USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 24
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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.
actor notified 4/9/35
STANDARD CERTIFICATE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
1. PLACE OF DEATH
County
Suffolk
State Massachusetts.
Registered No.
58
Township
Winthrop
or Village
or
City
No. Station Hospital, Fort Banka
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Length of residence In city or town where death occurred
yrs.
mos. ds. How long In U. S. If of foreign birth? yrs ..
. mos. ds.
2. FULL NAME
Joseph T. Leon
(a) Residence: No.
Main
(Usual place of abode)
(If nonresident give city or town and State)
PERSONAL AND STATISTICAL PARTICULARS
3. SEX
Male
4. COLOR OR RACE 5. SINGLE, MARRIED, WIDOWED,
White
OR DIVORCED (write the word)
Married
5a. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Emma D. Leon
Unferionon
6. DATE OF BIRTH (month, day, and year)
1876
7. AGE
Years
59
Months
Days
If LESS than
1 day, _____ hrs.
or _____ min.
8. Trade, profession, or particular Retired Enlisted 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.
U. S. Army
10. Date deceased last worked at
this occupation (month and
уевг).
11. Total time (years)
spent in this
occupation
12. BIRTHPLACE (city or town)
New York City
(State or country)
13. NAME
Unknown
14. BIRTHPLACE (city or town)
Unknown
(State or country)
15. MAIDEN NAME Unknown
16. BIRTHPLACE (city or town)
Unknown
(State or country)
17. INFORMANT Wife Erna D. Lim (Address) action
18. BURIAL, CREMATION, OR REMOVAL
Place Gatan maso Date March 17, 1935
19. UNDERTAKER
. a.J
mbly
(Address) maynard
mais,
20. FILED
Registrar.
MEDICAL CERTIFICATE OF DEATH
21. DATE OF DEATH (month, day, and year) March 14.
, 19 55
22.
I HEREBY CERTIFY, That I attended deceased from
March 10,
19.55 March
14,
19.35
I last saw h __ alive onMarch 14
1985; death is said
to have occurred on the date stated above, at 7:50 An.
The principal cause of death and related causes of importance were as follows:
Septicmenin,goneralized, severe.
Datesof onset 3/6/35
Other contributory causes of Importance: Erysipelas, face andneck,accident. ally incurred. by cutting left check while.shaving.March.6.1935
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy? NO
23. If death was due to external causes (violence) fill in also the following:
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.
1935
Manner of injury
Nature of injury
24. Was disease or Injury in any way related to occupation of deceased?
If so, specify ..
ROBERT E.TIO AS.HaSor,N.C., M. D.
(Signed).
(Address) Station Hospital Fort Banks
Tri D. Childrene . K.O. 3/14/35
011-9184
----
V. S. No. 98
MOTHER FATHER 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 OCCUPATION
St.
Ward. Agton, Massachusetts.
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 onset
The principal cause of death and related causes of importance were as follows:
Dale cf onset
Arteriosclerosis
1915
Attack of epilepsy
1 week ago
Chronic interstitial nephritis
1921
Run over by street car
1 week ago
Cerebral hemorrhage
July 5, 1927
Peritonitis
3 days ago
Other contributory causes of importance:
Other contributory causes of importance:
Gallstones
May 1, 1928
Gastroenteritis
1 year
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
L'. S. GOVERNMENT PRINTING 057108: 1939
c11-3184
STANDARD CERTIFICATE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
1. PLACE OF DEATH
County
Suffolk
State Massachusetts.
Registered No.
Township
Winthrop
or Village
or
No.Station Hospital, Fort Banks
St ..
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Length of residence in city or town where death occurred
yrs.
mos.
.ds. How long In U. S. If of foreign birth?
- yrs.
.. mos.
ds.
2. FULL NAME
Joseph T Leon
(a) Residence: No.
Main
St.
Ward. Acton, Massachusetts.
(If nonresident give city or town and State)
PERSONAL AND STATISTICAL PARTICULARS
3. SEX
Male
4. COLOR OR RACE
White
5. SINGLE, MARRIED. WIDOWED,
OR DIVORCED (write the word)
Married
5a. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Emma D. Leon
6. DATE OF BIRTH (month, day, and year)
1876
7. AGE
59
Years
Months
Days
If LESS than
1 day, _____ hrs.
or _____ min.
8. Trade, profession, or particular
Retired Enlisted
Man
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
U. S. Army
10. Date deceased last worked at
this occupation (month and
year).
11. Total time (years)
spent in this
occupation
12. BIRTHPLACE (city or town)
New York City
(State or country)
FATHER
13. NAME
Unknown
14. BIRTHPLACE (city or town).
Unknown
(State or country)
15. MAIDEN NAME
Unknown
16. BIRTHPLACE (city or town)
Unknown
(State or country)
17. INFORMANT
(Address)
18. BURIAL, CREMATION, OR REMOVAL
Place.
Date
19
19. UNDERTAKER
(Address)
20. FILED 19 15 1935
Registrar.
MEDICAL CERTIFICATE OF DEATH
21. DATE OF DEATH (month, day, and year) March 14
, 19 35
22.
I HEREBY CERTIFY, That I attended deceased from
March 10,
19.35 to March
14,
19_35
I last saw him __ alive on March 14
1935; death is said
to have occurred on the date stated above, at 7:50 Am.
The principal cause of death and related causes of importance were as follows:
Septicaemia,generalized, severe
Date of onsel 3/6/35
Other contributory causes of importance: Erysipelas, face and neck accident- ally incurred by cutting left cheek while shaving March 6 1935 Name of operation Date of.
What test confirmed diagnosis?
Was there an autopsy? NO
23. If death was due to external causes (violence) fill In also the following:
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.
Manner of Injury Nature of Injury
24. Was disease or Injury in any way related to occupation of deceased?
if so, specify
(Signed).
ROBERT E ... THOMAS, Major,M.C .--- , M. D.
(Address) Station Hospital, Fort Banks Mass
011-3184
MARGIN RESERVED FOR BINDING OCCUPATION
MOTHER
V. S. No. 98
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 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
City
(Ugual place of abode)
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
July 5, 1927
Peritonitis
3 days ago
Other contributory causes of importance:
Other contributory causes of importance:
Gallstones
May 1, 1928
Gastroenteritis
1 year
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
U. S. GOVERNMENT PRINTING GFTION: 1000
c11-3184
OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item ce PARENTS 100m-11-'30. No. 605-b
PLACE OF DEATH
Suf.folk
(County)
Winthrop
(City or Town)
No. 49 Moore St.
St., ..
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Charlotte ....
.. Vinal ..... Wilder
(If deceased is a married, widowed or divorced woman, give also maiden name.)
49 Moore
.St., ............
Ward,
(If nonresident give city or town and state)
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Agusta A Wilder
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE .... 86 Years .... 5 . .... MonthsI. 6 .Days
If less than 1 day
Hours
Minutes
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.
At Home
10 Date deceased last worked at
this occupation (month and
year).
1 1 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City).
East ... Boston
(State or country)
Mass .
13 NAME OF
FATHER
Erza Vinal
14 BIRTHPLACE OF FATHER (City)
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Am Collins
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Massa
17 Daughter Ann M. Bassett
Informant
(Address)
49 Moore St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D . Childress (Signature of Agent of Board of Health or other) Health Olivier (Official Designation) V (Date of Issue of Permit)
3/16/35
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March I4
35
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That i attended deceased from 14 19 19.5. ., to.
35
I last saw h.
alive on.
to have occurred on the date stated above, at 2:45 Pm. The principal cause of death and related causes of importance in order of onset were as follows:
Cardiovascular Distant
Date of Onset 1910
Contributory causes of importance not related to principal cause:
1921
Name of operation
Clinical
.Date of
Was there an autopsy?
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
w & walkery
(Signed)
M. D. (Address) 7 richness Place Date Ture $5 19 35
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Glenwood
(Cemetery)
for town)
DATE OF BURIAL
March
I7
35
19
22 NAME OF
UNDERTAKER
Richard H. White
ADDRESS
147 Winthrop St. Winthrop
Received and filed. 19
.... 4.3 1935
A TRUE COPY, ATTEST: (Registrar)
of
1-301 M R-301A
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
59.
(If U. S. War Veteran, specify WAR)
(a) Residence. No
(Usual place of abode)
Length of residence in city or town where death occurred 27
yrs.
1
Ezra
19.2.5 death is said
Revised United States Standard Certificate of Death
Statement of occupation .- Precise statement of occupation is ervy 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 LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia). and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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