USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 21
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(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 hy 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 -301A
Suffolk
*
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.
(If death occurred in a hospital or institution, Ward [ give its NAME' instead of street and number)
Speaking Nee Giuffre) Gusano
(If deceased is a married, widowed or divorced wontad, give also maiden name.)
(a) Residence.
No.
30 Gaine
(Usual place of abode)
Length of residence in city or town wbere death occurred
years
months
days.
How long in U.S., if of foreign birth?
49 years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Lemale Achito
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
5a If married, widowed, or divorced
HUSBAND of .......
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 61
AGE .. .Years. Months .Days
If less than 1 day Hours .Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
Housewife
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
39
12 BIRTHPLACE (City)
Messina
(State or country)
Italia
13 NAME OF
FATHER
Joseph Guiffre
14 BIRTHPLACE OF
FATHER (City)
...
Mascha
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
angelina atasproto
16 BIRTHPLACE OF
MOTHER (City)
Messina
(State or country)
Italy
Peter Guarneri (Cod) Relation, if any
17 Informant/ (Address) 21 Moseley SY Daich Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Uma Childrens
(Signature of Agent of Board of Health or other)
.
(Official Designation) (Date of Issue of Permin)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Mar 9, 1938
DEATH
(Month)
(Day)
(Year)
18 I HEREBY CERTIFY, That i attended deceased from
Feb 19,
1938 to Mar 9.
1932
I last saw h ......... allve on mar 9, ...... 19.9 ...... , death is said to have occurred on the date stated above, at ..... Som. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
Chemie Myocarditis
143 @
mall stagungulation
1930
Contributory causes of importance not related to principal cause: atypertension
1932
1992
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? If so, specify .... ......
....
(Signed)
M. D.
(Address)
Date ......
19. 35 ....
Holy Cross Malden Maso
N
Place of Burial, Cremation, or Removal. (City or Town)
22 NAME OF
UNDERTAKER
DATE OF BURIAL .........
6 Michael J. legg
ADDRESS
97 Saratoga St GastBook
Received and filed. 19
THAR 2,
..... 1938
(Registrar)
100m-12-35. No. 6156F
tion should be carefully supplied. 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 WITH TINFADING RI ACK INK THIS IS A PERMANENT RECORD. Every item of informa-
PLACE OF DEATH
(County)
1
(City or Town) 30 Paine No ..
St.,.
Registered No. ...
4€
(If U. S. War Veteran specify WAR)
2 FULL NAME
St., ...
(If monresident, give city or town and state)
year)
42/02 /h 151938
PARENTS
Mar 1 1/38
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 ANO 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.
A physician or registered hospital medical office
with, aiter 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 datc'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 hoard of health, or employed by it or hy 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 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 huried 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.
1.301A Suffolk.
1
PLACE OF DEATH
(County) Winthrop
(City or Town) 25 Quincy are No.
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.
47
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME.
Jacob 'S Kischen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
No. 25 Quincy Ade St.
........
.Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE
while
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
mand
ba If married, widowed, or divorced Elisabeth Ssenman
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE.
7
43
Years.
Months
.. Days
If less than 1 day
Hours.
Minutes
OCCUPATION
8 Trade, profession, or particular
kindof work done, as spinner,
sawyer, bookkeeper, etc .....
artist
9 Industry or business in which work was done, as ailk mill, alpine Press
saw mill, bank, etc ...
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
year)
Dec 20, 31
spent in this
12
occupation.
12 BIRTHPLACE (City)
Bistino
(State or country)
Maso
18 NAME OF
FATHER
Nathan Kirschen
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Rusa
(State or country)
15 MAIDEN NAME
OF MOTHER
Sha Smorack
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Rusia
17
May Kinhen
Relation, if any
o brother
.)
DATE OF BURIAL ..
March 20
(Cemetery)/
(City or town) 19
38
22 NAME OF
Israel Einstein
UNDERTAKER
...
ADDRESS
394 Washington Of. Ller.
Received and filed .. .. 19.
MAR.
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
March
19
1938
(Month)
(Day)'
(Year)
19
I HEREBY CERTIFY, That i attended deceased from
nor.1
1937, 10 War 19
1938
I last saw him ... alive on
mar. 19
193 & ... , death Is sald
to have occurred on the date stated above, at/ 0 6 m. The principal cause of death and related causes of Importance In order of onset were as follows: Carcinoma 1/ bronchio,
Date of Onset IMPORTANT
Oct 1937
metodalic
Contributory canses of importance not related to principal cause:
Name of operation.
Craniotomy
... Date of ....
Jan 1938
What tast confirmed diagnosis? Pathological Was there an autopsy? her
no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Robert
Isenman
am
.. , M. D.
(Address) 356 Ferry ST Malden Date Mar 19 19 38.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mislikan Lefile.
W.Rex
Informant ........
(Address)
275 Lean Rd. Brukline
I HEREBY CERTIFY that a satisfactory standard certificate of death was Hled with me BEFORE the Duriet or transit parmit was Issued: Min. S. Childrens
(Signatury of Agent of Board of Health or other)
He altle
Aquecer 3
20/38
St ......................
„Ward
(L U. S. War Veteran,
specify WAR)
(a) Residence.
(Usual place of abode)
Length of residence in city er town where death occurred
3 Gra.
mos.
days. How long in U. S., if of foreign birth?
yrs.
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 ............. .... ...
100m-12-'34. No. 293S-f
(Registrar)
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 ct 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 as "employec." "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, ete.
In stating the industry or business, avoid the use of such general ternis as "store," "factory," "mill." etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, cte.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, ctc. 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 calicd 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. naine 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 ouset
Chronic interstitial nephritis
I027
Cerebral hemorrhage
July 5, 1037
...
...
Contributory causes of importance not related to principal cause:
...
In a group of causes containing the principal eause 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.
A physician or registered hospital medical officer snail forthe
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 meniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belicf the name of the deceased, his supposed age, the discase 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. Chab. 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 hody 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 liereinafter 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 suchi 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 deccased 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 healthli, 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 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.
)IM 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-e N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
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