Town of Winthrop : Record of Deaths 1934, Part 61

Author: Winthrop (Mass.)
Publication date: 1934
Publisher:
Number of Pages: 500

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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 LAS - OF THE COMMONWEALTH OF MAY GOVERNING THE

CHUSETTS

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, of 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 i 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, n, 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.

Form 88-1930 (Always write with black ink)

TRANSPORTATION OF CORPSE

State of Maine STATE DEPARTMENT OF HEALTH

CERTIFICATE OF DEATH

Place of Death-Town or City

New Gloucester Line

No. Centennial Spring Ijise

Street, Locality, Institution or Hospital

Full Name

william tun nellenDE. jer

How Long a Resident. 1 week

Previous Residence

Winthro ......

PERSONAL AND STATISTICAL PARTICULARS

Married, Single,)

Sex ...: m.

Color.white

Widowed orharried

Divorced)

Deceased was husband of Ina G. Bailey

Deceased was wife of

Date of Birth: Year .. 18.68 Month .. 10 ...... Day 8 ...... Age : Years. 6B Months. .. 10. Days ... 18

*Occupation Provision fouler

Place of Birth

Germany.

Name of Father

sellenberger

Birthplace of Father

Germany :

Occupation of Father

Maiden Name of Mother

Birthplace of Mother

* Exact statement of occupation is very important. Example; Instead of Laborer, write Farm Laborer.

(Signature of Informant)

Gray ,Maine

(Address)

MEDICAL CERTIFICATE OF DEATH

DATE OF DEATH (month,day, and year) 8/26/ 1934

I HEREBY CERTIFY, That I attended deceased from 216VEY

19.

., to

19 ..

that I last saw him. alive on nev.er

and that death occurred, on the date stated above,

8 .m.

The CAUSE OF DEATH was as follows:

...... wcutedililation ... of .... heart

(duration)

yrs

ds.

CONTRIBUTORY

Valvular Iert

(Secondary)

(duration) ........... yrs

.. mos.

.. ds.

Where was disease contracted if not

at place of death ?.

Minthiu, 59.

Did an operation precede death? no Date of

Was there an autopsy ?

(Signed)

I. A. Sweatt

,M.D.

Address

New Gloucester, Mine

PERMIT OF TOWN CLERK AND *HEALTH OFFICER

This Permit with above Certificate, must be presented to Initial Baggage Agent and delivered with body at destination Now Clubester, Mine . 7. 1934

Permission is hereby granted to remove for burial at ......... 3a.s.t.o.n ....... s.s ...... the body

Villia. num rettenberger , above described, if prepared in accordance with the laws

of this State, printed on the back of this permit .. If contagious or communicable, state name of person who is authorized to accompany the body.

W. L. Pitman Town Eterk

*The above permit is hereby approved. Health Officer

*To be used when the approval of the health officer is required.

Detach above portion at this perforation, and hand to passenger in charge, to be delivered to the undertaker at destination. If burial is made Ir. 1 !... State the sexton or other person superintending, must send this permit and certificate to the State Department of Health in ten days.

The information on this certificate is a copy in full of that on the official certificate filed at place of death

Rules of the State Department of Health of Maine, for the Transportation of the Dead.

Rule 1. A copy of the original death certificate, signed by the attending physician, a permit from the town or city clerk or local registrar, and a transit label signed by the shipping funeral director and the initial baggage agent, printed on strong paper, supplied by the State Board of Health, shall be required for the transportation by common carriers of the bodies of the persons who have died in this State. The death certificate shall contain such information, if obtainable, as is required in the form of death certificate which is furnished by the depart- ment of Vital Statistics.

The permit of the town or city clerk shall authorize the transportation of the body of the person described in the physician's certificate. The shipping funeral director shall state on the shipping label how the body is pre- pared and the local baggage agent shall state thereon the route and the name and address of the escort.

The physician's permit and that of the town or city clerk shall be given to the escort to be delivered with the body at destination. The shipping label shall be securely attached to the outside case. If the body is sent by express, the physician's certificate, and the permit shall be attached to the express way-bill, and delivered with the body at the destination, and the shipping label shall be attached to the outside case.

Rule 2. The transportation of bodies dead of smallpox, plague, Asiatic cholera, yellow fever, typhus fever, diphtheria (membranous croup or diphtheretic sore throat), scarlet fever (scarlet rash or scarlatina), erysipelas, and anthrax shall be permitted only under the following conditions: the body shall be thoroughly embalmed with an approved disinfectant fluid, all orifices shall be closed with absorbent cotton, the body shall be washed with the disinfectant fluid, enveloped in a sheet saturated with the same, and placed at once inthe coffin or casket; which shall be immediately closed, and the coffin or casket, or the outside case containing the same, shall be metal or metal lined, and hermetically and permanently sealed.

Rule 3. The transportation of bodies dead of any diseases other than those mentioned in rule two, shall be permitted under the following conditions :-

a. When the destination can be reached within twenty-four hours after death, the coffin or casket shall be enclosed in a strong outside box made of good sound lumber, not less than seven-eighths of an inch thick, all joints must be tongued and grooved, top and bottom, put on with cleats or cross pieces, all put securely together, and be tightly closed with white lead, asphalt varnish or paraffin paint, and a rubber gasket placed on the upper edge between the lid and box; provided, however, that caskets containing embalmed bodies may be shipped to points in this State in tight ordinary casket boxes; and provided further that bodies addressed to the Anatomical Board of this State may be received for shipment when prepared in such manner as the State Board of Health may direct.

b. When the destination cannot be reached within twenty-four hours after death, the body shall be thoroughly embalmed, and the coffin or casket placed in a strong well-made outside shipping case.

Rule 4. No disinterred body dead from any disease or cause, shall be transported by common carrier unless approved by the local board of health having jurisdiction at the place of disinterment, and a transit permit, and transit label shall be required as provided in Rule 1. The disinterment and transportation of bodies dead of diseases mentioned in Rule 2 shall not be allowed except upon special permission of the health authorities at both the place of disinterment and the point of destination. All disinterred remains for transportation shall be encased in metal caskets or metal lined boxes and hermetically sealed: Provided that bodies in a receiving vault when prepared by licensed embalmers, shall not be regarded as disinterred bodies until after the expiration of thirty days.

Rule 5. The outside case may be omitted in all instances when the body is transported in a hearse or a funeral director's wagon.

Rule 6. Every outside case shall have at least four handles, and when over five feet six inches in length shall'have six handles.

Rule 7. An approved disinfectant fluid shall contain not less than five percent of formaldehyde gas. The term "embalming," as implied in these rules shall require the injection by a licensed embalmer, of not less than ten percent of the body weight for bodies of persons dead of diseases under Rule 2, injected arterially in addition to cavity injection; and not less than six percent of the body weight injected arterially in all other cases in addi- tion to cavity injection, and ten hours shall elapse between the time of embalming and the shipment of the body.

Rule 8. The attached form of death certificate, town or city clerk permit, and label as described herein, with these rules printed thereon, shall be used in this State for the shipment of bodies as herein provided.

Made at a meeting of the State Board of Health, July 13, 1915.

Approved by the Governor and Council, July 28, 1915.

The penalty section of the law provides that any person who shall violate any rule or regulation of the State Board of Health for the preparation, embalming, shipping or burial of any dead human body shall be guilty of a misdemeanor, and upon conviction thereof shall be punished by a fine of not less than ten dollars nor more than fifty dollars, or imprisonment in the county jail for not less than ten days nor more than sixty days, and it shall be the duty of the county attorney of the county in which violation occurs to prosecute all such persons.

RM R-301A

PLACE OF DEATH

Suffolk

(County)

Winthrop

(City or Town)

No ...

190Circuit Rd.

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 or its Agent.

Registered No 150

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

2 FULL NAME

Augusta A (Stubbs) Libbey

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(M U. S. War Veteran, specify WAR)

(a)

Residence.

No .... 19QCircuit Rd.

.St.,.

..........

Ward,

(Usual place of abode)

Length of residence in city or town where death occurred

JTs.

mos.

days.

How long in U. S., if of foreign birth?

yrs.

mos. days.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

August

(Month)

(Day)

(Year)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

(Giye maiden name of wife in full)

John H .... Libbey

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 9 AGE .80 Years. 3 Months .Days

If less than 1 day

Hours

Minutes

OCCUPATION:

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..

Housewife

9 Industry or business in which work was done, as silk mill. saw mill, bank, etc.

At home

10 Date deceased last worked at

11 Total time (years)

spent in this

occupation.

12 BIRTHPLACE (City)

Bangor

(State or country)

Me .

13 NAME OF

FATHER

Asa Stubbs

PARENTS

14 BIRTHPLACE OF

FATHER (City)

Me.

(State or country)

15 MAIDEN NAME

OF MOTHER

Julia A. Patten

16 BIRTHPLACE OF

MOTHER (City)

Me ..

(State or country)

Harry W. Libbey

Informant

(Address)

90 Bellvue Ave. Winthrop

1 HEREBY CERTITY that a satisfactory standard certificate of death was filed with me BLFORE the burial or fransit permit was issued:

(Signature of Agent of Board of Health or other)' 8/28/34

(Official Designation)

(Date of Issue of Permit)

19 HEREBY CERTIFY That I attended deceased from I august 1 793 4/ t august 27, 1934

I last saw her ... alive on

., 19 .2 %, death is said

to have occurred on the date stated above, av. J.m. The principal cause of death and related causes of importance in order of onset were as follows:

Date of Onset IMPORTANT

Cerebral Hemorrhage Aug 20/34

Contributory causes of importance not related to principal cause: Senility

1930

arteriosclerosis

...

1930

Name of operation none

What test confirmed diagnosis Clinicalx

Date of.

Was there an autopsy? a

tab

20 Was disease or injury in any way related to occupation of deceased? 40

If so, specify ..

lacotro afrangs

(Signed)

(Address) 562 Stanley

21 PLACE OF BURIAL,

CREMATION OR REMOVAL .

Woodlawn

Everett

DATE OF BURIAL

August 29, 1934

(Cemetery) (City or town) 19

22 NAME OF

UNDERTAKER

Richard H. White

ADDRESS

147 Winthrop St., Winthrop

Received and filed

SEP 5 1934

(Registrar)

N. B .- WRITE PLAIN

75m-5-'32. No. 5469

3 SEX

Female

4 COLOR OR RACE

Whi te

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

Wi dow

(write the word)

1934

(If nonresident, give city or town and state)

St.,

.Ward

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 WITH UNFADING BLACK INK-THIS IS A PERMANENT RECOR"

at dag 28 19 34

Mais

this occupation (month and

year)

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

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 LP OF THE COMMONWEALTH OF MAL ACHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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.

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Town of Winthrop : Record of Deaths 1934, Part 61

Author: Winthrop (Mass.) Publication date: 1934 Publisher: Number of Pages: 500

Author: Winthrop (Mass.)
Publication date: 1934
Publisher:
Number of Pages: 500