USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 1
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一节
حصر
J. L. FAIRBANKS DIV. Thomas Groom & Co. Stationers 105 State St., Boston
To duplicate this book order No. 9228-11
FORM R-305
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD MARGIN RESERVED FOR BINDING
No. 3 SEX Female AGE. Years 9 Occupation: 10 or Business: 15 MAIDEN NAME OF MOTHER PARENTS 25m-10-'39. No. 8427-g of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (Sce Chap. 46, Sec. 12, G. L.) Coples of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time - (State or country)
PLACE OF DEATH
Suffolk (County)
Revere
1495 North Shore Road
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
REVERE
(City or town making return)
Registered No.
$ (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Ruth Mildred Allen (Russell)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
240 Winthrop Shore Drive
.St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ....
years
months
days.
In this community
yrs.
mos. days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
January
1943
18 DATE OF
DEATH.
(Month)
(Day)
(Year)
19 ! 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.) Acute Cardiac Failure
Probably Coronary Sclerosis Hypertensive Heart Disease
20 Accident, suicide, or homicide (specify).
Date of occurrence 0
Where did Injury occur? (City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place ? Collapsed sidled quickly ..... ...
Manner of Injury
Nature of Injury
No
While at work ?.
Was there an autopsy ?.
21 Was disease or lojury lo any way related to occupation of deceased ?
I! so, specify W/m. J. Brickley.
(Signed) ..
Boston, Kass.
(Address)
Date
19
22 Winthrop, winthrop
Place of Burial, Cremation or Removal.
January
4
(City or Town)
43
FUNERAL DIRECTOR
C. R. Bennison
1 ADDRESS Winthrop, Mass.
Received and Blad
19
(Registrar of City or Town where deceased resided)
B
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
8
52
8
Months
Days
If less than 1 day
Hours
Minutes
Usual At Home
Industry Keeping House
11 Social Security No.
None
12 BIRTHPLACE (City)
South Boston,
(State or country) lass.
13 NAME OF FATHER Herbert Russell
14 BIRTHPLACE OF
FATHER (City)
Unable to obtain
(State or country)
Unable to obtain
16 BIRTHPLACE OF MOTHER (City) Unable to obtain
Relation, if any
17 Mrs. Ruth Carlton ... ( Daughter)
Informant (Address) 2010 Shore Drive Winthrop Hasta NAME OF
A TRUE COPY.
ATTEST.
(Repetiu uf city or town where death occurred)
DATE FILED January 6, 43
19
(write the word)
Widowed
5a If married, widowed, or divorced HUSBAND of
LesteriveDom At Hen inteceased
(or) WIFE of (Husband's name in full)
4 COLOR OR RACE 5 SINGLE
White
MARRIED
WIDOWED
or DIVORCED
Winthrop
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
None
1
Jan. . M, D43
DATE OF BURIAL
19
FORM R-301!
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
200m-10-'39. No. 8427-d
I HEREBY CERTIFY, that a satisfactory standard certificate of death was Eled with me BEFORE the burial of transit permit was issued: Www. D. Cfut dress. (Signature of Agent of Board of Health or other) Healthe Office
(Official Designation) (Date of Issue of Pofmit) / 1/4/43
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
2.
1943
(Month)
(Day)
( Year)
HEREBY CERTIFY. That I attended deceased from
42
pour. 2
19 ×3
I last saw h. W.x alive on .......
to have occurred on the date stated above, at.
8 th m.
Duration
...
1 Day. ...
...
1 yr. ...
Due to
Chronic kaphentes and
Lecridomy Queria
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of .......
Of autopsy
What test confirmed diagnosis ?.
7
to
20 Was disease or lojory in aoy way related to sccopatioo of deceased ?
If so, specify.
Sama. H. Schwartz
.. M. D.
(Signed)
19 Princeton Str C13 Date 1/21923
(Address)
21 Place of Burial, Cremation or Removal (City of Town)
DATE OF BURIAL V 19
22 NAME OF
FUNERAL DIRECTOR
John J@ Maler.
ADDRESS
Received and filed
A TRUE COPY ATTEST:
(Registrar)
MARGIN RESERVED FOR BINDING
1 PLACE OF DEATH 3 SEX HUSBAND of (or) WIFE of. Usual 9 Occupation: 17 Informant (Address) is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Industry 10 or Business:
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return) ...
Registered No
2
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
MAY CARNES MASON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Shirley2
St.
months
7
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
5a If married, widowed, or divorced
+T (Give maiden name of wife in full)
(Husband's name in full)
47
6 Age of husband or wife if alive. .years 7 IF STILLBORN, enter that fact hero.
8 AGE Years Months. Days
If less than 1 day
.. Hours .......
Minutes
House "i +
11 Social Security No.
Boston
12 BIRTHPLACE (City)
(State or country)
13 NAME OF FATHER
14 BIRTHPLACE OF
FATHER (City)
Jennai
(State or country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
1
.07 Relation, if any
........
No
St. (
(I U. S.
War Vete on.
specify WAR).
2 FULL NAME
(a) Residence. No ....... O. (Usual place of abode) ! ength of stay : In hospital or institution (Specify whether)
years
(If nonresident, give-city or town and state)
19
Que. 24.
19
....... , to ...
Sac /1.
19 /2
death is said
Immediate cause of death .....
arquia Pretorio
Due to
Arterio- Silencio
...
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
..........
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, 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 be died, defined as required by section one, where same was contracted, the duration of bis 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 bas 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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- incr 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 commonwealth 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 a removal shall constitute a permit for such removal ; 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 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 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 fur- nish 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., (Tercentenary Edition.)
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 bave 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 observ- ance 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 ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to sucb deaths only as those of persons who, though disabled by recognized discase un- related 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 septice- inia), 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 occupa- tion, the sudden deathis of persons not disabled by recognized disease, and those of persons found dead.
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 con- ditions, if any, related to the principal cause and any important complieation of the principal cause.
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 bad been given up or changed on account of the disease causing deatb, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual 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. 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 bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FORM R-301 A
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and N. B .- WRITE PLAINLY. WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of Information extracts from the laws on back of certificate. should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. PARENTS
100M-G - 2-42-8855
PLACE OF DEATH
(County)
1
(City or Town)
No. TOR Court, Rd
The Commonforalil 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.
3
Registered No.
S ( If death occurred in a hospital or institution, St. [ give its NAME instead of street and nuniber) PHYSICIAN · IMPORTANT
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
St.
(If nonresident, give city or town and State)
2
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEĮ
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED .
1.70
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
years
> IF STILLBORN. enter that fact here.
8 63 Years . Months Days
If less than 1 day Hours Minutes
Usual 9 Occupation :
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( Siate or country)
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (Clty) (State or country)
15 MAIDEN NAME OF MOTHER
7
16 BIRTHPLACE OF MOTHER (City) (State or country)
(Address) 144 Prot hun 89, Date 1/4
19.5 ... 2
21
l'Isce of Burial, Creniation or Removal. DATE OF BURIAL .. (City or Town) John F. Omalen 19
22 NAME OF FUNERAL DIRECTOR ....
ADDRESS
(Signature of Agent of Board nt thatthe other)
Health Office جيه/ 1/4
(Omcial Designation) ( Date of Immue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
191 HEREBY CERTIFY. 17 1942, to 3 19.52
I last saw h ............. allve on ........ grik.hmm ... ms 195:2, death Is sald to
have occurred on the date stated above, at ........
Je25 G. m.
Immediate cause of death.(.
Duration
IMPORTANT
Due to.
Decommander Crowe
17dias
Due to .....
· Michal Strmenin + /mofacung. yani
-
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
Underline the cause to u hich death should ba charged sta- tintically.
20 Was disease or injury in any way related to oooupstion of deceased ?. and ...
If so, spsolfy ... y
(Signed).
M. D.
17 Informant ( Address)
(
Relatlon, If any
I HEREBY CERTIFY thst & satisfactory standard certificata of death was filled with as BEFORE the barhud or fransit permit was Issued : Win.S. Children &
Raosived and Alsd
19
(Registrar)
....
Major findings :
Of operations
Date of. -
Of autopsy.
What test confirmed diagnosis? Cancel
3 1943 ....
That I attended deceased from
(Give maiden name of wife in full)
(Was deceased
U. S. War Veteran,
if so epeoify WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or ragistared hospital medical officer shall forthwith, 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 name of the deceased. his supposed age, the disease of which he died. defined as re- quired by section one. where same was contracted. the duration of his last illneaa, when laat aeen alive by the physician or officer and the date of his death ... Gen. Lawa, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, served In the army, navy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war. and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, auch physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen. the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place hetwcen February fourteenth, eigliteen hundred and ninety- eight and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undartaker 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 haa received a permit from the board of health, or its agent appointed to lasue such permita, 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 froin 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 haa received a permit from the board of health or ita 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 inay be, a satisfactory written atatement containing the facta 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, aa required by law. o1 in lieu thereof a certificate aa hereinafter provided. If there ia no attending physician, or if, for sufficient reasona, hia certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who ia a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death is caused by violence, the medl- cal examiner shall make such certificate. If auch a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the posaesaion ot the undertaker desiring to make such removal shall constitute a permit for such removal; 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 containa a recital, aa required
by section ten of chapter forty-six, that the deceased aerved in the army, navy or marine corps of the United States In any war In which It has heen 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 nece+ sary information which can be obtained as to the deceased, or as to the manner of cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition ).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the hoard of health or its agent appointed to issue such permita, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the Interment ia made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examinera 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 hody of such a jerson, he shall forthwith go to the place where the hody lies aud take charge of the same; ... - General Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health phyalolans will certify to such deatha only aa those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose physi- cian ia ahsent from home when the certificate of death ia needed.
(3) Medloal Examinars will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease rasulting from injury or Infaotion related to occupation, the sudden deaths of persons not disablad by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the dlaease, or complication which causea death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng death. As related causes, name earlier morbid conditiona, if any, related to the principal cause and any Important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation la very Im- portant, so that the relative healthfulnesa of various pursuits can be known. Make some entry in this section for every person aged 10 yeara or over. If the occupation had been given up or changed ou account of the discase causing death, report the usual occupation prior to Illness. If the deceased had retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at hoine. For a woman whose only occupatiou waa that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
muºfolk .
(County)
lint rop
The Commontoralth 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.
S ( If death occurred in a hospital or institution, St. { give its NAME Instead of street aud nuniber)
Nellie Corbett Thompson
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give alao maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so speolfy WAR)
(a) Residence. No.
76 Woodside Park
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
yeara
months days.
In this community
20 yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
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