USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1937 > Part 11
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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 Onset
1915
Chronic interstitial nepbritis
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.
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, alter 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 sup- posed 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 satisfactory written statement con- taining 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 re- quired by law, or in lieu thereof a certificate as hereinafter pro- vided. If there is no attending physician, or if, for sufficient rea- sons, his certificate cannot be obtained early enough for the pur- pose, 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 attend- ing physician. If death is caused by violence, the medical examiner If such a permit for the removal shall make such certificate. of a human body, not previously interred, from one town to an- other within the commonwealth 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 a removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was re- moved 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 required 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 ap- pear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician cer- tifying 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. (TER- CENTENARY 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 cemetery 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 ob- servance 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 unrelated to any form of injury, have died without recent medical attendance 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 septi- cemia), 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.
-
-301A
Suffolk
County Winthrop
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. S (If death occurred in a hospital or institution, -Ward ( give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden nar e.)
(a) Residence.
No.
64 Jain
(Usual place of abode) Length of residence in city or town where death occurred 16 years months
days.
How long in U.S., if of foreign birth?
years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
S SEX Mals
COLOS OR RACE
while
5 SINGLE
MARRIED
WIDOWED
(write the word) Marginal
Place
............
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 47 Years. ......... Months .Days
If less than 1 day Hours. .Minutes
8 Trade, profession, or particular Elevator quechance kind of work done, as spinner, sawyer, bookkeeper, etc ....
OCCUPATION
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ....
a B Ser Co
10 Date deceased last worked It 36
11 Total time (years) spent in this occupation.
5
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Frank Rose
14 BIRTHPLACE OF
FATHER (City)
azorro Duland.
(State or country)
15 MAIDEN NAME
OF MOTHER
amis Lashra
16 BIRTHPLACE OF MOTHER (City) (State or country}
agora tolando
17_ Taking E. Roos,
Nation of any wits
(Address) 64 quan -1/
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the barjel .or transit/permit was issued:
{Signature of Agent of Board of Health of other
Vealla (Oficial Designation) (Date of Issue of Permit)
2/6/37
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Ich.
5
1937
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
may
5
1936, to February 5, 1937
I last saw b. I.i.r.2.alive on.
February 4, 1937, death is said
to have occurred on the date stated above, a 14 a.m. The principal cause of death and related causes of Importance la order of onset were as follows:
Date of Onset IMPORTANT
Carcinoma of intestines-
1936.
Contributory causes of importance not related to principal cause:
Name of operation ..
No
Date of
What test confirmed diagnosis? X Fel.y.
Was there an autopsy? IV.O.
20 Was disease or injury in any way related to occupation of deceased?
No
If so, specify.
Edurne/ S. trang
(Signed) ..
(Address) 2.40 Wanderngyvy Bor Date F. D. S. 1937.
Joseph W. Box
21 ..
Place of Burial,
Crematan off Removal
(City or Town)
DATE OF BURIAL T2h.
1937
22 NAME OF
UNDERTAKEN
ADDRESS: 60 Harrison /aeri
Received and filed. 19
1B& 1937
(Registrar)
100m.12 '35. No. 6156F
important. See instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very PARENTS
1
PLACE OF DEATH
No.
(City or Town) 64 Main William & Pass
St.,.
(If U. S.
War Veteran
specify WAR)
Ward,
Winthrop
St.,
(If nonresident, give city or town and state)
5a If married, widowed, or divorced E HUSBAND of
this occupation tropth And
year)
1300 Lon
Maso
. M. D.
Statement of occupation. - Precise statement of occupation is. very important, so that the relative healthfulness of various pur- suits 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 bus- iness, 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 whatever 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.
1
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the partic- ular kind of work done and return that, as SPINNER, WEAVER, etc.
In stating the industry or business, avoid the use of such gen- eral 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 ENGIN- EER, 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 nepbritis
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.
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, atter 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 sup- posed 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 satisfactory written statement con- taining 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 re- quired by law, or in lieu thereof a certificate as hereinafter pro- vided. If there is no attending physician, or if, for sufficient rea- sons, his certificate cannot be obtained early enough for the pur- pose, 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 attend- ing 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 an- other within the commonwealth 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 a removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was re- moved 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 required 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 ap- pear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician cer- tifying 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. (TER- CENTENARY 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 I the care of the cemetery or burial ground in which the interment f is made. . . .- CHAP. 114, SEC. 46, G. L. (TERCENTENARY EDITION.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ob- servance 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 unrelated to any form of injury, have died without recent medical attendance 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 1 directly or indirectly by traumatism (including resulting septi- cemia), 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.
:
11 .- The number of years the deceased followed the occupation.
1 R-302
Norfolk
PLACE OF DEATH
(County) Norfolk
(City or Town) Pondville Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Norfolk
(City or town making return)
33
Registered No. (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Nelson Warren Marra
(If deceased is a married, widowed or divorced woman, give also maiden name.)
91 Bartlett Road
.St., ...........
Ward, inthrop, Mass.
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
hite
5 SINGLE
MARRIED
WIDOWED
OF DIVORCED
Widowed
5a If married, widoneh dyth Farrington HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 82
7
AGE
Years
O
Months
.Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinder, tired sawyer, bookkeeper, etc.
ncineer
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
Canton
Mass.
Edward Marra
Cannot be learned
Lass.
Mary Crocker
Cannot be learned
Mai ne
17 Hospital Records
ATTEST: Ginge SOauftill
(Registrar of city or town where death occurred)
DATE FILED
Fielmany
.. 19
37
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
February 5th, 1937
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from January 26th .1907 ebruary 5th # 19 37
I last saw h 1m .. alive ơn ebruary 5th .1937 death is said to have occurred on the date stated above, at1.5 .... P.M.
The principal cause of death and related causes of importance in order of onset were as follows: Basal cell carcinoma of left Dateofonget bout eye with direct invasion of 2 yrs
bone. Acute vegetative endo-
carditis, . lemorrhare into
peritoneal cavity.
Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis?
Date of
Was there an autopsy?e.S ...
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed) George L. Parker
(Address Pondville Hospital Date/5/379
M. D.
21 PLACE OF BURIAL MATION OR RÉ Canton Corner Canton
(Cemetery (City or town)
DATE OF BURIAL
February thi
19.37
19
22 NAME OF UNDERTAKER Harrap A
Meham
ADDRESS
BEHINHE
ـنى 111
Received and filed
$1/8111937 AH
19
(Registrar of City or Town where deceased resided)
1
3 SEX
Male
OCCUPATION!
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Informant
(Address)
A TRUE COPY
tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
important.
OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
50m-9-'31. No. 338€ _~
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-
(State or country)
(I U. S.
specify WAR)
(a)
Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yTs.
(write the word)
St.,
Ward
-301A
PLACE OF DEATH
Julfolk County) Lê intherok (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
[ (If death occurred in a hospital or institution, .Ward { give its NAME instead of street and number)
Greig Ir
(If U. S. War Veteran
specify WAR)
(a) Residence.
No.
142 Washington avz St.,
. Ward,
(If nonresident, give city or town and state)
How long in U.S., if of foreign birth? 57 years months days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Fab.
6 th
1937
(Month)
(Day)
(Year)
6a If married, widowed, or diverced
HUSBAND of
(give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 92 Years 0 Months. 18 Days
If less than 1 day
Hours
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
Carpenter
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ..
Shif builder
10 Date deceased last worked at
this occupation (month and
1910
11 Total time (years)
spent in this
occupation.
50
12 BIRTHPLACE (City)
arbroath
(State or country) Scotland
18 NAME OF
FATHER
Arsig
14 BIRTHPLACE OF
FATHER (City)
Scotland
(State or country)
15 MAIDEN NAME OF MOTHER Could not be learned
16 BIRTHPLACE OF MOTHER (City) (State or country) Scotland
17 Captain James V. Graig(
Relation, if any
Son
Informant (Address) 142 Wasting lon Gus Winthrop
I HEREBY CERTIFY, that a satisfactory standard certificate of death was Hled with me BEFORE the burial of transit permit was issued:
(Sigoature of Agent of Board of Health of other)
9/6/3/
(Oucial Designation) (Date of Issue of Permit)
19 I HEREBY CERTIFY, That [ attended deceased from / GNUar. 25 1936 to February - J, 1937 I last saw h ... \ ........ alive on. February 0, 190%, death is said
to have occurred on the date stated above, at The principal cause of death and related causes of Importance in order of onset were as follows: Minutes
Date of Onset IMPORTANT
1-24-37
Contributory causes of importance not related to principal cause:
Name of operation
0
Date of.
Was there an autopsy? NO.
20 Was disease or Injury in any way related to occupation of deceased? If so, specify Edward & Fran
(Signed)
trangers M. D.
(Address).
200 Warham bre Date Fab 61937
21. Westlawn
Lowell War.
Place of Burial, Cremation or Remoral
(City or Town)
37
DATE OF BURIAL
tab
19
22 NAME OF
Wm H. Saundere
UNDERTAKER
ADDRESS
90
Westford St. Lowall
Received and filed. 19
(Registrar)
100m 12. 35. No. 6156F
1 8 SEX male (or) WIFE of AGE OCCUPATION PARENTS tion should be carefully supplied. Age should be stated EAACILI. PHYSICIANS should state CAUSE OF DEATH year) important. See instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very
No.
2 FULL NAME
alexander
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Usual place of abode) Length of residence in city or town where death occurred 12 years months days.
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