USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 40
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(2) Board of Health physicians will certify to such deaths only as those of persons who, though disahlcd bv recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septi- cemia), and by the action of chemical (drugs or poisons ). thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
lesly
R-301A
PLACE OF DEATH
Suffolk County) Winthrop (City or Town) 10 nevada
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.
§ (If death occurred in a hospital or institution,
.St.,.
Ward \ give its NAME instead of street and number)
(If U. S. War Veteran
( specify WAR)
St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
years
mouths
days.
How long in U.S., if of foreign birth?
years
months
days.
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
april
29
1939
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That ! attended deceased from april 23 19 39, 10 april 29, 19 39.
i last saw her ... allve on
april 29
19 39, death is said
to have occurred on the date stated above, at 10 P.m. The principal cause of death and related causes of Importance in order of onset were as follows:
1 Coronary
auricula fibrillation
4-23.59
Heart black Renal failure
4-25-39
4-27-39
Contributory causes of importance not related to principal cause: Diabete es mellitus arteriosclerosis
Name of operation.
What test confirmed diagnosis ?.
Ekg
......
.Date of
.. Was there an autopsy?
20 Was disease or Injury in any way related to occupation of deceased? bo
If so, specify
...
(Signed)
M. D.
(Address).
287th
Shirley It With Date 4-30
1939
David View Choulim, W. Rot- 21
1
Place of Burial, Cremation or Removal City or Town)
DATE OF BURIAL
aqui 30
1939
22 NAME OF
Benjamint-Solomono
UNDERTAKER ...
"420 HARVARD ST BROOKLINE. MASS.
ADDRESS
Received and filed.
MAY-2-1939
19
(Registrar)
100m 12-'35. No. 6156F
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D. Childrens
(Signature of Agent of Board of Health or other)
agent
f april 30/39
(Official Designation) (Date of Issue of Permit)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1
No ..
2 FULL NAME
Etta Millan
(a) Residence.
No.
lo nevada
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
(write the word)
Female White
4 COLOR OR RACE
5 SINGLE
MARRIED
undowed
WIDOWED
6a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
.....
6 IF STILLBORN, enter that fact here.
7
67
... Years.
.. Months
.. Days
If less than 1 day
Hours ...
......
.Minutes
AGE
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ..
10 Date deceased last worked at
11 Total time (years)
OCCUPATION
Riga
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Israel Sopran
14 BIRTHPLACE OF
FATHER (City) ...
Riga
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Sorria Orfino
16 BIRTHPLACE OF
MOTHER (City)
PARENTS
(State or country)
17
Freda Cappon
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
9 Industry or business In which
work was done, as silk mill,
Relation, if any
(daughter
(Address) SProsned Bry detanony hitt.
tion should be carefully supplied. Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH
saw mill, bank, etc ..
our home
occupation ...
47
year)
Bail 1939
spent in this
Date of Onset IMPORTANT
vidtco vidudard Certificate of Deal
Statement of occupation. - Precise 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, etc.
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 cause, 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 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 cxample happens to be the second cause given.
COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A pbysician 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 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 have been delivered to such board, agent or clerk, as the case may bc, 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 shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was re- moved within thirty-six hours after such removal. unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall ap- pear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death. which the clerk or registrar may require .- CHAP. 114, SEC. 45,, G. L. (TER- CENTENARY EDITION.)
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. .- GEN. LAWS, CHAP. 38, SEC. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- GEN. LAWS, CHAP. 38, SEC. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. .. .- CHAP. 114, SEC. 46, G. L. (TERCENTENARY EDITION.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ob- servance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septi- cemia), and by the action of chemical (drugs or poisons). thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
R-301
Tayland
.
G
39
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
96
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME ERNEST L. SANDWELL
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Wayland, Mass.
.St., .......
.. Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
If less than 1 day Hours ......... ... Minutes
C.C.C.
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
spent in this
year) ............................. 1.9.30 ...
.......
occupation
18 NAME OF
FATHER
Leslie g. Sandwell
14 BIRTHPLACE OF
FATHER (City)
Unknown Manchester
15 MAIDEN NAME
OF MOTHER
Caroline &. Moog
Unknown
Unknown
Roxbury
(State or country)
Unknown
mass.
Relation, if any Informant Registrar, Sta Hosp Ft Banks, Lass.) (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: L
battle "(Official Designation)
(Signature of Agent of Board of Health of other)
(Date of Issue of Permil) / 39
5/1
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
30
1939
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
April 10,
19.39, to.
April 30,
19.39.
I last saw h.j.m.
... ailive on ..
April 30
19 .. 3.9, death is sald
to have occurred on the date stated above, at. J.0 :25 m. The principal cause of death and related causes of importance in order of onset were as follows:
1. Valvular heart disease aortic and mitral insufficiency. 2. Rheu- matic fever chronic involving
.Unknorm
joints of extremities. 3.Anemia
secondary severe. Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis?
Date of
Was there an autopsy ?.
No
20 Was disease or irgjury in any way related to occupation of deceased?
If so, specify
(Signed)
JOSEPH RICH, Capt, N.C.
M. D.
(Address) Fort Banks, Mass.
Date May 1, 19 39
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
May
Lakeview - Wayland
DATE OF BURIAL
(Cemetery) 3,
(City of own)
1934
22 NAME OF
UNDERTAKER
Ville Funeral Service
ADDRESS
Cochituate, Mass
Received and filed. 1939
19
A TRUE COPY, ATTEST: (Registrar)
100m-12-'34. No. 2938-e
(County)
1
„INTEROP
3 SEX
Male
4 COLOR OR RACE
White
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
18
AGE
Years ...
-
.. Months.
13 Days
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,
OCCUPATION
12 BIRTHPLACE (City)
Lass.
(State or country)
(State or country)
Unknown
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
17
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
saw mill, bank, etc.
C.C. C.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
SUFFCLK
PLACE OF DEATH
(City or Town) Sta Hosp, Fort Banks, Mass. No ...
St., ...................... Ward
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred
YTs.
HOS.
days. How long in U. S., if of foreign birth?
yrs.
Date of Onset
truncate of ve
Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits ean be known. Make some entry in this seetion for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman wliose 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, ete. For a person who had no occupation what- ever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was 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," ete. Find out the parti- cular 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." ete. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, ete.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechonicol engineer, mining engineer, stationory engineer, ete. Avoid the term "laborer" when a more precise statement of the oceupation ean be secured. Do not use the word "mechanie, " but give the exact occupation, as corpenter. painter, machinist, ete. Distinguish carefully between retail merchants and wholesole 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, c. g., heart failure, asphyxia, asthenia, ete. 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 eause. Under contributory causes of importance not related to principal eause, 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
1013
Chronic interstitial nephritis
1021
Cerebrol hemorrhoge
July 5. 1927
...
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal eause and related causes, the eauses should be given in the order of onset, so that in a group of three eauscs 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.
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 registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or offieer 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 elerk 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, ct 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 sueh board, agent or clerk, as the case may be, a satis- factory written statement containing the faets 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 eannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the 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 eause of the death, which the clerk or registrar may require. - Chop. 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 violenec .... Gen. Laws. Chap. 38, Scc. 6.
.... He shall in all cases certify to the town elerk or registrar in tho place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the eause and manner of death .-- Gen. Lews, Chap. 38, Sec. 7.
1
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 eare of the eeme- tery or burial ground in which the interment is made .... Chop. 114, Sec. 46, G. L., (Tercentenory Edition.)
RULES OF PRACTICE
The fulfillinent of the purpose of these laws calls for the observanee of the following rules of practice:
(1) Attending physicians will certify' to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized diseasc un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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