USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 65
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301A
PLACE OF DEATH
BOSTON NOTIFIED Suffolk ali
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:
Hittarof Community Hasthetown) (If death occurred in a hospital or institution, give its NAME instead of street and number) (If U. S. War Veteran specify WAR)
2 FULL NAME
Baby Salamone
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No 335 maverick
St.
Ward,
802.
(If nonresident, give city or town and state)
months
days.
How long in U.S., if of foreign birth?
years
months
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
7 1939
(Month)
(Day)
(Year)
19
I HEREBY
CERTIFY
1959, to Cung
1939
That 4 attended deceased from
I last saw /
.alive on
19
death Is sald
to have occurred on the date stated above, at
m
The principal cause of death and related causes of Importance in order of onset were as follows:
Contributory causes of importence not related to principal cause:
Name of operation ...
What test confirmed diagnosis ?....
.Date of.
Was there an autopsy ?...
20 Was disease or injuly in any wey releted to occupation of deceased?
if so, specify
193
(Signed)
Raquale &
(Address) 235 Marchility
LAP SK Date 8/7/
...
., M. D.
صد21 J. Michael Boston mass (City or Town) 1939 Place of Burial, Cremation or Removal DATE OF BURIAL .......
22 NAME OF FUNERAL DIRECTOR . ADDRE Rox mauri tt. PB
Received and flied. .19
(Registrar)
100m-9.'37. No. 1859.1.
I HEREBY CERTIFY that a satisfactory/standard certificete of death was filed with me BEFORE the buyai or transit permit was issued:
(Signature of Agent of Board of Healer on other ) Health Office 2/1/39 (Official Designation) (Date of Issue of Permit)
(write the word)
7 AGE .. Years .. .Months Days .Hours ............ Minutes
Hinterop Mart
14 BIRTHPLACE OF FATHER (City) Bostan Mass
15 MAIDEN NAME OF MOTHER Evelyn Bracc
16 BIRTHPLACE OF MOTHER (City) (State or country) malden mass
17 dames Salomone (fattig)
Relation, if any
(County) * Winthrop mass. (City or Towa) (Usual place of abode) Length of residence in city or town where death occurred years PERSONAL AND STATISTICAL PARTICULARS 3 SEX 4 COLOR OR RACE temale white 5 SINGLE MARRIED WIDOWED or DIVORCED 5a If married, widowed, or 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. Stillcom If less than 1 day 8 Trade, profession, or particular kind of work done, es 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 occupation .. this occupation (month and year) 12 BIRTHPLACE (City) (State or country) (State or country) PARENTS Informant 335 Markus 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 THER James Salomone
Registered No.
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 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.
To be complete, an occupation return must state :
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or husiness 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 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 OF CERTIFICATEO
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 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 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 be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as re- aquired 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 hoard 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 he buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial 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 hy the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, hut 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)
Winthrop
(City or Town)
No. 125 Cliff Ave .. Winthrop
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
'lo 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)
2 FULL NAME
Emma Forsyth Brom
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
125 Cliff Ave., Winthrop
St.,
.Ward
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
40
years
months
dayı.
How long in U.S., if of foreign birth?
years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
.........
August
8
1939
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
George cm
(Giva maiden garas of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
84
.. Years
1
Months ...
28
.... Days
If less than 1 day
.. Hours
.. Minutes
8 Trade, profession, or particular
kindof work done, as spinner,
sawyer, bookkeeper, etc.
Housewife
9 Industry or business In which
work was done, as silk mill,
saw mill, bank, etc.
Retired
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City).
St. John
(State or country)
N. B.
13 NAME OF
FATHER
James Forsyth
14 BIRTHPLACE OF
FATHER (City)
(State or country)
not know
15 MAIDEN NAME
OF MOTHER
not know
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
not .... know
17 Walter H. Gordon
Iaformant
(Address)
65 Park St., Roxbury, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er /transit permit was issued:
.
(Signature of Agent of Boardwer Italia of other ) Health fuel 8/10/39
Official Designation) (Date of Issue of Permit?
19 I HEREBY CERTIFY. That I attended deceased from
august 6
19 39, to aug. 8
19.39
I last saw h .. C.h .... alive on.
august 2,
19.2.9 .. , death is sald
to have occurred on the date stated above, at 5 a. m. The principal cause of death and related causes of Importance la order of onset were as follows:
Date of Onset IMPORTANT
Generalizedarteriosclerosis Chronic miocarditis
1930
1935
Contributory causes of importance not related to principal cause:
Name of operation.
none
What test confirmed diagnosis? Clinical
...... (Date of.
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify die y Ruchuchor, M. D.
(Signedy ...
(Address) Winthrop ma
......
Date aug. 9 1939
Mt. Wollaston, Quincy
Place of Burial, Cremation or Removal, (City or Town)
DATE OF BURIAL
« ...
19
....
22 NAME OF
Richard 26 White
FUNERAL DIRECTOR
ADDRESS 147 Winthrop St. Winthrop
Received and filed. 19
(Registrar)
100m-9-'37. No. 1859.i.
OCCUPATION 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 PARENTS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
(write the word)
(L U. S. War Veteran
specify WAR)
(Usual place of abode)
21
Relation, if any
nephew
August 10, 1939
....
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 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.
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 aud 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 "einployee," "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 nepbritis
1921
Carebral 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.
medical officer shall forth- with, alter the death of a person whoin 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 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 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 hoard 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 heen 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 l'nited 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 he 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 Examinera 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-301A
Suffolk (County)
Winthrop
(City or Town)
No.
27 Tileston Road
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.
f (If dcath occurred in a hospital or institution,
St.,
Ward ( give its NAME instead of street and number)
2 FULL NAME
sarah Louise (Anderson) Tewksbury
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
27 Tileston Road
St.
Ward,
(Usual place of abode)
Leoxtb of residence in city or town where death occorred 63
years
months
days.
How long in U.S., if of foreign birth?
years
months
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
er DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
Frank (CiE maidra same of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter thet fact here.
Years
9
.Months
2
.Days
If less than 1 day
Hours.
Minutes
8 Trade, profession, or particular kind of work done, as spinnei, sawyer, bookkeeper, etc ....
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