USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 84
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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.
IR-301
Suffolk . ...
..... (County)
Winthrop
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Lucy Annie ( Beadle )
Martin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence.
No ....
60 Johnson Avenue
St.,.
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
43
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Ambrose Albert Martin
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 84
AGE
Years x Months .Days
If less than 1 day Hours. Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
House work
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Own home
10 Date deceased last worked at
11 Total time (years)
this occupation (month and Aug. 1935
year)
occupation.
spent in this 50
12 BIRTHPLACE (City)
Marblehead
(State or country) Massachusetts
13 NAME OF
FATHER
Joseph Beadle
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF
MOTHER (City)
Unable to obtain
(State or country) Unable to obtain
Relation, if any
17 Clarence A. Martin ( son
Informant . (Address) 60 Johnson Ave. Winthrop Mass
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) The arter prices 10/18/35
(Official Designation) (Date of Issue of Permit)
19 I HEREBY CERTIFY, That I attended deceased from
September 15, 1933, to.
October 16 19 35
I test saw her
allve on
October 16, 19 35, death is said
to have occurred on the date stated above, at 9:00 Piry. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
Cerebral Hemontage
act. 10/ 135
Contributory causes of importance not related to principal cause: arterialerano
19.30
Senility
1935
Name of operation more Date of. Was there an autopsy? no
What test confirmed diagnosi Plusex
20 Was disease or injury in any way related to occupation of deceased? To
If so, specify ..
Jacob Change
(Signed)
(Addre ) 562 Plumley H
.M. D.
det 17/35.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL
October 19
19.35
22 NAME OF
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed. 19
A TRUE COPY, ATTEST: OCT 21
.... 1 1935
(Registrar)
--- --
100m-12-'34. No. 2938-e
PARENTS WELL UIMI ADING BLACK INK-THIS IS A PERMANENT REC RU. Every item of 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. PHYSRIANS should state
PLACE OF DEATH
1
...
(City or Town) 60 Johnson Avenue
No.
St., ........... .Ward
(If U. S.
18 DATE OF
DEATH
October
16
1935
(Year)
(Month)
(Day)
(Usual place of abode)
Salem
Massachusetts
(Cemetery)
(City or town)
UNDERTAKER
Revised Unity 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, designato 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,' "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.
Examplo
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onset
...
Chronic interstitial nephritis
1021
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 MASWS CHUSETTS 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 disposo of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. "If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. .. 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.
-
IM R-302
1 3 SEX Male (or) WIFE of 7 53 AGE OCCUPATION 13 NAME OF FATHER 14 BIRTHPLACE OF PARENTS A TRUE COPY. ATTEST :. important. tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE 50m-9-'31. No. 3385-g N. B .- WRITE PLAINL'Y" WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every Kem of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very FATHER (City)
PLACE OF DEATH
Suffolk (County)
Chelsca
(City or Town) No. U.S.Save] Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Randolph Albin Pollard
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. NO. 50 Peble St .. (Usual place of abode)
Length of residence in city or towa 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
Oct. 16, 1935
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from 9/10 995. ..... 10.10.10 195.5.
I last saw in ... alive on Oct. 15, 19 ... 75 death is said to have occurred on the date stated above. abO .... A ...
The principal cause of death and related causes of importance in order of onset were as follows: Dateofonset
Pulmonary tuberculosis un own Lung abscess 1 month
Contributory causes of importance not related to principal cause:
Blood transfusion
Name of operation. b) Tosection
Øre /11/35
What test confirmed diagnosis Juntoal Was there an autopsyno.
20 Was disease or injury in any way related to occupation of deceased? LLO
If so, specify
(Signed) *
Sullivan IL. Co. At (010), M. D.
(Address) ) Chelsea Hase, Dated/16196
21 PLACE OF BURIAL,
Winthrop Cem. , Winthrop
CREMATION OR REMOVAL
(Cemystery) 19,
(City of town) 5
DATE OF BURIAL
22 NAME OF
Richard I.white
ADDRESS
147 Winthrop St. , Winthrop
Received and filed 19
.......
(Registrar of City or Town where dece cesself beside(22)
-
4 COLOR OR RACE
(write the word)
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years
12
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Interior decorator
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
cum business
10 Date deceased last worked at this occupation (month and year)
11 Total time (years) spent in this occupation
Boston
12 BIRTHPLACE (City)
(State or country)
Nass.
Issac
Boston
(State or country)
Hars.
15 MAIDEN NAME
OF MOTHER
Sophia Laclean
16 BIRTHPLACE OF MOTHER (City) (State or country)
Nova Scotia
17 Informant : Mes. Marcorette Pollard rice (Address) Pablo Ave. Winthrop Mars.
(Registrar of city or town where death occurred)
DATE FILED Oct. 17,
19 35
St.,
Ward
If U. S. War Veterans ?.
199
St.,
Ward,
(If nonresident, give city of town and state)
1
10 Months Days
M R-301 A
PLACE OF DEATH
(County)
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)
(If U. S. War Veteran,
specify WAR)
.Ward Winthrop
(If nonresident, give city or town and state)
mos. days. How long in U. S., if of foreign birth? y.s.
mcs. days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
5a If married, widowed, or divorced HUSBAND of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 74 Years Months 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.
10 Date deceased last worked at this occupation (month and year)
11 Total time (years) spent in this occupation
David Shapure
15 MAIDEN NAME OF MOTHER Dora Cornifly
Fusing
17 Mat Schweighusband
Informant (Address) 4) Peanfald
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Im. I Cularesis (Signature of Agent of Board of Health or other)
10/22/33
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
1435 (Year)
19 HEREBY CERTIFY, That I attended deceased from
(3)
to ..
19
I last saw h ........ .. alive on.
Cent 21 35 death is said
19 m.
to have occurred on the date stated above, at 154
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT 7/1/18
Contributory causes of importance not related to principal cause:
Sucredary cinema
Name of operation. Date of What test confirmed diagnosis? Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify. (Signed)
M. D.
(Address)
my Tene + Date1 0/24 1835
3 7
21 PLACE OF BURIAL. CREMATION OR REMOVAL
Cemeteryy (City of townde
DATE OF BURIAL ... Oct 220
22 NAME OF UNDERTAKER 63 Greenvy
ADDRESS
Received and filed 31 1935
191 ....
(Registrar)
--
22
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(If deceased is a married, widowed or divorced woman, give also maiden name.)
47 Pearl Ouest
(a) Residence. No (Usual place of abode) Length of residence in city or town where death occurred mrs.
(City or Town) 47 Pearl Que. St., Willie Schwein
..... .Ward
1 No .. 2 FULL NAME SEX Female (or) WIFE of OCCUPATION 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) (State or country) 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 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should stato N. B .- WRITE PLAINLY ,Y'VITH UNFADING BLACK INK-THIS IS A PERMANENT RECOR, Every item of 12 BIRTHPLACE (City) (State or country) 100m-0-'33. No. 9321-a
--
Housewife
A
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. 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 WS OF THE
COMMONWEALTH OF SACHUSETTS 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.
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