USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 4
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PLACE OF DEATH
Sultorio (County)
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.
Q
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Ette geraldine Harrison
(If U. S. War Veteran,
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. No ....
9 Floyd St. Anthrop,
.. Ward,
(If nonresident, give city or town and state)
Length of residence in city or lown where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 STX
4 COLOR OR, RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
pa If married, widowed, or divorced
HUSBAND of .......
Paderno arriscar.
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 77
AGE
Years
Months
Days
If less than 1 day
... Hours.
.........
.. Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, hookkeeper, etc.
at- home.
OCCUPATION
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.
12 BIRTHPLACE (City)
(State or country)
Ottawa Canada.
13 NAME OF
FATHER
James ti Walls.
PARENTS
14 BIRTHPLACE OF
FATHER (CitTY
....
Valcartier Can.
(State or country)
15 MAIDEN NAME
OF MOTHER
unknam
16 BIRTHPLACE OF MOTHER (City)
(State or country)
Ottawa Can.
17 JErald Harrison San
Informanl (Address) 70 Edocinare Ra. Delmonte
THEREBY CERTIFY that a sansfactory standard certificate of death was filed with me BEFORE the buNal or transit permit was issued:
(Signature of Agent of boerd of Health or other)
(Official Designation) Tophe of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jan-
17-
1939
(Month)
(Day)
(Year)
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.) Lobar Pneumonia. 5 emil its
Found collepark ou hus flour
Jan-1111939
(See reverse side for description for unknown person )
20 IN WHAT CITY OR TOWN
WAS INJURY SUSTAINED ?.
(Signed)
1-17
M. D.
39
Date
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
but. aubran Crematory 19 (Cemeter au 19/19.
(City or town) Y
DATE OF BURIAL.
22 NAME OF
UNDERTAKER
0
Vroston
ADDRESS
Received and filed JAN 20 1939
19
(Registrar)
5m-12-'34. No. 2938-g
1
Registered No.
No.
(City of Town) 9 Floyd St. St., Ward
(Usual place of abode)
600
(Address)
Bartin
this occupation (month and
year)
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- witb. 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.
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 he 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 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 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 sball 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 deccased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of 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. - Chop. 114, Sec. 45, G. L. (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the aslies 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. (Tercenten- ary 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. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ;...- General 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; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease 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 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.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident. " "Pistol shot wound of the chest with. associated hemorrhage, homicidal." ' "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anæsthetic. " "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. Ifinvestigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorr- hage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-301A
Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH
tion should be carefully supplied.
00m 11.'36. No. 9080.F
I HEREBY CERTIFY that a satisfactory standard certificate of death was thed with me BEFORE the burial/or transit permit was issued: Mag Guldrech
signature of Agent of Board of Theand of other) Health Afecer /2/39
(Official Designation)" (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
27
1939
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Jan. 16
19.3.9., to.
Jan .... 21
19 ... 39
I last saw him .allve on Jan. 20 19.39, death Is sald to have occurred on the date stated above, at ......: 55am The principal cause of death and related causes of Importance lo order of onset were as follows: Date of Onset IMPORTANT Tuberculosis, pulmonary, acute,
miliary, ... right .lung, .... chronic.,
Unknown
active, left lung.
Contribatory causes of importance not related to principal cause: Pulmonary hemorrhage.
Jan 16/39
Name of operation
--
What test confirmed diagnosis ?.
Date of.
Was there an autopsy ?... NO.
20 Was disease or Injury in any way related to occupation of deceased?
If so, specify
(Signed)
Charles W. Sale, Lt. Col.1C
M. D.
(Address) Fort Banks, lass. Date Jan 2119 39
Jak
Fall farei
2K Place of Burial,
Pination or Removal.
DATE OF BURIAL 24
22 NAME OF UNDERTAKER
178 Unter 5 Ile Here
ADDRESS
Received and filed
JAN.2.1.1939
1
(If U. S. War Veteran specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
881.Malnut
( Usual place of abode)
Length of resideoce in city or town where death occurred ="years " mooths
4 days. -
How long in U.S., if ol foreign birth?
years -
months
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
6a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
If less than 1 day
Hours.
Minutes
10 Date deceased last worked at
11 Total time (years)
spent in this
?
occupation.
unknown
Unknown.
17 Registrar Sta Hosp Ft Banks, Dass. (Address)
Relation, if any
PLACE OF DEATH
SUFFOLK (County)
2.8/39 The Commonwealth of Alassachusetts 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. 9
f (If death occurred in a hospital or institution, .Ward ( give its NAME instead of street and number)
1
WINTHROP
(City or Town),
2 FULL NAME
RANDOLPH GILL
8 SEX
L'ale
4 COLOR OR RACE
Colored
(or) WIFE ol
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
20
Years
3
Months
7 Days
8 Trade, profession, or particular
kind of work done, as spinner,
CCC
sawyer, bookkeeper, etc ....
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
CCC
this occupation (month and.
OCCUPATION
year) Jan. 10, 1939
12 BIRTHPLACE (City)
Unknown
(State or country)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Unknown
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
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
-
13 NAME OF
FATHER
Unknown
Fall River
No. Station .. Hospital,Fort. Banks, Nass ....... St., ..
St.,
Ward, Fall .. River, .. Lass.
(If nonresident, give city or town and state)
(City 1939 .. 19. -
15 .........
(Registrar)
.....
GOVERNING THE
Statement of occupation. Precise statement of occupation is very important, so that the relative healthfulness of various pur. suits can be known. Make some ent y in this section for every person aged 10 years or over If the occupation had been given up or changel on account of the disease causing death. icpoit 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 :
The trade, profession, or particular kind of work done. 8.
9 The industry or business in which the work was done.
10 -The mouth and year the deceased last worked at the occupation.
The number of years the deceased followed the occupation. 11
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 husincss. avoid the use of such gen. eral terms as "storc." "factory." "mill." ete State the particular kind of state, factory, mill, etc. as GROCERY STORE, SOAP FACTORY, COTTON MILL .. etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as CIVIL ENGINEER, MECHANICAL ENGIN- YER. 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, Nor the mode of dying. E. G., heart failure, asphyxia, asthenia, etc. As principal causc 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. U'nder contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importanec in order of onset were as follows:
Dste of Onset
Arteriosclerosis ...
1915
Chronsc interstisial 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 canse may appear in either first, second, or thud position. The principal cause in the above example happens to be the second cause given.
RETURN OF CERTIFICATES 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, furuish 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 elate of his death. . GEN. LAWS, CHAP. 46, SEC. 9.
No undertaker or other person shall hury 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 hoard, 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 tomh 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 afoirsaid or from the clerk of the town where the body is buried. No such permit shall he 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 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 rca- 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 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 he 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 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 body has been sooner obtained hereunder. If the death certifcate 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 eer- 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.
.... Jle 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 peintits, or if there is no such board, from the clerk of the town where. the hody 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 bv 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.
R-301A
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
10
§ (If death occurred in a hospital or institution, Curry. 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.)
20-Sea francest.
Que Ward,
Winthrop, head
(If nonresident, give city or town and state)
How long in U.S., if of foreign birth? 5 years - months ~ days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
A.(write the word)
Wideweb
Da If married, widowed, or diforced HUSBAND of
(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 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.
Tailor-for
.
10 Date deceased last worked at
11 Total time (ears)
spent in this
Occupation yra
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Sanne Levine
PARENTS
15 MAIDEN NAME
OF MOTHER
Cannotbe learned
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Informant ... .... (Address) 20-Jea María
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE theburial or transit permit was issued:
1 Childressd-
(signature of Ageny of Board of Health or other)
Hallo
Officer
1/2//39
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Jan.
21
1939
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFR. That i attended deceased from
Email 19 3 85
to
19.
21
39
last saw h Am alive on.
to have occurred on the date steten above, at. 6.30 P.m.
The principal cause of death and related causes of Importance In order of onset were as follows:
Date of Onset IMPORTANT
Central Hemorrhage
1/19/39 ....
Hy protrusion Groucho neumonia Corbibatory causes of Importance not related to principal cause:
1/9/39
...
artemis Selectie NL
2 1933
Name of operation ....
Date of ....
What test confirmed diagnosis?
.Was there an autopay?
20 Was disease or Injury in any way related to occupation of deceased? If so, specify
(Signed) Ribadumia, M. D. (Address) 26 Vlauewas Lac Date :////1936 Beth Jacob Con L'olio 21
Place "of Burial, Cremation or Removal. (City or Town)
22 NAME OF
UNDERTAKER
ADDRESS
Received and filed ...
JAN. 24 1939
(Registrar)
Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH
tion should be carefully supplied.
important.
100m-12-'35. No. 6156F
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