USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 58
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16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia.
17 Jacob Berger
(Address) 33 Survie St., 50
I HEREBY CERTIFY that e satisfactory standard certificate of death was filed with me BEFORE theburialor transit permit was Issued: Www. D. Juldress (Signature of Agent of Board of Health or other) Health Officer 8/1/38
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
/
1938
Month)
(Day)
(Year)
19/ I HEREBY CERTIFY ,That I attended deceased from Jily 25/ 3. 2. .....
1 last samen alive on.
July 31, 1936, death is said
to have occurred on the date stated above, 5Cm. The principal cause of death and related causes of Importance in order of onset were as follows: Date of Daset IMPORTANT Cerebral Alemontage
7/25/38
Contributory causes of Importance not related to principal cause: arteriosclerosis
1936
Senility
1938
Name of operation.
What test confirmed diagnos @linical X was there an autopsy?
Date of.
7/20
aked to occupation of deceased?
0
20 Was disease or Injury in any Way related
If so, specify
Jacob, Aberaufs
12.80 M. D.
(Signed)
(Address) 562 Stanley Date.
aug/1938.
1 Squid Views Chouhan W Rot.
Relation, if any
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
august 1,
1938
22 NAME OF
UNDERTAKER
Brookline
ADDRESS
Received and filed
AUG
1938
19
(Registrar)
100m 11 :30 No. 9080 F
important.
N. B.
1 7 AGE 81 PARENTS OCCUPATION 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 WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of informa- year)
(If U. S. War Veteran specify WAR)
SE.
Ward, Boston, JeAS.
(If nonresident, give city of town and state)
to
August 1, 1938
(or) WIFE of
Solo
Bergen
-
noul
Sty
Statement of occupation. - l'recisc statement of occupation is very unportant, 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 donc 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, ctc.
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 "laborcr" 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 causc, 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 ....
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.
physician
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 dlate 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 hoard 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 nave 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 he 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 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 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.
1915
M -301 A
PLACE OF DEATH
(City or Town) Winthrop Immunity (+0' St. 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.
145
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
Cowen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
14 River Road
.St., ...
.Ward,
(If nonresident, give city or town and state)
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
august
5
1938
(Month)
(Day)
(Year)
19-
I
HEREBY CERTIF
That I attended deceased from
October 19
1934 to.
august 5, 1938
I last saw ben alive on .....
august 4
......
1938
death is said
to have occurred on the date stated above, at 5 Cm. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onsel
IMPORTANT
Acute Coronary Trombones Aug 192
Contributory causes of importance not related to principal cause:
diabetes Mellitus
1936 ...
Name of operationf
imputation of leg. april 1937.
What test confirmed diagnosi Clinicalx Was there an autopsy?
laboratory
20 Was disease or injury in any way related to occupation of deceased.
If so, specify ..
(Signed) ...
(Address) 562 thulay Date
tuque38.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
(City or town) 1938
DATE OF BURIAL
22 NAME OF
UNDERTAKER
178 Binnington it Cost Bortac
ADDRESS
Received and filed
Aug. 5,
19
38
(Registrar)
C (County)
1
2 FULL NAME.
3 SEX
Female
4 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
(or) WIFE of
6 IF STILLBORN, enter that fact here.
7
83
AGE
Years.
Months
Days
10 Date deceased last worked at
this occupation (month and
OCCUPATION
year)
van. 1934
12 BIRTHPLACE (City).
(State or country)
n.E.
14 BIRTHPLACE OF
FATHER (City)
PARENTS
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. Seo instructions and extracts from the laws on back of certificate.
100m-0-'33. No. 9321-a
N. H .- WRITE" PLAINLY. WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every itorof
(State or country)
Una Sentía
5 SINGLE
(write the word)
cuidamed
5a If married, widowed, or divorced
HUSBAND of
MM (Give maiden name of wife in full)
(Husband's name in full)
1 Conven
If less than 1 day .. Hours. .Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ...
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
at home
11 Total time (years)
spent in this
occupation ..
45Mm
13 NAME OF
FATHER
Frank DeLarey
15 MAIDEN NAME
OF MOTHER
Orcette Deaplican
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
lieve. Sentia
(fan)
17
Informant
(Address)
2 + River Road Winthro
I HEREBY CERTIFY that a satisfactory Standard certificate of death was filed with me BEFORE the bunal or transit permit was issued: Man. D. Childreny. (Signature of heeft of Board of Health orother )
Healite office (Oficial Designation// (Date of Issue of Permit)
8/8/38
mos.
Ward
Catherine,
(a) Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
(If U. S.
War Veteran,
specify WAR)
Pline
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, designatc 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 donc.
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,' w "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 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 sccured. 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: Arteriosclerosis
Date of onset
1015
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.
RE TURN OF · CERTIFICAT
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 thercfrom 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 deccascd: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 i 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. - Chop. 114, Sec. 45, G. L., as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
Medical examiners shall makc examination upon the view of the dead bodies of only such persons as arc 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 dicd 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. 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 diseasc 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.
F301
OF DEATH
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
The Commonwealth of Alassachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
(City or town making return) 146
Registered No.
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.
(Usual place of abode)
11 Evans Place
St.,
Ward,
(If nonresident, give city or town and state)
months
days.
How long in U.S., if of foreign birth?
years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
V
4 COLOR OR RACE
While
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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 thet fact here. Stillborn
7 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 .......
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)
L
11 Total time (years)
spent in this
occupation.
V
12 BIRTHPLACE (City).
(State or country)
Man.
13 NAME OF
FATHER
Carl Moulin
14 BIRTHPLACE OF
FATHER (City) ......
maldin
(State or country) Micas.
15 MAIDEN NAME
OF MOTHER
Murgia Cation
16 BIRTHPLACE OF
MOTHER (City)
Middleboro,
(State or country)
Mans.
17
Carf 1
ich Maulen
Relation, if any (Father)
Informant
(Address)
11 Evans Pl. Wahufuld Mais
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed withme BEFORE the barja) or transit permit was issued:
....
Childrens. (Signature of Agony of Board of Health of other Health Officer 8/18/38 (Date of Issue of Permits
Received and filed.
Aug ....... 25,
19
38
A TRUE COPY ATTEST
(Registrar)
See instructions and extracts from the laws on back of certificate.
in plain terms, so that it may
important.
100m-12-'35. No. 6156E
"Official Designation)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
5
(Month)
(Day)
(Year)
19
19 I HEREBY
CERTIFY, That I attended deceased trom
19
to
I last saw h.
.allve on
19
death Is sald
to have occurred on the date stated above, at.
.... m.
The principal cause of death and related causes of Importance in order of onset
were as follows:
Date of Onset
Stillborn (macerated)
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