USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 100
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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 causcs, 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
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.
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 carly 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 onc town to another within the common- wealth cannot be obtained carly 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 sucli 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 ecrtificate 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. - Ckap. 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. Lews, 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 lield, 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 observanco 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 whosc physician is aosent 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-302
PLACE OF DEATH
WORCESTER (County)
RUTLAND (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
Registered No.
199
(If death occurred in a hospital or institution,
give its NAME instead of street and number);
2 FULL NAME
Wilton Wharton, Jr .
(If deceased is a married, widowed or divorced woman, give also maiden name.)
53 Crest Avenue
St.,
Ward,
Winthrop Mass
Length of residence in city or town where death occurred
yrs.
3
mos.
-
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
27.
1938
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
48
1
23
AGE
. Years
Months
Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
Newspaper man
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)
this occupation (month andFeb. 1934
spent in this 20
occupation.
12 BIRTHPLACE (City)
New York
(State or country)
New York
13 NAME OF
FATHER
Wilton Wharton
14 BIRTHPLACE OF
FATHER (City)
Richmond
(State or country)
Virginia
15 MAIDEN NAME
OF MOTHER
Elizabeth Curley
16 BIRTHPLACE OF
New York
MOTHER (City)
(State or country)
New York
17
Hospital Records
50m-9-'31. No. 3385-x
ATTEST: Frances P. Hanff.
(Registrar of city or town where death scorred)
DATE FILED December 28,1938 19 --
September 27
CERTIFY, That I attended deceased from
December 27
.38
im
December 27
38
19
I last saw h
alive on
19
death is said
to have occurred on the date stated above, at
9:45 P.M.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Tuberculosis of the lungs
Unknown
Contributory causes of importance not related to principal cause:
Name of operation
Physical
Date of
What test confirmed diagnosisgy, lab.
Was there an autopsy?
No
20 Was disease or injury in any way related to occupation of deceased?
GEM
If so, sp
(Şigned)
E.Keirans, Act'g Clin. Director
VAF
Rutland Hts .Mass. pat.1.2/28.1938
21 PLACE OF BURIAL,
National, Pinelawn, N. Y.
CREMATION OR REMOVAL
DATE OF BURIAL
(Cemetery
December 30,1 g3gowa)
19
22 NAME OF
Frank H.Miles Co.
UNDERTAKER
ADDRESS
Jefferson,Mass.
Received and filed
19
(Registrar of City of T or Town where dospend excited
-
No. Veterans ... Administration St., ..
..... Ward
(If U. S.
War Veteran,
specify WAR)
(a)
Residence. No ..
(Usual place of abode)
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
Agnes Reynolds
(If nonresident, give city or town and state)
1 3 SEX Male (or) WIFE of PARENTS OCCUPATION Informant (Address) A TRUE COPY. 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 LAActLf. PriISiciANS should state CAUSE year) . important.
DF TOW
11 12
3
6
-
HROP.
-301
Suffolk.
(County)
(City or Toyn) No. 25/earl Grey
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
248
f (If death occurred in a hospital or institution, Ward \ give its NAME' instead of street and number)
(If U. S. War Veteran
specify WAR)
(a) Residence.
No.
25 Karl Che.
St.,
....
.Ward
(Usual place of abode)
Leogth of resideoce in city or town where death occorred years
mooths
days.
How long in U.S., if of foreign birth?
years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
male Mite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
rrite the word)
Single
5a If married, widowed, or divorced 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 65
AGE .. .. Years .... .. Months. .. Days
If less than 1 day Hours .......... .. Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .......
Clerle
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
City of Boston
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation .......
42
Charlestoron
12 BIRTHPLACE (City ...
(State or county)
13 NAME OF
FATHER
Michael OMail
14 BIRTHPLACE OF FATHER (City) ... (State of country)
Charlestour
mass
15 MAIDEN NAME
OF MOTHER
may n° Eloy
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sveland
Kelation, if any
17 Informant ... (Address) 25 earl Que
L
... (Signature of Agent of Board of Health/or othery Health Hacer 12/29/38
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
DEe-
28 1938
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That i attended deceased from
I last saw h.2./.\ ..... allve on
DEC.27
19.8.&, death Is sald
to have occurred on the date stated above, at 600#m.
The principal cause of death and related causes of Importance In order of onset
were as follows:
L
Date of Onset
Hodatis Disease
June 1938 ...
....
...
Contributory causes of Importance not related to principal cause:
none
.. Date of
Was there an autopsy? To
20 Was disease or injury in any way related to occupation of deceased? if so, specify
(Signed)
Essas E- Bourse
M. D.
Date De 29 1938
(Address).
Holy Cross malden
21.
Place of Buyal, Concion or Remoyal DATE OF BURIAL DEC 30
22 NAME OF
UNDERTAKER
Kolmist@maleo
ADDRESS
Pinturafr
Received and filed .......
19
DEC
A TRUE COPY ATTEST :
(Registrar)
100m-12-35. No. 6156E
OCCUPATION important. Sce 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
2 FULL NAME
Thomas & O Neil
{If deceased is a mortedy widowed or divorced woman, give also maiden name.)
(If nonresident, give city or town and state)
19.3.8, to.
Azc.28, 1938
Name of operation ...
What test confirmed diagnosis? Climent
......
no .
(City or Town) 2 1938
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mm. D. Sfuldelong y ...
GOVERNING THE
Statement of occupation. - l'recise 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.
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.
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. . Is 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 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.
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 scen 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 hody has been sooner obtained hereunder. If the death certificate contains a recital. as required hy 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.
M R-302
OCCUPATION important. 50m-11-36. No. 9080-g N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every 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 PARENTS
PLACE OF DEATH
NORFOLK (County)
BROOKLINE
(City or Town)
No .... 76 BROOK
St.,
.....
.Ward give its NAME instead of street and number)
2 FULL NAME.
SARAH ... VIO.ODRING
(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
21 ORLANDO AVENUE
.St.
Ward,
.. WINTHROP ..... MASS.
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
James N. Woodring
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 98
Years 4 Months 21 Days
If less than 1 day Hours ... Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
At home
9 Industry or business In which work was done, as silk mill, saw mill, bank, etc ..
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City)
(State or country)
Pennsylvania
13 NAME OF FATHER (Unknown) Roth
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Pennsylvania
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cannot be learned
17 Informant Isobell Zehringer ( Daughter.)
Relation, if any
( Address)
21 Orlando Avenue, Winthrop
A TRUE COPY.
arthurJ
Shimmera
ATTEST: (Registrar of city pr town where death occurred)
DATE FILED December 31 19 .. 38
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
31
193.8
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Nov ..
19 38to December 31, 19 38
I last saw h.
e.r ... alive on
December 30
19 ... 3.8., death Is said
to have occurred on the date stated above, at.
5
A m.
The principal canse of death and related causes of Importance in order of onset were as follows: Hypostatic pneumonia
Dateofonset 1 ... wk.
Contributory causes of importance not related to principal cause: Senility
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
.. no.
If so, specify.
M. D.
(Signed)
Edward L. Kickham
(Address) 432Wash ..... St.Brkln
Date
12/319.3.8.
21
Newton Cemetery,
Newton
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
January 3,
19 39
22 NAME OF
UNDERTAKER
Richard H. White
ADDRESS
winthrop
Received and filed 19
(Registrar of City or Town where deceased resided)
1
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BROOKLINE
(City or town making return)
Registered No.
595
(If death occurred in a hospital or institution,
(If U. S.
War Veteran,
249
specify WAR)
yrs.
mos.
days. How long in U. S., if of foreign birth?
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