USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1934 > Part 39
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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, 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 LAWS OF THE COMMONWEALTH OF MASAWSHUSETTS GOVERNING THERC
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. - 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 .. .. 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.
R-301
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
No ... Winthrop .... Community Hospital., ......... ......... Ward
give its NAME instead of street and number)
2 FULL NAME
Charles Edward Leahan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
7 Triton Ave
.St.,.
Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH may
23
1994 (Year)
(Month)
(Day)
19 I HEREBY CERTIFY, That I attended deceased from
19.94 to. may 23 19.3.4
I last saw h. live on. death is said may 23 01934 to have occurred on the date stated above, at ..... m. The principal cause of death and related causes of importance in order of onset were as follows: Date of Onset ante-fractuns
Henlouhogo
Contribatory causes of importance not related to principal cause:
Name of operation
What
clinical
.. Date of. Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
(Address) ... Z
Date[ ............. 19
21 PLACE OF BURIAL.
Winthrop
Winthrop
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
May 25, 1934
19
22 NAME OF
Charles R. Bennison
UNDERTAKER
ADDRESS
Winthrop Mass
Received and filed MAY 28 1934 19
A TRUE COPY, ATTEST:
(Registsar)
Winthrop (City or Town) 4 COLOR OR RACE White 5a If married, widowed, or divorced HUSBAND of 10 Date deceased last worked at this occupation (month and year) CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
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 5/25/34
(Date of Issue of Permit)
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE Years Months Days 5.
If less than 1 day
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
11 Total time (years) spent in this occupation ...
12 BIRTHPLACE (City)
Winthrop
(State or country) Massachusetts
13 NAME OF
FATHER
John P. Leahan
Boston
Massachusetts
15 MAIDEN NAME
OF MOTHER
Ida May Horner
Baltimore
(State or country) Maryland
17 John P. Leahan
(Address)? Triton Ave. Winthrop Mass
Registered No
97
(If death occurred in a hospital or institution,
(If U. S. War Veteran, specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mes.
days.
How long in U. S., if of foreign birth?
yrs.
1 3 SEX Male (or) WIFE of 14 BIRTHPLACE OF FATHER (City) OCCUPATION PARENTS 16 BIRTHPLACE OF MOTHER (City) Informant information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state is very important. See instructions and extracts from the laws on back of certificate. (Official Designation) 100m-12-'32. No. 7070-h N. B .- WRITE PLAINLY- WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)
. D.
Revised United Et ces 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 houseke 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 k'na 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 causa, 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
Chronsc 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 LAWS OF THE COMMONWEALTH OF MASSAWSIUSETTS 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 one 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 hody 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 cemne- 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 occupations, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
M R-303 EI
PLACE OF DEATH
Suffolk. County)
No. Wallin Community Hapoel
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
19.543
To be filed for burial permit with Board of Health or its Agent. 38
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Frank W Cham Charles Schueler
(If deceased is a married, widowed of divorced woman, give also maiden name.)
(a) Residence. No Wrathof: 63 Bates art st
(Usual place of abode)
Length of residence in city or town where death occurred
39 yrs.
mos.
...... .Ward,
(If nonresident give city or town and state)
days, How long in U. S., if of foreign birth? 54 yrs. mos. days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
2024
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
(See reverse side for description for unknown person)
20 IN WHAT CITY OR TOWN
WAS INJURY SUSTAINED ? ..
-34
Sighet) ....
, M. D.
Address) ..
. Date
... 19 .C.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Bellevue Laurence
(Cemetery)
(City or town)
DATE OF BURIAL
May
26
1934
22 NAME OF
UNDERTAKER
Frank S. Huthey
ADDRESS
30 Laurel St. Melrose
Received and filed.
MAY 25 1934
19
(Registrar)
1
(City or Town)
3 SEX
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Male
4 COLOR OR RACE
Iute
Sa If married, widowed, or divorced Minnie
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
64
Years.
2
Mouth
22 Days
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
9 Industry or business in which
this occupation
year) ..
Ichard 1934
OCCUPATION
12 BIRTHPLACE (City)
Lobenstein
14 BIRTHPLACE OF
Labenstein
FATHER (City)
PARENTS
Labenstein
Informant
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
(State or country)
Germany
5m-2-'30. No. 7997-c
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
Married
Friese
If less than 1 day
.Hours
Minutes
Linotype Operator
as silk
Newsfajer Office
saw mill, bank, etc .........
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ..
47
(State or country)
Germany
13 NAME OF
FATHER
Frank Schueler
15 MAIDEN NAME
OF MOTHER
Henrietta Binstock
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17 Charles J. Schueler
(Address)
Laurence, Masz.
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 Fermit)
5/25/34
Ward
(If U. S.
War Veteran,
specify WAR)
1434
4 mil tente wendet
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 regis- tration 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 con- tracted, 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 under- taker 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 satisfactory 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 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.
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 cemetery or burial ground in which the interment is made ....- Chap. 114, Sec. 46, G. L. as amended
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