USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1937 > Part 4
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yrs.
.St.,.
Ward,
mos.
days.
How long in U. S., if of foreign birth?
yrs.
Jan
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 regis- tration 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 con- tracted, 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.
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 intermentis made ....- Chap. 114, Sec. 46, G. L. as amended
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ;...- General 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; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfilment 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 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 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.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. Ifinvestigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorr- hage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
I R-301
PLACE OF DEATH
SUFFOLK (County)
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)
(L U. S.
War Veteran,
Spaneel
specify WAR) World
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St., ..
.....
Ward, South Boston, Mass
(If nonresident, give city or town and state)
4
days.
How long in U. S., if of foreign birth?
yrs.
mes.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH . January. 10
1937
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from January 6 1937 to January 10 19.3.7
I last saw him .... alive on ... January .... 10
19.3.7
death is said
to have occurred on the date stated above, at .. 5 .:. 50P. m. The principal cause of death and related causes of importance in order of onset were as follows:
J.Pellagra 2.Liver, cirrhosis of severe 3 .Pneumonia, broncho., acute, termin- al severe bilateral
Date of Onset 8/10/36 Unknown
1/8/37
Name of operation.
What test confirmed diagnosis?
Was there an autopsy? Yes
20 Was disease or injury in any way related to occupation of deceased? No
If so, specify
(Signed)
Thomas .... M.Arnett,Ist ... Lieut,IRC, M. D.
(Address)
.Fort ... Banks , ... Mass
Date ..
Jan 10 19 37
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
now Calvan
Besten
(Cemetery)
(City or town) 1937
DATE OF BURIAL
Jan 13:
22 NAME OF
UNDERTAKER
ADDRESS
259 Beach St Reuse
Received and filed JAN 1 1 1937
19
A TRUE COPY, ATTEST: (Registrar)
(City or Town) No.Sta Hospital Fort Banks Mass 2 FULL NAME. JOSEPH .. SWEENEY (a) Residence. No. 398 Fast 8th Length of residence in city or town where death occurred yrs. PERSONAL AND STATISTICAL PARTICULARS 5 SINGLE (write the word) MARRIED WIDOWED or DIVORCED Married 5a If married, widowed, or divorced Maiden name HUSBAND of Mr.s ... Helen ... Sweeney .... unknown (Give maiden name of wife in full) (or) WIFE of (Husband's name in full) 7 .Hours AGE ..... 53 Years. Months Days If less than 1 day Minutes 10 Date deceased last worked at 11 Total time (years) this occupation (month and spent in this year) January 1937 occupation. 34 12 BIRTHPLACE (City) (State or country) New York W N Informant Registrar ,StaHosp,Fort Banks Winthrop, Mass I HEREBY: CERTIFY that a satisfactory standard certificate of death was Wed with me BEFORE the banal or transit permit was issued: 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 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.Headquarters ,Ist Corps Area ..
Warrant .... Officer.,USArmy
>nature pf agent of Board of Health or other!" Health Officer
1/12/37 ( Date of love of Perffat )
St., ................... .Ward
Bartow notified 2/8/37
1 WINTHROP (Usual place of abode) 3 SEX 4 COLOR OR RACE White Male 6 IF STILLBORN, enter that fact here. 8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. OCCUPATION 13 NAME OF FATHER U 14 BIRTHPLACE OF N FATHER (City) (State or country) K N PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 17 is very important. See instructions and extracts from the laws on back of certificate. Official Designation) N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 15 MAIDEN NAME OF MOTHER 0 100hn-12-'32. No. 7070-h
:
Contributory causes of importance not related to principal cause:
Date of.
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-privais 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, Dainter, 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
1915
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 3, 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.
KLIKAGIS TRUM ING LAIT- VI 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 dothe 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 of 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. 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.
-
IR-301A
PLACE OF DEATH
Suffolk County) W authrop (City of 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)
Mildred Alice Drake
(If U. S.
War Veteran
specify WAR)
61 Johnson
Are.
.St.,
Ward,
(If nonresident, give city or town and state)
months days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
6a If married, widowed, or diverced 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 40 Years. Months Days
If less than 1 day
.Hours.
none
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc ....
none
10 Date deceased last worked at
this occupation (month and
year)
East Boston
11 Total time (years)
spent in this
occupation ..
12 BIRTHPLACE (City)
(State or country)
mass.
FATHER John W. Drake
14 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country} mass.
15 MAIDEN NAME OF MOTHER
Jennie 7. M. Sur
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
mass.
100m 11.'36. No. 9080 F
I HEREBY CERTIFY that a satisfactory standard certificate of death was flod with me BEFORE the burial ør transit permit was issued: Ww. I Culares.I (Signature of Agent of Board of Health or other)
Mulch
07/2/37
(Official Designation) (Date of Issue of Pepinit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That i attended deceased from
1936, 10/2011
19.37
I last saw h M alive on 19 .? ), death is said to have occurred on the date stated above, at 9.3 0Pm The principal cause of death and related causes of Importance in order of onset were as follows: Minutes
Date of Onset IMPORTANT
Coronary sublime
-
Contributory causes of importance not related to principal cause:
Chile cystite
1
Name of operation
What test confirmed diagnosis?
Date of
Was there an autopsy?
4
20 Was disease or injury in any way related to occupation of deceased? La
If so, specify.
(Signed)
M. D.
(Address)
Date 1/12 19×37
21. Holy Cross Malden
17 John W. Drake Relation, if any Place of Bofial, Cremation of Removal. (City or Town)
DATE OF BURIAL
January
14,
193%
22 NAME OF
UNDERTAKER
. Pelly
ADDRESS
11 Meridian St. 8.10.
Received and filed. 19
(Registrar)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ...
(Usual place of abode),
Length of residence in city or town where death occurred //
years
months
days.
How long in U.S., if of foreign birth?
years
To be filed for burial permit with Board of Health or its Agent.
61
No ... towson Are
St.,
Informant (Address) 6/ Johnson Are.,
Father
Winthrop
1 8 SEX Temale AGE OCCUPATION PARENTS 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 tion should be carefully supplied. Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of informa- 13 NAME OF
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ....
11
1437
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 OF 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.
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 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.
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