USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 82
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(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.
M R-301A
Suffolk
(County)
Winthrop
(City or Town)
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
Goorge .. Whitaon .. Cook
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... Station.Hospital ... Fort ... Benkm ... St., ......... (Usual place of abode)
.Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred JTS. ILOS.
days. How long in U. S., if of foreign birth? yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE
Years ... Months 8 ... Days
If less than 1 day) Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .....
OCCUPATION
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) .. (State or country)
Fort.Banks
assech
13 NAME OF FATHER
Jesse S. Cook
14 BIRTHPLACE OF FATHER (City)
Bergen .........
(State or country) Kentucky
15 MAIDEN NAME OF MOTHER
Betty Rosenborg
16 BIRTHPLACE OF MOTHER (City)
Hayward,
(State or country) California
Relation, if any
.... Cook (. Father.
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 or other)
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October 10
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from October 2 19.55, to. October 10 ,19 35 I last saw h ... ... alive on October 10 19.5.6., death Is sald to have occurred on the date stated above, at ... L.Q .: 15m. P.II. The principal cause of death and related causes of importance in order of onset were as follows:
Congenital malformatimm of with .. absence ... of. upper two thirds inter ventricular sepiam.
Birth Oct.2.35
Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis ?..
Date of
.Autopay
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
aplica
(Signed)
GLt . C . M. D.
(Address). Sta ,Hosp ani Date Oct ... 10 ...... 35
21 PLACE OF BURIAL, CREMATION OR REMOVAL
(Cemetery) (City or town)
DATE OF BURIAL
19
22 NAME OF UNDERTAKER
ADDRESS
Received and filed
19
...
(Registrar)
NN. D .- WRITE PLAINL
100m-12-'34. No. 2938-f
SeANS should state 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 showW' be carefully supplied. AGE should be stated EXACTLY. PHYSIC WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
1
PLACE OF DEATH
NoStation.Hospital,.Fort Banis. .... .St.
....... .Ward
(If U. S. War Veteran, specify WAR)
Data of Onset IMPORTANT ...
.heart
PARENTS
17 Informant J (Address) 306 Huron Are Cambrido
(write the word)
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNIN MÌHE
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 will, 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.
Examplo
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 9, 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.
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, Chat. 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.
1
1
1
RM R-302
N. B .- WRITE PLAINLdYWITH UNFADING INK-THIS IS A PERMANENT RECORD. Ever; bem 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
SUFFOLK (County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
8844
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Ida
Abrams on
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence. No.
(Usual place of abode)
171.Shore.Prive
St.,
.....
Ward, Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
TTI.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 50
AGE Years Months Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
OCCUPATION
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
at home
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
year)
Oct .1.1935
spent in this occupation 32
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Sydney Simons
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Cyril -
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Husband- Morris Abramson
Informant
(Address)
above
A TRUE COPY
Aceda Ofedition Quick
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED Oct 15
193.5
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct 11
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
Oct ... 1
1935., to.
Oct. 11
19 .. 35
I last saw h.
er
alive on
19
Oct 11
35
death is said
to have occurred on the date stated above, at. 1.20P.m. The principal cause of death and related causes of importance in order of onset were as follows:
Datesfonset
brain abscess
Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis?
Was there an autopsy? yes
20 Was disease or injury in any way related to occupation of deceased? ...... no.
If so, specify.
(Signed)
S.R. Kelson
(Address)
Boston
Date.
10/12.35
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Beth El Mt Lob W Rox
(Cemetery)
(City or town)
1935
22 NAME OF
UNDERTAKER
JH Levine
ADDRESS
Boston
19 35
Received and filed.
"NOV 8
1935
(Registrar of City or Town where deceased resided)
important.
50m-9-'31. No. 3385-g
1
No ... Beth Israel.Hospital
Ward
1.90
(If U. S.
War Veteran,
F
(write the word)
PARENTS
Russia
Date of
M. D.
DATE OF BURIAL
Oot
13
H
R-301A
Suffolk
(Count We inchof
(City of Town) 35 Banks
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 ..
194
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Rose a. South
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
35 Banks
.St., ...
.. Ward,
(if nonresident, give city or town and state)
(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?
yTs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
12
1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Mas. 1
1935, to
Oct 12, 1935
I last saw h. A ....... ailve on
1275 .... , death Is sald
to have occurred on the date stated above, at. Com. The principal cause of death and related causes of Importance In order of onset were as follows:
Date of Onset IMPORTANT ...
Cotronic Comprardeles
decompensation
1955
Contributory causes of importance not related to principal cause:
Name of operation.
Date of.
What test confirmed diagnosis? Cineal
Was there an autopsy ?...
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Ena & Bourn
(Signed)
M. D.
(Address)
East Berlin
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Joly eross walden
(Cemetery)
15
(City or town) 935
22 NAME OF
David & Dooley
UNDERTAKER
135 London St
16, Boston
ADDRESS
Received and filed ...
OCT 2 1 1935
19
(Official Designation)
5 SINGLE
c(write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
Ba If married, widowed, or divorced HUSBAND of Roberto maiden tomerci in full)
(or) WIFE of ...
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 72 .Years. Months Days
If less than 1 day
Hours.
.Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
Housework
at home
10 Date deceased last worked at
11 Total time (years)
spent in this
50 yas
12 BIRTHPLACE (City)
(State or country)
Ireland
18 NAME OF
FATHER
William Ennis
(State or country) Ireland
Margaret Show
Ireland
17 Mary A. Squiti
Informant (Address) 35 Banks #
DAUGHTER)
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 or other)
Heute frecer 15/14/30 (Date of Issue of Permit)/
100m-12-'34. No. 2938-f
1 ... No ... 2 FULL NAME 3 SEX 4 COLOR OR RACE 20 AGE OCCUPATION 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (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 sho f be carefully supplied. AGE should be stated EXACTLY. PHYS' MANS should state WANT UNFADING BLACK INK=THIS IS A FLAMANENI KECOND. Every item of 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ...
PLACE OF DEATH
St., .................. Ward
CHE U. S.
War Veteran,
specify WAR)
(Registrar)
Date.
Del.18 1935
Relation, if any DATE OF BURIAL Oct
this occupation (month and Van 1934
year)
----
Revised United States Standard Certificate of Death
Statement of occupation .- Precise statement of occupation is very important, so that the relative healthifulness 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 trom 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 ......
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 3. 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.
KLIMAGAS FROM THE LAWS OF THE
COMMONWEALTH OF MASSACHUSETTS GOVERNING T
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, Scc. 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 appcar 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.)
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