USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 61
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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
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 he 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
with, atter the death of a person whom he has attended during 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 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 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 heen delivered to such board, agent or clerk, as the casc may be, a satisfactory written statement con- taining the facts required by law to be returned and recorded, which shall he 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 he obtained early enough for the pur- pose, or is insufficient, a physician who is a member of the board of health, or employed hy 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 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 ahortion, 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.
FB01A
Sufficle (County )
286 (City or Town) 263 Fred. Main 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.
351
Registered No. § ( If death occurred in a hospital or institution, Ward ( give its NAME' instead of street and number)
2 FULL NAME
Daniel M Brocho
(If U. S. Yar Veteran
specify WAR)
(a) Residence.
No
263 Main Rd.
( Usual place of abode)
Length of residence in city or town where death occorred
years
months
days.
How long in U.S., if of foreign birth?
years
mouths
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
8 SEX
Trale A trite
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Huyte
18 DATE OF
DEATH ..
Fangut
18
1938
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
august 13
1938, 1
august 18
1938
I last saw h .. .. Y ... allve on
august 16, 1938, death is said
to have occurred on the date stated above, at 4:40 Am. The principal cause of death and related causes of Importance In order of onset were as follows:
Date of Onset IMPORTANT
.... Congenital hydrocephalus
1910
Status epilepticna ticvis
8/13/38
Contribatory causes of Importance not related to principal cause:
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.,
I. D.
(Address) ... Winthrop Man Date 8/19/1938
Taky Cion Halden. 21 .. Place of Burial, Cremation or Removal (City of Town) DATE OF BURIAL. 94 17 20
19 ......
22 NAME OF
UNDERTAKER
ADDRES s/78 Thennika Come & C Butland
Received and filed.
AUG 2 ..
19
(SiMatury of Agent of Board of Health ofother) Healthe officer 8/20/38
(Official Designation)
(Date of Issue of Permit)
(Registrar)
1
PARENTS
15 MAIDEN NAME
OF MOTHER
mary playle
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
......
17 Many ! Birche ( Multor)
Robtion, if any
Informant (Address)
HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjalfor transit permit was Issued:
100m 11 36 No 9080 F
1
1
PLACE OF DEATH
CCofA NON are very
A FY ACTI Y PHYSICIANS .hould etnta CAUSE OF DEATH
classined. " Date of onset and exact statement of
important. See instructions and extracts from the laws on back of certificate. termis, so that it may be properly ciassthe In plain terms
OCCUPATION
8 Trede, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ..
.Days
If less than 1 day
Hours.
........... Minutes
9 Industry or business in which
work was done, as ailk mill,
saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ...
this occupation (month and
year)
Cust Boston
12 BIRTHPLACE (City).
(State cr country)
13 NAME OF
FATHER
14 BIRTHPLACE OF FATHER (City) (State or country) more
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE ...
.. Years.
Months
(write the word)
·
6a If married, widowed, or divorced HUSBAND of
(If deceased is a married, widowed .or divorced woman, give also maiden name.)
St ..
Ward,
(If nonresident, give city or town and state)
St.,
(Signe
Statement of occupation. - l'recisc 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 donc and return that, as SPINNER, WEAVER, etc.
In stating the industry or business, avoid the use of such gen- cral 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 "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
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.
with, alter the death of a person whoni he has attended ouri 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. poscd 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 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 therc shall nave been delivered to such board, agent or clerk. as the casc may bc, a satisfactory written statement con- taining the facts required by law to he returned and recorded. which shall he 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 he 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 hy 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 obtaincd 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 hoard 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 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.
1 2-302
PLACE OF DEATH
WORCESTER (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
Registered No.
130
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
John FrancisEzekiel
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 ... Bates .... A.v ....
St.,.
........
Ward,
Winthrop.ass ...
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
RUTLAND
1
(a) Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced.
HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
60
9
AGE
Months
8
Days
Years
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc ..
this occupation (month and
OCCUPATION
year)
12 BIRTHPLACE (City)
(State or country)
Newfoundland
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Ann Woodford
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Newfoundland
17
(Address)
A TRUE COPY.
OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important.
DATE FILED
August 20,1938
50m-9-'31. No. 3385-g
N. B .- WRITE PLAINLY. WITH UNFADING INA-THIS IS A PERMANENT RECORD. EVOTY LORATOR ANOMALIA
(State or country)
Newfoundland
ATTEST:
Frances S. Hanff
(Registrar of city or town where death occurred)
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
ugust
20
1938
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from January 25 19 38 to August 20 . 19 .. 3.8 I last saw h ... 1m2 alive on August 20 19:30, death is said to have occurred on the date stated above, at.3 .:. 2 .... .m. R
The principal canse of death and related causes of importance in order of onset were as follows:
Dateofonset
Pulmonary tuberculosis
1919
Contributory causes of importance not related to principal cause:
Name of operation
None
Date of
What test confirmed diagnosis?
x-ray
Sputum &
Was there an autopsy ?. . M.O.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Henry J. Lorge
M. D.
(Address) Rutland State San. Date 8/20 19 38
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Winthrop "inthron ass.
(Cemetery)
(City or town)
DATE OF BURIAL
August23 1938
19
22 NAME OF
UNDERTAKER
John 1. 0'ialey
ADDRESS
Winthrop. "ass.
Received and filed 19
(Registrar of City or Town where deceased resided)
(write the word)
Married
lizabeth A. Costigan
(Give maiden name of wife in full)
If less than 1 day Hours .Minutes
8 Trade, profession, or particular kind of work done, as spinner, Vault attendant sawyer, bookkeeper, etc ..
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
13 NAME OF
FATHER
Samuel Ezekiel'
Informant
Rutland State San Records
(City or Town) No. Rutland State Sanatorium St.,
Ward {
(If U. S.
War Veteran,
152
specify WAR)
How long in U. S., if of foreign birth? yrs.
6 mos. 25 days.
TOW,
13 12.
1
5
6
SOVE
H
np
SEP-81938 AM
RIO1A
PLACE OF DEATH
1 Suffolk (County) Itenthing 1 (City or Town)
/ 38
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
153
§ (If death occurred in a hospital or institution,
.. Ward \ give its NAME' instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
25 Lawverense ave Revere
mass
St.
Ward,
(Usual place of abode)
Length of residence in city or town where death occorred
years
months
days.
How long in U.S., if of foreign birth?
years
months days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
(Month)
(Day)
(Year)
6a If married, widowed, er 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 AGE Years .. Months .......... .Days :
If less than 1 day 7. .Hours. .. 2.5 ... 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 ......
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ..
this occupation (month and
year)
12 BIRTHPLACE (City) Anthrop Maggy hucette (State or country)
13 NAME OF
FATHER
Hyman Cohen
14 BIRTHPLACE OF
FATHER (City)
Quesia
(State or country)
15 MAIDEN NAME
OF MOTHER
Mircon Levine
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
17 audrey Cozinha
Relation, if any 1.none
Informant
(Address)
Kirchsap Community Harpital
I HEREBY CERTIFY thay a satisfactory standard certificate of death was filed with me BEFORE the buyer or fransit/permit was Issuad:
(Signature of Agent of Board of Health, or other ) Health Aprile (Official Designation) (Date of Issue of Permit)
8/21/38 ... Recelvad an i filed .. AUG 75-1938
19
(Registrar)
.... [ .. Il. ... nelind Age should he stated EXACTLY. PHYSICIANS should stato CAUSE OF DEATH .
OCCUPATION in plain terms, so that it important. See instructions and extracts from the laws on back of certificate. PARENTS
100m 11 36. No. 9080 F
19 I HEREBY CERTIFY, That i attended deceased from
Cung . 21
20
1938, to
1938
I last saw b ......... alive on
20
. .....
19 38, death Is said
....... -A.m.
to have occurred on the date stated above, at. The principal cause of death and related causes of Importance In order of onset were as follows:
Dato of Oneet IMPORTANT
Premature
Contributory causes of Importance not related to principal cause:
Nama of operation
What test confirmed diagnosis?
.Date of
Was there an autopsy ?.
0
20 Was disease or Injury in any way related to occupation of deceased? If so, specify
(Signed)
Juris
Legel
....
.....
M. D.
(Address)
12 Shirley Am
Date.
8/2/1998
21 ..
marek Relieffer ans- monteale
Place of Burial Cremation br Removal.
(City or Town)
DATE OF BURIAL. aug, 21
1938
22 NAME OF
UNDERTAKER
Kradl Einstein
ADDRESS 32 Henonal it Roux masi
To be filed for burial permit with Board of Health or its Agent.
Winthrop Community Hasfeltal St. No.
(Male) Cohen
(If U. S. War Veteran
specify WAR)
(If nonresident, give city or town and state)
21,
1934
3 SEX
male
4 COLOR OR RACE
Ithite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Statement of occupation. - l'recisc 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 everv 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.
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