USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 82
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Example
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onsct
1015
Chronic Interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1027
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 cither first, second, or third position. The principal cause in the above example
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 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 naine of the deceased, his supposed age, the disease of which he died, defined as required by scetion 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 buricd. No such permit shall be issued until there shall have been (lelivered 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 carly 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- Inoval; provided, that such body shall be returned to the town fromn 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 hercunder. 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 I 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. - Chap. 114, Sec. 45. G. L., as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
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.
.... Ife shall in all cases certify to the town clerk or registrar in the place where the deceased dicd his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held. or from a person appointed to have the care of the come- tery or burial ground in which the interment is made .... Chop. 114. Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physiclans 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 Ilealth 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 niedical attend- ance or whose physician is absent from home wlien 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 clectrical agents, and deaths following abortion, but also deatlis from disease resulting from injury or infection related to occupation, the sudden deaths of porsons not disabled by recognized disease
R-301A
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No 1 Washington Terrace
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. 207
Registered No (If death occurred in a hospital or institution,
Ward \ give its NAME instead of street and number)
2 FULL NAME
Gerogianna (Prior) Hamilton
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
1 Washington Terrace
Ward,
(If nonresident, give city or town and state)
months
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
12
1939
(Month)
(Day)
(Year)
6a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John Walter Hamilton
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years.
x
Months
21
.Days
If less than 1 day
.. Hours.
.. Minutes
8 Trade, profession, or particular kindof work done, as spinner, House work
sawyer, bookkeeper, etc ...
9 Industry or business In which
work was done, as silk mill,
saw mill, bank, etc.
Own home
10 Date deceased last worked
this occupation (month angept. 1939
11 Total time (years)
spent in this 61
occupation
12 BIRTHPLACE (City)
Duxbury
(State or country)Massachusetts
13 NAME OF
FATHER
George Prior
14 BIRTHPLACE OF
Duxbury
FATHER (City)
(State or country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Lydia Ann Sampson
16 BIRTHPLACE OF
MOTHER (City)
Duxbury
(State or
Massachusetts
17 Estella H Palmer
(Address39 Sumner Ave Springfield Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was Med with me BEFORE the burial.or transit permit was issued: Www. S. Clubdress x.
(Signature of Agent of Board of Health or other) Health Habeces 10/14/39 (Official Designation) (Date of Issue of Permit)
I HEREBY CERTIFY That I attended deceased from
January 10
1930 to.
October 121939
I last saw b en alive on. October 12 1939, death is said
to have occurred on the date stated above, at ... R. m. The principal cause of death and related causes of Importance la order of onset were as follows: acute Coronary Thrombosis Date of Oneet IMPORTANT
Sept18 1939.
Contributory muses of Importance not related to principal cause: acute pulmonary oedema
act12 1939
Name of operation«
none
.Date of.
What test confirmed diagnosis clausenly Was there an autopsy /20
labrating
20 Was disease or injury in any way related to occupation of deceased? ....
If so, specify
Jacob Lebjaus M
(Signed)
M. D.
(Ad
99562 lumley , Dat CT/31934
21 Mayflower Cemetery Duxbury
Relation, if any
Place of Burial, Cremation or Removal
Town)
October 14, 1939
19
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
winthrop Mass
ADDRESS
Received and filed. 19 .. ......
(Registrar)
100m.9. 37. No. 1859.i.
1 3 SEX Female 7 AGE 80 OCCUPATION PARENTS Informant, tion should be carefully supplied. Age should be stated LAnuitI. THISIcians should state Cause OF DEATH year) in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very See instructions and extracts from the laws on back of certificate. important.
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
(If U. S.
War Veteran
specify WAR)
(Usual place of abode)
Length of residence in city or town where death occurred
30years
months
days.
How long in U.S., if of foreign birth?
years
( daughter)
DATE OF BURIAL
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 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
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
COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
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, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, bis 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 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- 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 I'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 tany 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, CHIAP. 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 For 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 for the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . .- CHAP. 114, SEC. 46, G. L. (TERCENTENARY EDITION.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ob- servance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the ¡certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septi- cemia), and hy the action of chemical (drugs or poisons). thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not die bl.J. L.
L'INIV ...
CVHIN
HNI
R-301A
PLACE OF DEATH
Suffolk
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.
208.
.....
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(Ii U. S. War Veteran,
specify WĄR)
(a) Residence.
No
26 Sagamore Ave.
(Usual place of abode)
Length of residence in city or town where death occurred
yTs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct
14
1939
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That | attended deceased from
Oct 11
1939, to Oct 14
,
39
I last saw b. han allve on
Oct 14
1939
death Is sald
to have occurred on the date stated above, at /00 m.
The principal cause of death and related causes of Importance In order of onset were as follows:
Date of Onset IMPORTANT
aceite webothhis
secondary avenue
... Oct 5
Gancho- Americana
Oct 13
Contributory causes of importance not related to principal cause:
Name of operation
nor
.Date of.
What test confirmed diagnosis?
no
Was there an autopsy? NO
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
M. D.
(Address
108 Meridian St 25 Date 10/15/19 29
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holyhood Broo kline
(City of town)
(Cemetery)
Doct657 1939,
19
22 NAME OF
UNDERTAKER
Winthrop
Folmi HO males
ADDRESS
Received and filed
Cd. 21.
1939
(Registrar)
-
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
If less than 1 day
.Hours
.. Minutes
10 Date deceased last worked at
11 Total time (years)
this occupation (month and) 1939
spent in this
occupation.
I5
100m-12-'34. No. 2938-f
I HEREBY CERTIFY_that a satisfactory standard certificate of death was filed with me BEFORE the burial pr transit permit was issued:
(Signature of Agent of Board of Health or other)
Health Offices 18/17/39 (Date of Issue of Permit,
(Official Designation)
(City or Town) No.inthron Community Hospitals. Harris A.
Ward {
Cusich
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St., ...
Ward,
(If nonresident, give city or town and state)
days.
(County)
Winthron
2 FULL NAME
4 COLOR OR RACE
White
5a If married, widowed, or divorced
Catherine McNamara
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Days
Years
Months.
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
Clerk
9 Industry or business in which
work was done, as silk mill,
12 BIRTHPLACE (City)
Winthrop
(State or country)
Mass
13 NAME OF
FATHER
John F. Cusick
14 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Mary Harris
16 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Ma.s
17
Mrs, Edward Casey
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
saw mill, bank, etc.
Steamship
1 8 SEX Male 7 AGE 35 OCCUPATION PARENTS Informant information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state year) is very important. See instructions and extracts from the laws on back of certificate.
(Address)
241 Cottage PK, Rd.
Relation, if any Sister DATE OF BURIAL.
BUYRU UDILCU OLALes DIandara Certificate 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 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 whosa 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 what- ever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work donc.
9 .- The industry or business in which the work was done.
10 .- The month and year the deccased 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 "employce," "worker," "operative," etc. 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 generd! terms as "store. " "factory." "mill." etc. State the particular kind of store, factory, mill, etc., as grocery store, soat factory, cotton müll, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborcr" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as corpente?, painter. machinist, etc. D'stinguich chrefully between retail merchan's 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 ineans the discase, 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 diseascs.
Example
The principal cause of death and related causes! of importance in order of onset were as follows:
Date of onset
Arteriosclerosis
1919
.....
......
Chronic interstitial nephritis
1021
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.
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