Town of Winthrop : Record of Deaths 1935, Part 103

Author: Winthrop (Mass.)
Publication date: 1935
Publisher:
Number of Pages: 524


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 103


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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.


R-301A


Suffolk


... (County)


Winthrop


...


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.


245


(If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME.


Minora Erskine Francis


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


95 Court Rd.


(a) Residence. No.


(Usual place of abode)


Length of residence in city or town where death occurred I


yra.


6


mos.


.. St.,.


............


.Ward,


(If nonresident, give city or town and state)


days.


How long in U. S., if of foreign birth L 1 f eyrs.


mes.


days.


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Married


5a If married, widowed, or divorced HUSBAND of Everetidenwarfen francis (Husband's name in full)


6 IF STILLBORN, enter that fact here.


AGE


70


3


Months


19


.Days


If less than 1 day


Hours


Minutes


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


9 Industry or business in which work was done, as silk mill, At Home


10 Date deceased last worked at


this occupation(month and


year)


11 Total time (years)


spent in this


occupation


12 BIRTHPLACE (City)


Round Pond


(State or country)


Maine


Joseph R. Erskine


FATHER (City)


Bristol Hills


(State or country)


Maine


Mary Duncandorf


16 BIRTHPLACE OF


MOTHER (City)


Bristol Hills


(State or country) Maine


17 Vivian Francis Phillips


Relation, if any (Address) 36 Lyn Fells Melrose Mass,


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


Ha


(Signature of Agent of Board of Health or other) Nec 80/35.


(Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Luc


28


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That i attended deceased from


1935


to


Dec 25


1935


I last saw b .......... allve on


Dec 27


19387


death is said


1


4.38A m.


to have occurred on the date stated above, at. The principal cause of death and related causes of importance In order of onset wera as follows:


Data of Onset


IMPORTANT


Chronic hyoralt


1935


Contributory causes of importance not related to principal cause:


Condicio Dilatation


Name of operation


none


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


... 19.05


21 PLACE OF BURIAL,


Winthrop


Winthrop


CREMATION OR REMOVAL


(Cemetery)


(City or town) 19


3


22 NAME OF Ermana T. Rolling E.721. UNDERTAKERC


ADDRE


300 Meridian St. East Boston


Received and filed ...


JAN 2


19


(Registrar)


100m-12-'34. No. 2938-f


THISICIANS should state


stateu LAMCILT.


1 ... No 3 SEX Female (or) WIFE of 7 Years OCCUPATION 13 NAME OF FATHER 14 BIRTHPLACE OF 15 MAIDEN NAME OF MOTHER PARENTS Informant 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 saw mill, bank, etc.


PLACE OF DEATH


- (City or Town) 95 Court Rd.


St., ....................


.Ward


CHE U. S.


specify WAR)


1935


DATE OF BURIAL.


Dec. 31 1935


F


Revised U; "/" 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 of 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, soaf 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 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 ...


1913


Chronic interstitial nephritis


Cerebral hemorrhage


July 3. 1927


...


Contributory causes of importance not related to principal cause:


...


In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.


-


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING TLAN


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 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., (Tercentenary Edition.)


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., (Tercentenary Edition.)


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 discase 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.


use the word " mechanic, " but give the exact occupation, as carpenter obtained hereunder. If the death certificate contains a recital, as re-


M R-301


PLACE OF DEATH


Suffolk (County)


(City or Town) 171 Woodside Avenue


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


(City or town making return)


205


Registered No.


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


Laura Louise (Pike)


...... Munch


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


171 Woodside Avenue


„St., ..


.. Ward,


(If nonresident, give city or town and state)


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Married


(Give maiden name of wife in full)


(or) WIFE of


Charles Reinholdt ... Munch


(Husband's name in full)


If less than 1 day Hours. Minutes


House work


9 Industry or business in which


work was done, as silk mill,


Own home


10 Date deceased last worked at


11 Total time (years)


this occupation (month and Sept. 193 5pent in this


year)


occupation. 55


(State or country) Newfoundland


14 BIRTHPLACE OF


FATHER (City)


Harbor Grace


(State or country)


newfoundland


(State or country)


Newfoundland


17 Relation, if any


Informant . Mrs. Kate G ... Willis daughter .... ) (Address) 171 Woodside Ave Winthrop


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 br other)


Hallte Milch 12/30/35


(Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Dec


28


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


lect


2


1935, 10


Erc


28


19 :35


i last saw her,alive on.


28


19.35


death Is said


to have occurred on the date stated above, at 5:30 itm. Tha principal cause of death and related causes of importance in order of onset were as follows:


Date of Onset


Chemie hugoandit


Jam 1934


Contributory causes of importance not related to principal cause:


Name of operation


none


Date of


What test confirmed diagnosis? (Libertam


.Was there an autopsy ?.


No


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


If so, specify.


(Signed)


M. D.


(Address) Wachung Was


Date: Cc 30 1935


21 PLACE OF BURIAL,


CREMATION OR REMOVAL woodlawn


Everett Mass


DATE OF BURIAL


December 30


1935


22 NAME OF


UNDERTAKER


Charles .R.Bennison


ADDRESS winthrop Mass


Received and filed.


19 .........


... A TRUE COPY, ATTEST: (Registrar)


1


St., ..................... Ward


1 winthrop No (a) Residence. No. (Usual place of abode) Length of residence in city or town where death occurred 3 SEX Female 4 COLOR OR RACE White 5a If married, widowed, or divorcei HUSBAND of 6 IF STILLBORN, enter that fact here. 7 AGE. .7.4 Years 1.Q ... Months 2.0Days 8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. OCCUPATION 18 NAME OF FATHER Jordan Pike 15 MAIDEN NAME OF MOTHER Susan Gordon PARENTS 16 BIRTHPLACE OF MOTHER (City) 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. Emact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state saw mill, bank, etc .. 100m-12-'34. No. 2938-e AV. MOWAVIL ILMINE , WIIN UNFADING BLACK INK-THIS IS A PERMANENT RECZ .. D. Every item of 12 BIRTHPLACE (City) Saint John


yrs. 3


mes.


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


yrs.


(If U. S.


War Veteran,


specify WAR)


1935


(Cemetery)


(City or town)


Revised US


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


1915


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 LAY'S 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 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., (Tercentenary Edition.)


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., (Tercentenary Edition.)


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.




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