USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 23
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GOVERNING
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, 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.
M R-302
1
PLACE OF DEATH
SUFFOLK 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.
2365
(If death occurred in a hospital or institution,
give its NAME instead of street and, number) 43
2 FULL NAME
Abraham
Numes-Vaz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
(Usual place of abode)
40 Trident Ave
.St.,.
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yTI.
nos.
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
(write the word)
married
5a If married, widowed, or divorced
HUSBAND of
Jennie Moscow
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 69
Years
Months
Days
If less than 1 day Hours Minutes
OCCUPATIONI
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.
salesman
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)
England
PARENTS
15 MAIDEN NAME
OF MOTHER
Reina Roblas
16 BIRTHPLACE OF MOTHER (City) (State or country) Holland
17
Informant
Wife- Jennie Nunes-vaz
(Address)
above
A TRUE COPY./
ATTEST:
Hilja Hedstrom Seink
DATE FILED
(Registrar of city or town where death occurred)
March 11
1936
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March
8
1936
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Feb ... 27
19 .. 36, to.
March
8
8
19 ..
.. 3.6
I last saw him ... alive on
March
to have occurred on the date stated above, at 5.20Pm.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
?coronary occlusion
hrs
1
prostatic hypertrophy
yrs ...
Contributory causes of importance not related to principal cause:
Date of.
Name of operation
What test confirmed diagnosis?
Was there an autopsy? no
20 Was disease or injury in any way related to occupation of deceased?
.no
If so, specify.
(Signed)
W W Knowlton
M. D.
(Address)
Boston
Date
3. 8 19 .36
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Roxbury Mutual.
Montvale
(Cemetery)
(City or town)
DATE OF BURIAL
March 10
19360
22 NAME OF
UNDERTAKER
B.F. Solomon
ADDRESS
Brookline
Received and filed
R &
1938
19
(Registrar of City or Town where deceased resided)
important.
50m-9-'31. No. 3385-
OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
HAU 19 71 LILIANENI ALLUKU. Every item of informa-
tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
No. Peter.Bent .. Brigham.Hospital ....... Sto
Ward
(If U. S.
War Veteran,
specify WAR)
Winthrop
M
(Give maiden name of wife in full)
19.3.6 death is said
13 NAME OF
FATHER
Ralph Nimes-Vaz
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Holland
٠ ٠٢٥٠٠ ـ
.
M R-301
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-12-'34. No. 2938-e TID"WRITE TLAINLI, WIIN UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
Suffolk
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 NAMEMary E (Jennings) Toohis
(If deceased is a married, widowed or divorced woman, give also maiden name.) .St., ................ Ward,
(a) Residence. No. 35 Lincoln St
(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
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March
10
1936.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
May- 5.
1934 to
august 22, 1935
I last saw b 121.
.alive on
march
1
1936, death is said
to have occurred on the date stated above, at 5:40 Pm. The principal cause of death and related causes of Importance in order of onset were as follows:
Date of Onset
anguna Padari
May-5:35
UMyocarditis
May 5.35
Contributory causes of importance not related to principal cause:
Name of operation.
....
What test confirmed diagnosis?
Date of
.Was there an autopsy ?.. ,2x.
20 Was disease or injury in any way related to occupation of deceased?
If so, specif
Eduard & Imanager
(Signed)
M. D.
(Address) 200 Wantinglain Aute Date Man 12.19.36.
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
inthrop Winthrop
(Cemetery)
(City or town) 19
22 NAME OF
UNDERTAKER
ADDRESS ..
John
maley
tirop
Received and filed ...
MAR 16 1036
19
....
Healthy fra cek
Signature of Agent of Board of Health of other 3/12/36
(Official Designation)
(Date of Issue of Permity
(write the word)
Karri:3.
If less than 1 day Hours .Minutes
Housewife
10 Date deceased last worked at
11 Total time (years)
spent in this % 2
occupation ..
(County)
...
1
Timilyon
(City or Town)
No ...
35 Lincoln St
8 SEX
5 SINGLE
MARRIED
WIDOWED
er DIVORCED
Female
4 COLOR OR RACE
Thito
5a If married, widowed, or divorced
HUSBAND cf
(Give maiden name of wife in full)
(or) WIFE
Patrici
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE.6.6
.. Years ....
.Months ....
... Days
8 Trade, profession, or particular
kind of work done, as spinner;
sawyer, bookkeeper, etc.
this occupation (month and_
OCCUPATION
year)
1ª26
12 BIRTHPLACE (City)
Jagt Boston
(State or country)
13 NAME OF
FATHER
Jamas Jennings
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Mary Sullivan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Patk Tookie
Informant
(Address)
35 Lincoln St
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
9 Industry or business in which
work was done, as ailk mill,
saw mill, bank, etc ...
Ovm Home
St., .................... Ward
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and state)
A TRUE COPY, ATTEST:
(Registrar)
-
Relation, if any
DATE OF BURIAL
lang I3,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: L W.m. D.
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: Arteriosclerosis
Date of onset
1015
Chronic interstitial nephritis
Cerebral hemorrhage
July 5. 1927
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If 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 .... Chap. 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 discase 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 supposabiy 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.
2
R-301
Suffolk
............ ....
....
(County)
Win throp
....
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
51
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME Ella Poole Perry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
114 Circuit Rd. Winthrop
.St., ...
.. Ward,
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
George H. Perry
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
.22
Years .. 5 Months 10 Days
If less than 1 day Hours. Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .....
Housewife
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City).
South Boston
(State or country)
Mass.
13 NAME OF
FATHER
Thomas H. Poole
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country) Mass.
15 MAIDEN NAME
OF MOTHER
Annie E. Small
16 BIRTHPLACE OF
MOTHER (City)
New Bedford
(State or country) Mass.
17 George H. Perry
Relation, if any Husband
Informant
(Address)
114 Circuit Rd., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William S. Childress
(Signature of Agent of Board of Health or other)
agent man.15/36
(Official Designation) (Date of Issue of Permit)
18 DATE OF DEATH March 12 .19.36
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from Fet. 14 1933 to March 12, 1936
I last saw her allve on march 12 19 36, death is sald to have occurred on the date stated above, at 49.m. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
Carcinoma of Stomadi
1933
1
Contributory causes of importance not related to principal cause: Several consommation
1935
Name of operation.
une
Date of.
What test confirmed diagnosis? Chemicalx
eat
Was there an autopsy ?...
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed)
(Ad
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Winthrop Winthrop
DATE OF BURIAL
March 15, 1936
19
22 NAME OF
UNDERTAKER
Richard H. White
ADDRESS
147 Winthrop St., Winthrop
Received and filed 19
.......
A TRUE COPY, ATTEST:
(Registrar)
--
AVillaLon should be careruy supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
100m-12-'34. No. 2938-e
1
PLACE OF DEATH
No II4 Circuit Rd. Winthrop
St., ..
Ward
(If U. S. War Veteran, specify WAR)
(Usual place of abode)
Length of residence in city er town where death occurred 23
days. How long in U. S., if of foreign birth? yrs.
(write the word)
this occupation (month and
year)
0
(Cemetery)
(City or town)
-
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 cwn 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.
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