USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 6
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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, 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
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1927
...
Contributory causes of importance not related to principal causc:
...
...
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 cxample 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 samc 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 therefroin 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 onc 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 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 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 rc- 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., (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 shail 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 .. .. Chop. 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 discase 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.
DRM R-302
MARGIN RESERVED FOR BINDING
1 3 SEX Male (or) WIFE of AGE . Years OCCUPATION year) (State or country) 14 BIRTHPLACE OF FATHER (City) PARENTS 17 (Address) A TRUE COPY. important. 50m-9-'31. No. 3385-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 saw mill, bank, etc.
PLACE OF DEATH
Suffolk (County)
Chelsea. (City or Town) No. U. Marine Hosp.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
12
(If death occurred in a hospital or institution,
give its NAME instead of street and number) ~ (If U. S.
2 FULL NAME
Eben Horton
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence.
No.
85 Herman St.
.St., ..
WardWinthrop
Mass.
(Usual place of abode)
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
0 yrs. 0 mos. 7
days.
How long in U. S., if of foreign birth? 20
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January 23,
1938
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
Bertha
...... agnas.sen
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
54
8
Months
Days
13
If less than 1 day
.Hours
Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
Custom Guard
9 Industry or business in which
, as silk mill, Coast Guard
10 Date deceased last worked at
11 Total time (years)
this occupation (m
january 13, 1938
spent in this
occupation
12 BIRTHPLACE (City)
Guysboro, N. S
13 NAME OF
FATHER
David
(State or country)
Guysboro, N.S.
15 MAIDEN NAME
OF MOTHER
Rebecca Jones
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Guysboro, N.S.
Informant
Deceased
FEB 20195
ATTEST :.
Mary E. ... Regan
(Registrar of city of town where death occurred)
DATE FILED
Clerk.
Jan. 24,
193.8
19 I HEREBY CERTIFY, That I attended deceased from January 17, 19 38 to January 23, 19 38 I last saw h im alive on .... January ..... 2.3., .. , 19.38., death is said
to have occurred on the date stated above, at. 4 A. m. The principal canse of death and related causes of importance in order of onset were as follows: Pneumonia, ..... lobar .... left Dateofonset
(Pheumococcus type 1)
1-13-38
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis? X ... ray.
Was there an autopsy? NO.
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
R
(Signed)
Mitchell
M. D.
(Address)
U.S.Marine Hosp . Date 1/23. 19.38
21 PLACE OF BURIAL,
CREMATION OR REMOVALForrestHills,Boston
(Cemetery)
(City or town)
DATE OF BURIAL
January 26 ,1938
19
22 NAME OF
UNDERTAKER
William F. Spencer
ADDRESS
408BroadwayBoston
Received and filed.
.
January 24, 1938 19
Touhard J. Notel
(Registrar of City or Town where deceased resided)
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
(write the word)
.....
St.,
....
Ward
M R-301A
1 No. Every item of informa- 8 SEX 4 COLOR OR RACE White Female 7 AGE - Years 9 Industry or business in which OCCUPATION Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (or) WIFE of this occupation (month and year) 14 BIRTHPLACE OF PARENTS tion should be carefully supplied. "Official Designation) N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. 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 work was done, as silk mill, saw mill, bank, etc.
00m 11 36 No. 9080 F
I HEREBY CERTIFY that a satisfactory standard certificate of death was Med with mo BEFORE the burial or transit permit was issued: Www. D. Culd
Signature of Arest of Boarder Health or other de alite Officer 1/24/38
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
January
.24.
1938
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That i attended deceased from
19
.. 10
19 ...
I last saw h.
allve on ... Stillborn ... Jan .. 241938 .... death Is sald
to have occurred on the date stated above, at.
m.
Date of Onset IMPORTANT The principal cause of death and related causes of Importance in order of onset were as follows: Breech presentation
Contributory causes of Importance not related to principal cause: None
Name of operation ..
... None
Date of.
What test confirmed diagnosis ?.
Was there an autopsy ?. No
20 Was disease or Injury in any way related to occupation of deceased?
If so, specify ..
aosta
M. D.
(Signed) ............ ... Capt ...... MC.
(Address) .. FortBanks Mass.
Date
19
21
Fort ... Devens, Mass.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL Jan. 25 1938
Mattier
22 NAME OF UNDERTAKER ... ADDRESS Ag. Co 6.6. It Slepens.
Received and filed. 19
JAN STI
(Registrar)
verifeitos la Horf.
(a) Residence.
No ..
Hort Deceux 11 mill
(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
months
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
6a If married, widowed, er divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here. Stillborn
Months .. Days
If less than 1 day - .. Hours .......... Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ....
Infant
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation.
.....
12 BIRTHPLACE (City) .. Winthrop,Mass .. (State or country)
13 NAME OF
FATHER
Marshall Ray Shore
FATHER (City) ...
Yadkinville.,North Carolina
(State or country)
15 MAIDEN NAME
OF MOTHER
Renee Cecile Basque
16 BIRTHPLACE OF
MOTHER (City)
Fitchburg, Mass.
(State or country)
17 Relation, if any Infermant Registrar,StaHosp Ft. Banks, Mass (Address)
Gyer notified 2/9/38 recalled 12/10/38 The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
10
§ (If death occurred in a hospital or institution, .Ward \ give its NAME' instead of street and number)
2 FULL NAME
... ROSEMARY ... SHORE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S. War Veteran
specify WAR)
ayer Shirley
St.,
Ward,
(If nonresident, give city or town and state)
PLACE OF DEATH
SUFFOLK (County)
WINTHROP (City or Town)
fwiley nietifere 12/10/3
Station Hospital, Fort Banks ,Mass,
Statement of occupation. Piccise 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 retuin that, as SPINNER, WEAVER, etc.
In stating the industry or business. avoid the use of such gen- cral terms as "store," "factory," "mill," ete. State the particular kind of store, factory, mill, etc .. as GROCERY STORE, SOAP FACTORY, COTTON MII.1 .. ctc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as CIVIL ENGINEER, MECHANICAL ENGIN- EER, MIXING ENGINEFR, STATIONARY ENGINEER, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic," but give the exact occupation, as CARPENTER, PAINTER, MACHINIST, etc. Distinguish carefully between RETAIL. MERCHANTS AND WHOLESALE MERCHANTS. A person who sells goods should be called a SALESMAN and not a CLERK.
Statement of Cause of Death. - Cause of death means the disease, or complication which causes death, NOT the mode of dying, E. G., heart failure, asphyxia, asthenia, etc. .As principal cause name the disease causing death. . As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal causc, 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
1921
July 5. 1927
Cerebral hemorrhage
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 CERT TIFIC
CAT
SOF 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 helief the naine of the deceased, his sup- posed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. .
GEN. LAWS, CHAP. 46, SEC. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the hody is buried. No such permit shall be issued until there shall nave been delivered to such hoard, 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- vidled. 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 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 hody, 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 ahove 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 he 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 makc 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 he, 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 stich 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 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.
-
DRM R-303 B
Suffolk / (County)
(City or Town) No. 444 Winthub St
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No ..
(If death occurred in a hospital or institution, give its NAME instead of street and number)
martha annie Goodall Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence.
No.
444 Winthrop St. Winthrop
Ward,
(If nonresident, give city or town and state)
.... (Usual place of abode) Length of residence in city or town where death occurred
6
yrs.
mos.
V
days.
How long in U. S., if of foreign birth? 80 yrs.
x
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
WidowEd
5a If married, widowed, or divorced
HUSBAND of ........
Samuel madonnamet with full the
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
93
Years
/
Months
17 Days
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, ax home
Homework
10 Date deceased last worked at
11 Total time (years)
this occupation (month and May 1975
spent in this
occupation
year)
60
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
FATHER
Henry Deux
15 MAIDEN NAME
OF MOTHER
30 King
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Coupland
17 Frederick DO Good all(Som)
Informant (Address) 444 Winthepost Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: WniChildren (Signature of Agent of Board of Health or other)
1to
(Official Designation) Jan, 20 8/38 Rate of Issue of Permet)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
tan -
25 -1938
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Fractured Right Jenur 1 Senilità : Brancho pneumouna 1. Tell accidentally in her home m hiv-28-1937
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