USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 39
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MASS.
From to
No. of Ticket of Escort
Form No. Ticket of Escort.
No. of Corpse Ticket
Form No. of Corpse Ticket.
Via
R. R. to.
Via
R. R. to.
Via
R. R. to_
Via
R. R. to.
Name of Passenger in Charge
Residence
Signed.
Baggage Agent
SEE RULES AND INSTRUCTIONS ON OTHER SIDE.
Write Plainly With Unfading Ink This is & Permanent ; . . ... .. PARENTS
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
May
(Month)
10
36
(Day)
19.
(Year)
16
I HEREBY CERTIFY, That I attended deceased from
May 7,
19 36, to May 10
10.36
that I last saw h.
iTA
_ alive on
May 10.
19.36
6:30 P
M.
7 AGE
52
years
months
days
8 OCCUPATION
(a) Trade, profession, or
particular kind of work.
(b) General nature of industry,
business, or establishment in
which employed (or employer)
Sgt. U. S. Army
CAUSES, state (1) Means of Injury; and (2) whether (probably)
11 BIRTHPLACE OF FATHER
(State or County)
Unknovm
12
MAIDEN NAME
OF MOTHER
Unknown
13
BIRTHPLACE OF MOTHER
(State or County)
Unknown
14 The Above Is True to the Best of My Knowledge
(Informant)
Hospital Records
19 Undertaker
Charles H
(Address)
Date of Shipment
5-12
36
19
SAN ANTONIO, TEXAS
Mags.
1
and
Date May 12, 1936
State of
Texas,
10 NAME OF
FATHER
Unknown
19.
:ale
White
Laws Governing the Preparation for Transportation of Dead Human Bodies
Rule 77. Bodies Dead of Pestilential Diseases. No body of any per- son dead of Asiatic cholera, bubonic plague, typhus fever or smallpox shall be transported except in a hearse or undertaker's wagon unless sald body shall have been cremated.
Rule 78. Bodies Dead of Contagious Diseases. The bodies of those who have died of diphtheria (membranous croup), scarlet fever (scar- Istine, scarlet rash), glanders, anthrax or leprosy, shall not be ac- cepted for transportation unless prepared for shipment by being thor- oughly disinfected by (a) arterial and cavity injection with an ap- proved disinfectant fluid, (b) disinfecting and stopping all orifices with absorbent cotton, and (c) washing the body with the disinfect- ant, all of which must be done by a licensed embalmer, holding a cer- tificate as such. After being disinfected as above, such body shall be encased in an airtight zinc, tin, copper or lead-lined coffin, or iron casket, all joints and seams hermetically soldered, and all enclosed in a strong, tight wooden box. Or, the body being prepared for ship- ment by disinfecting as above, may be placed in a strong coffin or casket and said coffin or casket enclosed in an airtight copper or tin case, all joints and seams hermetically soldered and all enclosed in a strong outside wooden box.
Rule 79. Bodies Dead of Non-Quarantinable Contagious Disense. The bodies of those dead of typhoid fever, puerperal fever, erysipelas, tuberculosis and measles, or other dangerous communicable disease. other than those specified in Rules 77 and 78. - may be received for transportation when prepared for shipment by filling cavities with an approved disinfectant, washing the exterior of the body with the same, and stopping all orifices with absorbent cotton and encased in an air- tight coffin or casket; provided, that this shall apply only to bodies which can reach their destination within forty-eight hour's from time of death. In all other cases such bodies shall be prepared for trans- portation in conformity with Rule 78. But when the body has been prepared for shipment by being thoroughly disinfected by an em- balmer holding a certificate, aq in Rule 78, the air-tight sealing may be dispensed with.
Rule 80. Bodies Dead of Other Discases. The bodies of those dead of diseases that are not contagious, infectious or communicable may be received for transportation when encased in a sound cof- fin or casket and enclosed in a strong outside box; provided, they reach their destination within thirty hours from time of death. It the body cannot reach its destination within thirty hours from time of death, it must be prepared for shipment by filling cavities with an approved disinfectant, washing the exterior of the body with the same, and stopping all orifices with absorbent cotton, and encased in an air-tight coffin or casket. But when the body has been prepared for shipment by being thoroughly disinfected by a licensed embalmer as in Rule 78, the air tight sealing may be dispensed with.
Rule 81. Persons Accompanying Bodies Dead of Contagious Diseases. In cases of contagious or Infectious diseases, the body must not be accompanied by persons or articles which have been exposed to the infection of the disease, unless certified by the health officer as hav- ing been properly disinfected; and before selling passage tickets, agents shali carefully examine the transit permit and note the name of the passenger in charge or any other proposing to accompany the
body, and see that all necessary precautions have been taken to pre- vent the spread of disease. The transit permit in such cases shall specifically state who is authorized by the health authorities to no- company the remains. In all cases where bodies are forwarded under Rule 78, notice must be sent by telegraph to health officer at desti- nation, advising the date and train on which the body- may be ex- pected. This notice must be sent by or in the name of the health officer of the initial point, and is to enable the health officer at des- tination to take all necessary precautions at that point.
Rule 82. Bodies Not Shipped by Express. , Every dead body not shipped by express must be accompanied by a person in charge, who must be provided with a passage ticket and also present a full first-class ticket marked "corpse," for the transportation of - the body, and & transit permit, showing physician's or coroner's cer- tificate, name of deceased, date and hour of death, age, place of death, cause of death, and if of a contagious or infectious disease, the point to which the body is to be shipped, and when death is caused by any of the diseases specified in Rule 78, the names of those authorized by the health authorities. to accompany the body. The transit permit must be made in duplicate, and the signatures of the physician or coroner, health officer and undertaker must be on both the original and duplicate copies. The undertaker's certificate and paster of the original shall be detached from the transit permit and pasted on the end of the Coffin. box. " The physician's certificate and transit permit shall be handed to the passenger in charge of the corpse. The whole duplicate copy shall be sent to the official in charge of the baggage department of the initial lines and by him to the Secretary of the State Board of Health at Austin.
Rule 83. Bodies Shipped by Express. When' dead bodies are shipped by express, the whole original transit permit shall be pasted upon the outside box, and the duplicate forwarded by the express agent to the Secretary of the State Board of Health at Austin.
Rule 84. Disinterred Bodies Treated as Contagions. Every disin- terred body, dead from any disease or cause, shall be treated as con- tagious or dangerous to the public health and shall not be accepted for transportation unless removal has been approved by the State or local health authorities having jurisdiction where such body is dlsin- terred, and the consent of the health authorities of the locality to which the corpse is consigned has first been obtained; and all such disinterred remains shall be enclosed in a hermetically sealed (soldered) zinc, tin or copper-lined coffin or box. Bodies deposited in receiving vaults shall be treated and considered the same as buried bodies.
Rule 85. Transfer of Bodies in Transit. When necessary to trans- fer dead bodies in transit from one railway train to another, or from one station to another, or from a station to a ferry, the affidavit of the undertaker and permit of the local health officer accompanying the remains shall be in all cases sufficient authority for such transfer.
Rule 86. Certificate of Undertaker. No common carrier shall ac- cept for transportation any body unless a certificate is furnished by the undertaker preparing such body for shipment to the effect that the foregoing rules have been complied with in the preparation for transportation of said body. --
Tariff Rules Governing Handling Corpses in Baggage Cars . .
Agents and Baggagemen will see Railway Companies' current baggage tariff to cover the ticketing, checking, routing, collection, etc., on corpses.
Transportation of Deceased Persons in Baggage Cars
To Railroad Agenta, Station and Baggagemen :. -
You will in no case receive a corpse for transportation unless ac- companied by a physician's, coroner's or Board of Health Certificate, also a licensed embalmer's certificate that the body has been prepared for burial and shipment In accordance with the rules of the Texas State Board of Health, nor will you receive it EVEN WITH SUCH CERTIFICATE IF FLUIDS OR OFFENSIVE ODORS ARE ESCAP- ING FROM THE CASE.
It will be the duty of Agents and Baggage Agents to see that each burial case is properly marked on "paster" giving date and at what station shipped, point of destination, "State," number and form of ticket, name of passenger in charge and place of residence, with name of agent. If the corpse is destined to a point beyond the initial line the initials of each road over which it passes must be written on the "paster," also the terminal point of each road at which transfer is to be made with the connecting line, as shown on the coupons of the ticket.
You will see that the "certificate" of licensed embalmer is properly filled out by him, and the "paster" is properly filled out by yourself and is securely pasted to the coffin box before It is put into the car, and the permit remaining you will hand to the pasenger in charge of the corpse.
The whole form must be made in duplicate, either with a pen, car- bon paper or simplex paper, and the signatures of the physician or coroner and licensed embalmer must be on both the original and. du- plicate copies. The licensed embalmer's certificate and "paster" of the original will be detached from the physician's certificate and per- mit and pasted to the coffin box. The physician's certificate and per- mit will be handed to the passenger. The whole duplicate copy shall be sent to the offical in charge of the baggage department of the initial line by first pasenger train and by him to the Secretary of the State Board of Health at Austin.
All of this information is necessary to insure the prompt and correct transportation of the corpse.
Agents and Baggagemen must satisfy themselves that the embalmer signing the above certificate holds a valid license, by having him exhibit his identification card issued by the Texas State Board of Embalming.
.
R-301 A
Sullalla
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) Battery Dl 1st ari.
(If nonresident, give city or town and state)
How long in U. S., if of foreign birth? yzs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACK
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
manud
5a If married, widowed, or divorced HUSBAND of martha Straw.
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years
1
Months ..
18
Days
If less than 1 day Hours. Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ......
Salesman
(retired)
10 Date deceased Lost worked at 11 Total time (years)
1933. spent in this 72/20 occupation
mara
13 NAME OF
FATHER
andrew M&bullough
teland
15 MAIDEN NAME
OF MOTHER
Hannah Smythe
Ireland
17 Mas Martha5 71 Cullman
Informant (Address) 20 Woodard, Or Mandage
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued: Wim. 2 luxde L A(Signature of Agent of Board of Health or other)
5/13/36 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
may
11
1936
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
19 87
I last saw him alive on.
11
1926
death is said
to have occurred on the date stated above, at ....... .. m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
Chemic myocardety
19.35
Chromic Valibulan I tout Quand
Contributory causes of importance not related to principal cause:
Name of operation
none
Date of.
What test confirmed diagnosis? Celzeventien
Was there an autopsy ?.
N
20 Was disease or injury in any way related to occupation of deceased? 40
If so, specify
(Signed)
Whiting man
Date May 12 1936
(Address).
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Hintlerok Winthrop
DATE OF BURIAL
may
13
1936
22 NAME OF
UNDERTAKER
Walterla Hanus
ADDRESS
23 Hilfes It malder hacer.
Received and filed
MAY 1 5 1936
(Registrar)
100m-9-'33. No. 9321-a
A (County) 1 No 2 FULL NAME 3 SEX m. (or) WIFE of 7 67 AGE this occupation OCCUPATION year) 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) (State or country) 16 BIRTHPLACE OF PARENTS 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 Carcruny supplieu. AuL should be stated EXACTLY. PHYSIKLAS should state 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
PLACE OF DEATH
(City or Town) Ward 20 Woodside Oh St. William & M= bullough
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20 Hrobbeide Gp. S.
(a) Residence. No
(Usual place of abode)
Length of residence in city or town where death occurred
17 yrs.
mos.
days.
.Ward,
12 1935, 11
, M. D.
(Cemetery
(City or towi.
19
e
Revised UnitedStates 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 discase 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 nor.c.
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.
Examplo
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 MEGACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge, and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body. not previously interred from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter
furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45, G. L., as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
R-301
PLACE OF DEATH
.. ..........
(County)
Went B
... ..
(City or Towp) Thomen París
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
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
days. How long in U. S., if of foreign birth?
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
18 DATE OF
DEATH
may
12
1936
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,That i attended deceased from
May 5
1936 to
May 12
1936
X
I last saw her alive on
May 12
, 19 36
death is said
6 IF STILLBORN, enter that fact here.
AGE
Days
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ....
or Jim.
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.
this occupation (month and
year)
Charlotte town
12 BIRTHPLACE (City)
......
(State or country)
Prince E wun es Cana la
13 NAME OF
FATHER
Sam
14 BIRTHPLACE OF
FATHER (City)
England -
(State or country)
15 MAIDEN NAME
OF MOTHER
mary Banker
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 lsworth Burrill,
Relation, if any
Informant_ (Address) 46 Thorn Ken Park Nettuno
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)
May 15/31
(Official Designation) (Date of Issue of Permit)
Name of operation.
What test confirmed diagnosis elemente Was there an autopsy 00
lab
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
iffrancis
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