана
13 NAME OF
FATHER
14 BIRTHPLACE OF FATHER (City) (State or country) AcaiLu
15 MAIDEN NAME OF MOTHER Margaret Glenn
16 BIRTHPLACE OF MOTHER (City) (State or country) Seatra
17 Charles Bright
Informant .... (Address) 15 Washington av enthus
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 othery Healthe Flick 12/27/33 Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec.
25- 1933 Year)
(Month)
(Day)
19
I HEREBY CERTIFY, That I attended deceased from
19
, to
19
st saw her alive on. 19 .. , death is said
to have occurred on the date stated above, at
5 P.
m.
The principal cause of death and related causes of importance In order of onset were as follows:
Dateofonset
natural Causes.
Dic 25
1933
Contributory causes of importance not related to principal cause:
1932
1932
Name of operation
no
Date of
What test confirmed diagnosis asmall Grants Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Daraus B Parke
(Sig
M. D.
(Address) Written Board of Health
Date De 27 1933
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Acurved
DATE OF BURIAL
(Cemetery)
(City or town)
37
1933
22 NAME OF
UNDERTAKER
ADDRESS .5 M 2. want1.
Received and filed DEC 3 0 1933 19
A TRUE COPY, ATTEST: (Registrar)
(If U. S. War Veteran, specify WAR)
(a)
Residence.
(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?
yra.
St., Ward
1
Pectrim
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. " 4 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
1021
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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