USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 73
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(Signed
quintino/ mars
9/19 1938
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL.September .... 20
19.38.
22 NAME OF
UNDERTAKER
Charles .......... Bennison
Received and filed ..
SEP 22 1938
......
..... 19
(Official Designation)
(Registrar)
100m-12-'34. No. 2938-f
1
3 SEX
Male
7
AGE
86
OCCUPATION
PARENTS
Informant
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
year)
is very important. See instructions and extracts from the laws on back of certificate.
19
P
Defit, 12,
HEREBY CERTIFY That I attended deceased from
I last saw hed ....... allve on
(Month)
(Day)
17
1938
(Year)
St., ...
Ward
(If U. S.
War Veteran,
specify WAR)
M. D
PLACE OF DEATH
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 deatb, 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 domestie 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 wbat- ever write none.
To be complete, an occupation return must state:
8 .- Tbe trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- Tbe 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 parti- eular kind of work done and return that, as spinner, weaver, etc.
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, cotion mill, ete.
Distinguish earcfully 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 wbo sells goods should be called a sales:nan and not a clerk.
Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the inode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing deatlı. 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 eause, name other important diseases,
Example
Tbe principal cause of death and related causes! of importance in order of onset were as follows: Arteriosclerosis ....
Date of onset
1015
Chronic interstitial nephritis
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 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 seetion 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 buman body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained 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 sooncr obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnislı for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Ckap. 114, Sec. 45, G. L., (Tercentenary Edition.)
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. 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 carc 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 eare 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 wben 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 deatbs 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.
301A
1
PLACE OF DEATH
Suffolk
(County)
Brookline
(City or Town)
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.
1.82
f (If death occurred in a hospital or institution, .St., Ward ( give its NAME instead of street and number)
2 FULL NAME
Paul I. Pekler
(If deceased is a married, widowed or divorced woman, give also maiden namc.)
(a) Residence.
No.
42 Ocean Ave.,
(Usual place of abode)
St.
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
25
years
months
days.
How long in U.S .. if of foreign birth?
years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
: ale
4 COLOR OR RACE
hite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
18 DATE OF
September
17
1938
DEATH
.....
(Month)
(Day)
(Year)
6a If married, widowed, or divorced
HUSBAND of
Dorothy A. Ross
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter thet fact here.
AGE
7
59
Years
6
Months
Days
25
If less than 1 day
Hours
Minutes
OCCUPATION
9 Industry or business in which
work was done, as silk will. IT Eng. waste Co.
saw mill, bank, etc ....
10 Date deceased last worked at
11 Total time (yeers)
this occupation (month and July 1938
spent in this
25
year)
occupation ..
12 BIRTHPLACE (City)
(State or country)
Germany.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany.
15 MAIDEN NAME
OF MOTHER
Cannot be obtained
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany.
17
Dorothy R Pekler
(
ife
Informant
(Address) 12 Occan ve inthron,
I HEREBY CERTIFY that e satisfactory standard certificate of deeth was Med with me BEFORE the burial of transit permit was Issued: u. D. Childrenxx
(Signature of Agent of Board of Health or other )
He althe officer
(Official Designation)
(Date of Issue of Permit)"("
9/19/38
MEDICAL CERTIFICATE OF DEATH
19 I HEREBY
CERTIFY / That & attended deceased from
June 20
1938 10 September 1/1938
A last saw h.6.2.&.1.allve on.
September 17,1938, death is said
to have occurred on the date stated above, at 10 Pim. Date of Onset IMPORTANT The principal cause of death and related causes of Importance la order of onset were as follows: acute Coronary
Thrombose
Sept 17 1938
Contributory causes of Importance not related to principal cause: arquia Pectoris
9 1935
Name of operation
none
Date of
What test confirmed diagnosis Clinical
.Was there an autopsy
20 Was disease or Injury in any way related to occupation of deceased?
If so, specify
7.
no
....
(Signed)
: . M. D.
(Address) 562 Shirley Date
Leptin 38
lbrutto, Mars
21 ...
Forest Fil
IS Crematory-Boston
Relation, if any
Place of Burial, Cremation or Removal.
(City or Town)
Cept.
,20
75.0
Eastman
22 NAME OF
UNDERTAKER
'astron
uneral
Lervice
ADDRESS
896
Beacon St., Boston.
19
Received and filed.
SEF 2 2 1938
(Registrar)
---
in plain terms, so that it may be properly classified. Date of onset and exact statement of OccuPATION are very important. See instructions and extracts from the laws on back of certificate.
100m I1 30 No. 9080 F
13 NAME OF
FATHER
Cannot be obtained
Pipler
3 Trede, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
Accountant
(write the word)
No.
42 Ocean Ave.
(If U. S.
War Veteran
specify WAR)
DATE OF BURIAL
19 .. 38
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 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, 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:
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.
RETURN Q
A physician or registered hospital medical officer shall forth- with, alter the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his sup- posed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the late 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 therc shall have been 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 be accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, as re- quired by law, or in lieu thereof a certificate as hereinafter pro- vided. If there is no attending physician, or if, for sufficient rea- sons, his certificate cannot be obtained early enough for the pur- pose, or is insufficient, a physician who is a member of the board of health. or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attend. ing physician. If death is caused by violence, the medical examiner
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 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 fromn 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.
shall make such certificate.
₹-303 B
PLACE OF DEATH
[(county) Hantherip (City or Town) No. 20 Bel her St
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH s৳ Ward
To be filed for burial permit with Board of Health or its Agent. 102
Registered No ....... (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Catherine A.
{O 'Brien
CUNNING
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 20 Belcher St Wushu.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos. .
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
DEATH
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
33
Years .Months
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, saw mill, bank, etc .. Om Home
10 Date deceased last worked at
this occupation (month -and - 2
11 Total time (years)
spent in this
occupation ...
50
12 BIRTHPLACE (City)
souti Borton
(State or country)
lass
13 NAME OF
FATHER
Peter O'Bri
14 BIRTHPLACE OF FATHER (City)
(State or country)
Ir 1 7
15 MAIDEN NAME
OF MOTHER
Apr Meksens
16 BIRTHPLACE OF MOTHER (City) (State or country) Irland
Daughter)
I HEREBY CERTIFY that a satisfactory standard certificate of death was Afved with me BEFORE the burial or transit permit was issued:
dealte officer (Official Designationf
Signature of igst of Board of Heald Tener ) , 19/19/38 (Date of Issue of Fermit)
19 I 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.) . Charrua my occurditos Tenilite Fractured Right jemun
tell accidentally in her home on Sept-10-1938
(See reverse side for description for unknown person )
20 IN WHAT CITY OR TOWN
WAS INJURY SUSTAINED ?
(Signed)
, M. D.
(Address)
at-181038
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Pirthron
nt? now!
(Cemetery)
(City or town)
DATE OF BURIAL
2020
.. 19
22 NAME OF
UNDERTAKER ......
Jolm F @ Maley.
ADDRESS
Received and filed, 19
SEP 2 2 1938 Registrar)
1 3 SEX - (or) WIFE of 7 AGE OCCUPATION PARENTS 17 Informant (Address) DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNERS OF year) of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
4 COLOR OR RACE
7
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
52727-17-1938
.Ward,
(If U. S. War Veteran,
specify WAR)
(If nonresident, give city or town and state)
Sm-12-'34. No. 2938-g
EXTRACTS
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS 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 regis- tration 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 con- tracted, 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.
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