Town of Winthrop : Record of Deaths 1935, Part 74

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

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 74

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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 .. .. Chop. 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.

(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.

COMMONWEALTH OF

The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

County

Worcester.

State

Massachusetts.

Registered No.

(Place of residence' St., Ward

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

2 FULL NAME

Albert.S. Smith.

(If in the Army or Navy of the United States, give rank, organization, etc.)

(a) Residence.

State

Mass

City or Town

No.

.St.

(Usual place of abode)

Length of residence in city or town where death occurred 4

years

months

days.

How long in U. S., if of foreign birth? 46

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

Male.

White.

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married.

5a If married, widowed, or divorced

Name of & HUSBAND

? (or) WIFE

Lillian. A. Wry.

6 AGE

Years

Months

Days

If LESS than

1 day, ... . hrs.

or .... min.

67.

If STILLBORN, enter that fact here

7 OCCUPATION OF DECEASERetired. Supt, of

particular kind of work. Buildings. (M. I. T.)

(b) Name of employer

8 BIRTHPLACE (city or townAmsterdam.

(State or country)

Holland.

9 NAME OF

FATHER

Unknown.

10 BIRTHPLACE OF

FATHER (city or town)

(State or country)

11 MAIDEN NAME

OF MOTHER

Unknown.

12 BIRTHPLACE OF

MOTHER (city or town)

(State or country)

13 Informant Albert. V. Smith. (Address)14. Brookfield, Rd. Winthrop. Mass

FiledSept. 30 , 35Mary.M. Odanet

Registrar of city or town where death occurred

Filed 19

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

15 DATE OF DEATH

September. 20th.

1935

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

Sept. 10th. . 1935 to Sept. 20th.

1935

that I last saw

alive

Sept.20th.

& m.

The CAUSE OF DEATH was as follows: (State fully)

Pulmonary. Adema.

Acute. Bronchitis.

Acute. Myocarditis

yrs ..

mos.

ds.

CONTRIBUTORY

(SECONDARY)

(duration)

yrs ..

mos.

.ds.

17 Where was disease contracted

if not at place of death

Did an operation precede death

For what

Date of operation

Was there an autopsy

What test confirmed diagnosis.

(Signed)

Francis. X Dufault.

M. D.

(Address)

465. Main. St. athol. Mass

Date

18 PLACE OF BURIAL, CREMATION, OR REMOVAL Winthrop. zWinthrop. Masg (Cemetery) (City or town)

19 UNDERTAKER Nelson.A.Lefluer.

DATE OF BURIAL Sept. 23.19 35 ADDRESS 74. Main.St.

Athol Mass

No. 4312

fully supplied. AGE Swould be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plan terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.

(City or town)

Registered No ..

( Place of death)

City or town

Phillipston.

No.

PARENTS

and that death occurred, on the date stated above, a

৳ 1020

RM R-301 A

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. 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

PLACE OF DEATH No

Suffolk "county) Winthrop

(City or Town) 8 Trident ave

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

2 FULL NAME

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

specify WAR)

(a) Residence.

No.

8 Indent Que

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

.Ward,

(If nonresident, give city or town and state)

(Usual place of abode)

Length of residence in city or town where death occurred 5 yrs.

mos.

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

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word) Mamed

5a If married, widowed, or divorced HUSBAND of

Millie Serson

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 82

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 ...

Tailor

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

Tailor Show

10 Date deceased last worked at

11 Total time (years)

this occupation (month and

spent in this

occupation

year)

21933

12 BIRTHPLACE (City).

Russia

(State or country)

13 NAME OF

Myer Flaxuman

FATHER

14 BIRTHPLACE OF

FATHER (City)

Russia

(State or country)

15 MAIDEN NAME

OF MOTHER

Pearl ( cannot be learned )

16 BIRTHPLACE OF MOTHER (City) (State or country)

Russia

17 Frances Blocker

Informant

(Address)

8 Trident ave. Winthrop

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

(Signature of Agent of Board of Health or other)

Realite Officer 9/22/35 (Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF DEATH September 21

(Month) X CERTO 35,0

FY, That Lattended deceased from Sept 15, 1935 19. death is said

I last saw h&s .. alive on

to have occurred on the date stated above, at.

a.na.

.. m. The principal cause of death and related causes of importance in order of onset were as follows:

Date of Onset IMPORTANT

Chronic Nephritis

Contributory causes of importance not related to principal cause:

Name:

Date of. Was there an autopsy? NO

20 Was disease or injury in any way related to occupation of deceased? If so, specify ...

(Signed)

., M_D.

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Both Semel- Everett

(Cemetery)

Sept. 22

DATE OF BURIAL

(City or town) 1935

22 NAME OF

UNDERTAKER

Tonis R. For.

ADDRESS

51 Everett ave- chelsea

Received and filed

SEP 2.6.1935

(Registrar)

100m-9-'33. No. 9321-a'

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

Aymare Flexman

(If U. S. War Veteran,

(Day)

1935 (Year)

Name of operation.

What test confirmed diagnosis? Chance

PARENTS

Revised ! ted 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, soup 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 ....

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 E LAWS OF THE COMMONWEALTH MASSACHUSETTS GOVERNING THE

-0 3 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 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.

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.

RM R-301 A

ITH UNFADING BLACK INK-THIS IS A PERMANENT RECEOD. Every item of

N. B .- WRITE PLAINLY,

100m-9-'33. No. 9321-a

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Club dreads (Algnature of Agent of Board of Health or other) Htelithe prices 19/23/35 " (Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH SEPT 21 1935

(Month)

(Day)

(Year)

19 HEREBY CERTIF 3 135, to A4+21

That I attended deceased from

1981

I Jast saw h ... ... alive on ...

Lat 21

193 ) death is said

10.30 Pm ... 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

Cerebral Thrombosis

1538-

Contribatory causes of importance not related to principal cause:

angina Pectoris

1983

Name of operation

What test confirmed diagnosis ?..

cardiograph

Date of.

Was there an autopsy?o

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

If so, specify.

Runde Gatel

(Signed)

M. D.

(Address) 1624 But

Vate 9-22 1935

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

WINTHROP WINTHROP.

(Cemetery)

(City or town)

DATE OF BURIAL

SEPT.

22 NAME OF

J. S. WATERMAN +SONS

UNDERTAKER

ADDRESS

1BOSTON, MASS.

Received and filed,

Donald Sons Leve

SEP 2 6 1935

(Registrar)

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

(a) Residence. No ....

(Usual place of abode)

Length of residence in city or town where death occurred yrs.

mos.

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

yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

WHITE

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

WIDOWED

5a If married, widowed, or divorced HUSBAND of

EDYT "e maiden name of wife in full).

D. HORSTEAD

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 67 Years. Months .Days

If less than 1 day Hours. .Minutes

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

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

10 Date deceased last worked at

11 Total time (years)

this occupation (month and

1931

year)

spent in this

occupation.

12 BIRTHPLACE (City)

ST. JOHNSBURY.

(State or country)

VERMONT

13 NAME OF

FATHER

JOHN SEVIGNE

14 BIRTHPLACE OF

FATHER (City)

UNKNOWN

15 MAIDEN NAME

OF MOTHER

MATILDA. CABANA.

16 BIRTHPLACE OF

MOTHER (City)

UNKNOWN

17 L.Imarie Sereine (Naught)

Informauf ... (Address) 40 Washington One.

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

(If death occurred in a hospital or institution,

give its NAME instead of street and number)

2 FULL NAME

HENRI. A. SEVIGNE

(If U. S.

War Veteran,

specify WAR)

40 WASHINGTON AVES, Ward,

(If nonresident, give city or town and state)

1 No .. 3 SEX MALE (or) WIFE of AGE ... OCCUPATION PARENTS (State or country) 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 (State or country)

PLACE OF DEATH

SUFFOLK. (County) WINTHROP. (City or Town) HO WASHINGTON AVE .St.,

..... ............ Ward

Revised United States Standard Certificate of Death ed :

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as houseke per-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.

To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation.

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee, " "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store, "'factory, 44 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.

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 LAWS OF THE COMMONWEALTH OF MA FACHUSETTS GOVERNING TẾ. .

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.

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Town of Winthrop : Record of Deaths 1935, Part 74

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

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