USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 53
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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 omset
Chronic interstitial nephritis
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause :
EXTRACTS FROM THE LAWS OF THE
COMMONWEALTH OF MASSACHUSETTS
GOVERNING TS C
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- th, 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. Lows, 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. Lows, 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 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.
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.
-
R-301
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. PHYSICIANS should state 100m-12-'34. No. 2938-6 IN. D."-WNIE ILM LI, WITH UNFADING BLACK INN-INIS IS A FEAMANDA NYELUND. Every ILem or PARENTS
PLACE OF DEATH
Suffolk -----...
(County)
.. winthrop
(City or Town)
The Commonwealth of Massachusetts . Reven 8/1 2/36 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
123
Registered No. .....
(If death occurred in a hospital or institution,
No. Winthrop Community HospitalSt.
Ward
give its NAME instead of street and number)
2 FULL NAME ..... Thire .... Gustave .. Nelson.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ....? Q ... Bellingham ... Ave ....... Revere.
.......
.. St., ...
.Ward,
(Usual place of abode)
Length of residence in city or town where death occurred yrs.
mot.
days. How long in U. S., if of foreign birth? 48 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
Male®
White
Married
Ba If married, widowed, or divorced
HUSBAND of ... Harman N.
(Give maiden name of wife in full)
(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
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
Interior ... De.c.torator
9 Industry or business in which work was done, as silk mill,
saw mill, bank, etc .. Shop
10 Date deceased last worked at
this occupation (month and
year)
1930
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City) (State or country)
Swe den
18 NAME OF
FATHER
mele alson
CK
14 BIRTHPLACE OF
FATHER (City)
not know
(State or country) Sweden
15 MAIDEN NAME
OF MOTHER
Karin
16 BIRTHPLACE OF MOTHER (City) not know
(State or country) Sevenden.
17 Informant (Address)
Conrad .Nel ..... 7 PickWick Rd .. , Marblehead
Relation, if any Son
| 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)
7/10/36
(Official Designation) (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
8
(Day)936
(Year)
19 I HEREBY CERTIFY
Dec 26
1935, 80
July 8, 1936
I last saw be alive on 6,19.3 death is said
to have occurred on the date stated above at 3:30Am. The principal cause of death and related causes of Importance in order of onset were as follows:
Date of Onset
1
alterio- Sclerosis
years
Contribatory causes of importance not related to principal cause:
Bronchu- PNEUMONIA
July 6-36
Name of operation
What test confirmed diagnosis ?.
0
Date of
Was there an autopsy? Me
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
M. D.
(Address) 200 Wiko tury 46 Date 7-9/2006
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Pritar Lawn OPeengryn)
DATE OF BURIAL.
July 10, 1936
.....
.....
19
22 NAME OF
UNDERTAK
Richard ... H ..... White
ADDRESS
1.47 Winthrop St. . Winthrop
19.38 19
.... Received and filed.
A TRUE COPY, ATTEST:
(Registra:)
1
(L U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
5 SINGLE
MARRIED
WIDOWED
Or DIVORCED
That { attended deceased from
Revised United Số. s 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 ag "employee," "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.
In stating the industry or business, avoid the use of such general terms as "store." "factory. " "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soup factory, cotton mill, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter. painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Date of onseè
Arteriosclerosis
Chronic interstitial nephritis
1921
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 MASSA TUSETTS
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 illuess, 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 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 diseass resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
DRM R-302
N. B .- WRITE PLANLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. ECEry item 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
Barnstable (County)
1
Yarmouth
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Yarmouth
(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 NAMEIsaiah William Crowell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. Winthrop,
(Usual place of abode)
Mass
.St.,.
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Miale
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
DIVOR
Married
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
June 10
1936 to July 8,
1936
[ last saw
alive on
July8.
1956 ... , death is said
to have occurred on the date stated above
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonsat
Hypostatic Pneumonia
7/6/36
Contributory causes of importance not related to principal cause:
lasential ... Hypertension
1032
Chr.Ilopatitia
1932
13 NAME OF FATHER Isaiah Crowell
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Yarmouth
(State or country)
15 MAIDEN NAME
OF MOTHER
Mercy B. Crowell
16 BIRTHPLACE OF
MOTHER (City)
Yarmouth
(State or country)
Mass.
17 Mrs. Isaiah W. Crowell Informant (Address Winthrop Mass.
A TRUE COPY.
ATTEST:
Cillin H. Knowles
(Registrar of city or town where death occurred)
DATE FILED
July
11,
36
19.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
8,
1936
5a If married, widowed, or divorced
HUSBAND of
Anna L. Walsh
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 56
Years 3 Months Days
If less than 1 day
Hours
Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinnere sawyer, bookkeeper, etc ......... Accountant.
9 Industry or business in which
work was done, as silltown of Winthrop
saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
this occupation (month and /15/36
spent in this
year)
8yrs
12 BIRTHPLACE (City)
Yarmouth
(State or country)
Mess.
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy?Jo
20 Was disease or injury in any way related to occupation of deceased?
NO
If so, specify.
(Signed)
Paul .......... Honson
, M. D.
(Address)
llyamis
Data /9
156
21 PLACE OF BURIAL,
Woodside.W. Yarmouth
CREMATION OR REMOVAL
DATE OF BURIAL
July
(Cemetery)
11,
(City or town)
156
22 NAME OF
Doane, Beal & Ames
UNDERTAKER If
"yannis,
Mass.
ADDRESS
Received and filed
Jules
22
19
36
1
(Registrar of City or Town where deceased resided)
MARGIN RESERVED FOR BINDING
important.
50m-2-'30. No. 7997-đ
No.
St.,
.......
.Ward
(If U. S.
1
War Veteran,
specify WAR)
(write the word)
AGE
RECEIVED
OF
TOWN
ICE O
11 12
1
.
5
6
P. MASS
JUL221936 PM
RM R-301 A
PLACE OF DEATH
Suffolk (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.
125
(If death occurred in a hospital or institution, give its NAME instead of street and rumte:,
2 FULL NAME
Elias Greenberg
(If deceased
(a married, widowed or diforced woman, give also maiden name.)
(If U. S. War Veteras,
specify WAR)
.St., ..
Ward,
(If nonresident, give city or town and state)
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Juan
9
(Month)
1936
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
19
to
19
Last saw h.Med ... alive on
19
death is said
to have occurred on the date stated above, a
1:45 A
m.
The principal cause of death and related causes of importance in order of
onset were as follows:
Dale cf Omset
IMPORTANT
natural causes
Ciente Mentation of Iteast.
1931.
Contribatory causes of importance not related to principal cause:
1910
Name of operation
none
Date of.
Was there an autopsy? No
What test confirmed diagnosis? heretigation
No
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
P. B Puku
(Signed)
M. D.
(Address)Within Brand of Heat Date Jag 9 19 36.
21 PLACE OF BURIAL.
CREMATION OR REMOVA
Ohabei Shalom, C. Boston
(Cemetery
Cityefter
DATE OF BURIAL
July 10, 1936
22 NAME OF
Benjamin7 Solomon
ADDRES
420 Harvard St., Brookline.
Received and filed 19
(Registrar)
Winthrop 1 (City or Town) No ... 21 Sturgis (a) Residence. No 2 Sturges (Usual place of abode) Length of residence in city or towa where death occurred 14 . PERSONAL AND STATISTICAL PARTICULARS 3 SEX Male 4 COLOR OR RACE White (Give maiden name of wife in full) (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 If less than 1 day 71 AGE Years Months .Days Hours 8 Trade, profession, or particular kind of work done, as spinner, Designer 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 1991 OCCUPATION year) (State or country) England. 14 BIRTHPLACE OF FATHER (City) (State or country) Poland 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) Poland is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Signature of Agent of Board of Health of oben N. B .- WRITE PLAINLY WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 12 BIRTHPLACE (City) .. Birmingham, 100m-9-'33. No. 9321-a
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