USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 4
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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:
Date of onset
Arteriosclerosis
1015
Chronic interstitial nephritis
1921
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 MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one. where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human · body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk > of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to. the manner or cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45. G. L., as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made ... . Chap. 114. Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia). and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
FORM R-302
MARGIN RESERVED FOR BINDING
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
PLACE OF DEATH
Worcester (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
Rut land
(City or town making return)
8
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Herbert Austin Mills
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
1
(a)
Residence. No.
53 Beale
.St.,.
.......
Ward,
Winthrop,Mas.s.
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
1
yrs.
1
mos.
21 days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
18 DATE OF
DEATH
January
13 ...
19.3.5
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
Ruth Harding
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 35 11 Months
AGE
Years
25
Days
If less than 1 day -Hours Minutes
OCCUPATION!
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
Electrician
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at this occupation (month and year)
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
Madisonville,
(State or country) l'exas
13 NAME OF
FATHER
William Henry Mills
14 BIRTHPLACE OF
FATHER (City)
(State or country) Texas
15 MAIDEN NAME
OF MOTHER
Olivia Lucas
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Texas
17 Informant Hospital Records
(Address)
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
January 13, 1935
19
20 Was disease or injury in any way related to occupation of deceased?
No
If so, specify.
(Signed) F. C. J . Miller Officer of the Day
VARAddress)
Futland HtS.Mass. Datel ... 1.3 ... 19 .... 5
21 PLACE OF BURIAL,
Forest Hills ,Crematory
CREMATION OR REMOVAL Forest Hill
LIS,Fass ..
(Cemetery)
(City or town)
DATE OF BURIAL
January 16,1935
19
22 NAME OF
Frank H.Miles Co.
UNDERTAKER
ADDRESS
Jefferson, Mass.
Received and filed
FEB 1
1935
19
(Registrar of City or Town where deceased resided)
important.
50m-2-'30. No. 7997-
1
Futland
STANDARD CERTIFICATE OF DEATH
(City or Town) No. Veterans ' Administration Faselity
Ward
Registered No.
8
(If U. S.
War Veteran,
P.T.E.
(Usual place of abode)
19 I HEREBY CERTIFY, That ! attended deceased from
November 22 1933 to January 13, 1935
im
I last saw h
alive on
January
1900
death is said
to have occurred on the date stated above, at.
10:20. A.R.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Tuberculosis of the lungs
Unknown
Tuberculosis of the larynx
Un .. nown
Contributory causes of importance not related to principal cause:
None
Name of operation
NonE.
Date of
What test confirmed diagnosts? Phys . x-ray, was there an autopsy?iVO
PARENTS
(write the word)
١
FORM R-301 A
MARGIN RESERVED FOR BINDING
(County)
1
Tinthrop
(Usual place of abode)
3 SEX
Female
4 COLOR OR RACE
white
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
57
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.
OCCUPATION
14 BIRTHPLACE OF
FATHER (City)
(State or country)
16 BIRTHPLACE OF
MOTHER (City)
Maryland
(State or country)
Virginia
PARENTS
Informaat
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
year)
(City or Town)
No.
297 inthrop
AGE
Years
5
Months
10 Days
100m-9-'33. No. 9321-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
12 BIRTHPLACE (City)
Cochituate
PLACE OF DEATH
Suffolk
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.
9
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Josephine (Bailey) Dodge
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No
297 Winthrop
.St., ...
.........
.. Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
25
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
(Give maiden name of wife in full)
Ezra Dodge
If less than 1 day Hours. Minutes
House work
Own home
10 Date deceased last worked at
11 Total time (years)
this occupation (monthjand 1935
spent in this occupation.
30
(State or country)
Massachusetts
13 NAME OF
FATHER
Benjamin Franklin Bailey
Cochituate
Massachusetts
15 MAIDEN NAMET
OF MOTHER
Jennie A. Howe
17
lirs. Olive B. Ferguson
(Address) Cochituate Lass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Childrens x (Signature of Agent of Board of Health or other)
Health officer (Official Designation) (Date of Issue of Permit)
1/17/35
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
15
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Jan
8.
19.
I last saw her alive on
Q
1935 death is said
TA. m.
to have occurred on the date stated above, at. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
.
Contributory causes of importance not related to principal cause:
Name of operation.
What test confirmed diagnosis Ubuntu
Date of
.. Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
(Address) Willerof Lese,
M. D.
Date ..
1/16 19 35
21 PLACE OF BURIAL,
inthron
CREMATION OR REMOVAL Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
Jan. 17. 1935
19
22 NAME OF
Charles R. Bennison
UNDERTAKER
ADDRESS
Winthrop Mass.
Received and filed 19
JAN.2.1 1935
(Registrar)
St., .........
.......... Ward
Registered No.
(L U. S.
War Veteran,
specify WAR)
1935
to tam
15
25
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:
Date of onset
Arteriosclerosis
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 scen 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 u"ual form for the removal of such body has been sooner obtained hereund.r. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased serve 1 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, 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.
ORM RR-303 B
Suffolk County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S 19,806 CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. Registered No. 10
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
John
2 FULL NAME
(If deceased is a married, widowed ondivorced woman, give also maiden name.) No. With: 48 Jefferson.
.St.,
.....
.Ward,
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX mais
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or difference Curvei
HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
74848 AGE
Years Months Days
If less than 1 day Hours
.Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
9 Industry or business in which, work was done, as silk mill, saw mill, bank, etc ..
10 Date deceased last worked at
this occupation month ard 35
year), ow
11 Total time (years) spent in this occupation ..
23
12 BIRTHPLACE (City) (State or country)
0mars
13 NAME OF
FATHER
PARENTS
14 BIRTHPLACE OF FATHER (City)
(State or country) p + Poughkeepsie
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) .....
(State or country) Poughkeepsie 1
Informant (Address) 46
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued.
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