USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1934 > Part 33
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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.
M R-302
SUFFOLK
(County) BOSTON
(City or Town)
No.
Boston City. .. Hospital
St.,
.Ward
BOSTON
(City or town making return)
Registered No.
4228
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME James
Bellas
(If deceased is a married, widowed or divorced woman, give also maiden name.)
332 Shirley
St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
5a If married, widowed, or divorced
HUSBAND of
Nota Courousis
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
.50
.Years Months Days
If less than 1 day Hours
Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ...
shoe shine parler
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)
Greece
13 NAME OF FATHER Vasilios Bellas
PARENTS
(State or country) Greece
15 MAIDEN NAME
OF MOTHER
im knarm
16 BIRTHPLACE OF MOTHER (City) (State or country)
Greece
17 Informant (Address)
Wife
A TRUE COPY.
ATTEST :...
Neida Ofedition Quinta
(Registrar of city or town where death occurred)
DATE FILED
May
3
34
19
18 DATE OF
DEATH
Apr 11 29 1934
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
April
26
19.34 to ...
.April
2.9 ....... 1934
I last saw him
L .. alive on
19.34
death is said
April 29
to have occurred on the date stated above, at.
10 P
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateefonsci
Perforated gastric ulcer (sause ... ımknown)
2 dys
Contributory causes of importance not related to principal cause:
expl lab cleaning of perforation
Name of operation
Date of 4/26/34
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)
F.S. Broderick
M. D.
(Address)
Boston
Date
4/29/19 34
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Pine Grove
Lynn
(Cemetery)
1
(City or town)
DATE OF BURIAL
19.34
22 NAME OF
UNDERTAKER
R .C.Hesiotis
ADDRESS
Boston
Received and filed
MAY 7 1034
19
(Registrar of City or Town where deceased resided)
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
PLACE OF DEATH
(If U. S. War Veteran, specify WAR)
83
(a)
Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
days. How long in U. S., if of foreign birth?
yrs.
mos.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
14 BIRTHPLACE OF
FATHER (City)
STANDARD CERTIFICATE OF DEATH
9560 DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
1. PLACE OF DEATH
County engedlaga
tate 1.122 State . or Village 126
Registered No3:1
or
Township City Maciel
No. 331Marquente al
Of death occurred in a hospital of ipatitution, give its NAME instead of street and number)
Length of residence in city or town where death occurred -yrs mos S ds. How long in U. S. If of foreign birth ?. - yrs. _____ mos. __... .ds.
2. FULL NAME Par h Bank
(a) Residence: No ..
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3. SEX
4. COLOR OR RACE | 5. SINGLE, MARRIED. WIDOWED,
OR DIVORCED (write the word)
Div-
MED .
21 DATE OF DEATH (month, day, and year) /6. 1934
22
I HEREBY CERTIFY, That I attended deceased from
19.
.. to
19
I last saw h. „alive on 19_ : death is sald
6. DATE OF BIRTH (month, day, andres 36) PRO
7. AGE
Years 52
Months
>
Days
If LESS than
The principal cause of death and related causes of importance were as follows:
Date of onset
:
or. min Starvation& Cachella
Vida.
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
Other contributory causes of importance: elvienehatiit
2mg
FATHER
13. NAME
14. BIRTHPLACE (city or toengland (State or country)
23. If death was due to externalrcauses (violence) fel Ih also the following:
15. MAIDEN NAME
Accident, suicide, or homicide? Date of injury. 19
Where did Injury occur?
(Specify city or town, county, and State) Specify whether Injury occurred in industry, in home, or in public place.
17. INFORMANT
(Address)
Manner of injury
18. BURIAL, CREMATION, OR REMOVAL
Nature of Injury
Place
Date
19
24, Was disease or Injury In any way related to occupation of deceased?
19. UNDERTAKER (Address)
If so, specify P. C. Ten Cych (Signed) _. M. D.
20. FILED 19
Registrar. (Address)
Alnature
MAY 12 1307
ue of Permit )
A TRUE COPY, ATTEST:
(Registrar)
V. B. No. 98 4
011-10931 OCCUPATION is very important. See instructions on back of certificate. state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of en
-
OCCUPATION
8. Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
UP
12. BIRTHPLACE (city or town) (State or country)
Pulmonary Carcinoma
Date of ______ Number of Operation Levary o was there an autofy? What test confirmed & agnosts?
MOTHER
16. BIRTHPLACE (city or town) (State or country)
England
MAY 14 1934
Ward
St.
Ward.
Winthrop Mars.
(If nonresident give city or town and State)
5a. If married, widowed, or divorced
/HUSBAND of
(on) WIFE of
to have occurred on the date stated above, at. _m.
1 day,
___. ITTs.
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 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 housewife 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 servant-private family, cook-hotel, etc. For a person who had no occupation whatever 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 particular 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 other contributory causes of importance, name other important diseases or injuries. Examples:
Example I
Example II
The principal cause of death and related causes of importance were as follows:
Date of onsel
The principal cause of death and related causes of importance were as follows:
Date of onset
Arteriosclerosis
1915
Attack of epilepsy
1 week ago
Chronic interstitial nephritis
1921
Run over by street car
1 week ago
Cerebral hemorrhage
July5, 1927
Peritonitis
3 days ago
Other contributory causes of importance:
Other contributory causes of importance:
Gallstones
May 1, 1923
Gastroenteritis
1 year
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
U. 8. GOVERNMENT PRINTING OFFICE: 1990
c11-3184
cory
85
- le, Rosa. Frank.
e of Death, .Newport .. N. Ji. 16 maple Street d, Village,
long a resident, 38 Forrest St.,
rious residence, inthrop; Mass. eath occurred at an institution give name of same
r long an inmate,
ere from, e of Death: Year,1934Month,. . 4 .. Day,. 23. :: Years,.52 .... Months, . Days, :e of Birth, Russia
e of Birth: Year,+ 1892Month,.
.... Day,
M , . F
... . Color,
Married, Single, Widowed or Divorced
Housewife
se of Death, Hypertension Cardiao allure. Duration, ?
tributing Cause, chronic myocarditis
Duration,
me of Father,
Fine
iden Name of Mother,
thplace of Father, Russia
thplace of Mother,
Russia
upation of Father,
[Record continued over.]
MAY 1 : 1934
I
.
-
1
-
4
upation,
99
. co.Ty .
Deceased was wife of.
I'yer. Frank
Widow of
Name of physician (or other person) reporting said
death
Everett J. Stone, M. D.
P. O. Address,
. Newport, N. H.
Place of Interment,
Boston,
Lass.
Date of Interment,
April 13, 1934
Name of Cemetery,
Boston, Jewish
Undertaker
Dixi C. Newton
P. O. Address,
Newport, N. II.
The State of New Hampshire
I hereby certify that the above death record ilc correct to the best of my knowledge and belief. H. E. Jameson
Clerk of
Newport, New Hampshire
A true copy Attest :
Town Clerk.
...........
E C
-
T
-
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
(County)
(City or Town)
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 ist
give its NAME instead of street a d intis
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No (Usual place of abode) Length of residence in city or town where death occurred yrs.
.St., .............. .. Ward,
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
(write the word)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 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) (State or country)
13 NAME OF FATHER
PARENTS
14 BIRTHPLACE OF FATHER (City)
(State or country)
15 MAIDEN NAME OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Informant (Address)
100m-12-'32. No. 7070-h
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 )
(Official Designation.)
(Date of Issue of Permit )
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Cifer.
(Month)
Day,
13, 1934
(Year)
19
I
HEREBY CERTIFY, That I attended deceased from
19
.. , to
19
Į last saw h .alive on 19 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
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?
If so, specify
(Signed)
M. D.
(Address)
Date
19
21 PLACE OF BURIAL
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL 19
22 NAME OF UNDERTAKER
ADDRESS
Received and filed 19
A TRUE COPY, ATTEST:
(Registrar)
1
No ..
.St., .......... Ward
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state,
mos.
(Give maiden name of wife in full)
If less than 1 day
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: Arteriosclerosis
Date of onset
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1027
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 LAW 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 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: 100m-9-'31. No. 3385-f N. B .- WRITE PLAZNILY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
1 3 SEX Male (or) WIFE of AGE 14 BIRTHPLACE OF FATHER (City). - (Address) 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 saw mill, bank, etc.
itoucenter
PLACE OF DEATH
SUFFOLK
(County)
WINTHROP
(City or Town) No. Sta Hosp. Fort Banks, Mass.
Laufend 6/15/34 The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No
86
(If death occurred in a hospital or institution, -
give its NAME instead of street and number)
2 FULL NAME.
Henry Bort- Knowlos
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 102 Theeler (Usual place of abode)
St.,
Ward,
Gloucester, Mass.
(If nonresident, give city or town and state)
nos. days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
(unknown)
5a If married, widowed, or divorced
HUSBAND of
Blanche.
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here
7
64
Years
11
Months
30
Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
Retired Officer, US Army.
9 Industry or business in which work was done, as silk mill,
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