USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 11
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(3) Medieal 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- mla), 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 deaths 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 eausing death. As related causes, name earlier morbid con- ditions, if any, related to the principal eause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of oceupation 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 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 had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
PLACE OF DEATH
WORCESTER
(County)
RUTLAND
(City or Town) Rutland State Sanatorium
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
Registered No.
15
33
(If death occurred in a hospital or institution,
St. (
give its NAME instead of street and number)
2 FULL NAME
Gertrude Theresa
Rouillard
(If deceased is a married, widowed or divorced woman, give also maiden name.)
266 Main
St.
Winthrop. Mass.
Length of stay: In hospital or institution ...
(Specify whether)
months
23
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE 5 SINGLE
White
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a lf married, widowed, or divorced
HUSBAND of
Samue Give maiden name of wife in full)
(or) WIFE of
Rouillard
(Husband's name in full)
57
years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
ÅGE 5.4
Years.
7
Months.2.3 .. Days
lf less than 1 day
Hours ....
Minutes
Usual
9 Occupation:
Housewife
Industry 10 or Business:
11 Social Security No.
None
Brooklyn
12 BIRTHPLACE (City)
(State or country)
New York
13 NAME OF
FATHER
James Cahill
14 BIRTHPLACE OF
FATHER (City)
Brooklyn
(State or country)
New York
15 MAIDEN NAME
OF MOTHER
Mary Jane Doyle
IG BIRTHPLACE OF
MOTHER (City)
Brooklyn
(State or country)
New York
17 State San Records.
Relation, if any
(Address) Rutland Mass.
A TRUE COPY.
ATTEST:
Frances.Hanfl
(Registrar of city or town where death occurred)
DATE FILED
February 9,1940
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
February
9.
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY
That I attended deceased from
February 17
19 39
February
19.40
I last saw h .......... alive on
February 9 1940
death is said
to have occurred on the date stated above, a
12: 20 Aspiration
Immediate cause of death.
7
Pulmonary tuberculosis
About 4 year
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
--
Of operations
.Date of.
Of autopsy
No
autopsy
should be charged sta-
What test confirmed diagnosis ? Phys x-ray laistically.
20 Was disease or injury in any way related to occupation af deceased ? Unknown
(Signed)
(Address)
State San Rutlandhate 2/9
19 .. 4.0
21 PLACE OF BURIAL,
Wyoming Melrose Mass.
DATE OF BURIAL
February 12,1940
19
22 NAME OF
Richard White
FUNERAL DIRECTOR
ADDRESS.
Winthrop , Mass.
Received and filed 19
(Registrar of City or Town where deceased resided)
of death should he transmitted on Form R-302 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. (See Chap. 46, Sec. 12, G. L.) PARENTS 50m-10-'39. No. 8427-f
1
No.
(lf U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Sanatorium
years
11
(If nonresident, give city of town and gtakg)
Underline the cause to which death
If so, specify
Gabriel Nadeau
M. D.
CREMATION OR REMOVAL.
(Cemetery)
(City or Town)
M R-301 !
PLACE OF DEATH 3 SEX male (or) WIFE of 8 Usual PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state is very important. See instructions and extracts from the laws on back of certificate. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry 10 or Business: 200m-10-'39. No. 8427-d
Suffolk .County) Winthrop (City or Town) 42 Triton are
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(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
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ...
42 Triton are Winterofse
(Usual place of abode)
Length of stay: In hospital or institution * ** years
(Specify whether)
months
days.
(If nonresident, give city or town and state)
In this community
11
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
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)
(Husband's name in full)
6 Age of husband or wife if alive. .yoars
7 IF STILLBORN, enter that fact here.
AGE 74 Years 10 .Months. .2 ...... Days
If less than I day
Hours ..
.Minutes
9 Occupation:
Retired foreman in boxing
factory
11 Social Security
12 BIRTHPLACE (City)
Weymouth
(State or country)
mano.
13 NAME OF
FATHER
Samuel M. Richards
14 BIRTHPLACE OF
FATHER (City)
Weymouth
(State or country)
mars.
15 MAIDEN NAME
Mary L Jivrell
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
Weymouth
(State or country)
Mars.
17
augustus E Richardo (brother)
Relation, if any
(Address)
## Each Weymouth, Maso.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wang. Children.
Health Office
(Signature of Agent of Board of Health or other)
2/12/40
( (Official Designation)
(Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
11
1940
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY , That I attended deceased from
august 10
1934,
February 11 1940
I last saw been
.alive on.
February 1/ 1940 deat
to have occurred on the date stated above, at .....
7P.m.
death is said
Duration
Immediate cause of death ...
Acute Coronary Renombre
.....
trado 2 days.
Due to
angina Pectoris
5 hours ....
byla ........
Other conditions"
noul
(Include pregnancy within 3 months of death)
Major findings :
Of operations
no operations
Date of ..
Of autopsy
no autopay
charged sta-
What test confirmed diagnosis ?
clinical & la istically.
20 Was disease ur lujury in any way related to occupation of deceased -? . 720
If so, specify.
Jacobs
(Signed)
(Address) 562 ShirleySt
.Date ......
10 2/11/420
21 Mount Hope,Venthugo Maso Place of Burial, [Creamdede KREdoBa (City of Town) DATE OF BURIAL Feb1411940. 19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS Broad &t. F. Weymouth
Received and filed. 19
.........
Å TRUE COPY ATTEST:
(Registrar)
PHYSICIAN Underline the cause to which death should he
Due to
arterio
caoclerosis
... , to ...
War Veteran. specify WAR).
No. Samuel E
RICHARDS
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer sball forthwitb, after the death of a person whom be has attended during bls last illness, at the request of an undertaker or otber sutborlzed 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 bis knowledge and belief the name of the deceased, bis 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 bis deatb ... 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 buman body wbich 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 sball exbume a buman hody 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, wbich sball 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 hercinafter 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 wbo 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, tbe medical exam- iner 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 early enough for tbc 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 bas been sooner obtained bereunder. If tbe 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 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 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 sball bury a buman body or tbe ashes thereof which have been brought into the commonwealth until be 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 tbe funeral Is to be beld, 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 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 such deatbs only as those of persons who, though disabled by recognized disease un- related to any form of injury, bave died without recent medical attendance or whose physician is absent from bome when tbe certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposabiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septice- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs 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 deatb, not the mode of dying, e. g., beart failure, aspbyxia, astbenia, 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 complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative bealthfulness 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 wbose only occupation was that of bome bousework, 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 had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-303 B
PLACE OF DEATH No
Suffolk cello (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No ..
25
(If death occurred in a hospital or institution,
e. { give its NAME instead of street and number)
Lionel Wallace Hopkins
(If deceased is,a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 450 Winthub St. Pantural
St.
(Usual place of abode)
Length of stay: In hospital or institution
years
months
days.
In this community
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male white
4 COLOD OR RACE| 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)
(Husband's name in full) .
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
AGE
63
Years
Months.
Days
If less than 1 day
Hours
.Minutes
Usual
Laborer w. P.A. (Electrician)
Industry
W.T.A.
Electrician
1I Social Security No.
012-18-3596
12 BIRTHPLACE (City)
(State or country)
P. S.
13 NAME OF
FATHER
Heury
Hopkins
14 BIRTHPLACE OF
FATHER (City)
...
M. S.
Fester
15 MAIDEN NAME
OF MOTHER
Ida Sweet
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
R. S.
17 Wro Marjorie M. Kinlin
Heatich, if any friend
Informant .. (Address) 450 Winthrop St., Win
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. A. Children Y Board of Heart mother) Health Officer 2/14/40
(Date of Issyol of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Feb -12 -1440
(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 . Chania Valvular Heart Disease alvala 2. 1
collapsed on street >died quietly
Was there an autopsy ?.
200
(See reverse side for description for unknown person)
20 Where did
injury occur ?.
(City or town and State)
21 Was disease or Injury In any way related to occupation of deceased ?.
If so, specify ............
(Signed)
ABBA-12-1940
(Address)
22
Smithville
No Scituate R. O.
Place of Burial, Cremation or Removal. (City or Town)'
DATE OF BURIAL
February 14
19
to
23 NAME OF
FUNERAL DIRECTOR.
M. S. Kelly
ADDRESS
11 Meridian St., E. OTO
Received and filed 19
(Registrar)
5m-10-'39. No. 8427-j
(or) WIFE of 9 Occupation: 10 or Business: PARENTS information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of Death. See reverse side for extracts from the laws relative to the return of certificates of death. (Official Designation) N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)
(City or (Town)
En route to Mutterio Communiste Hospitali
2 FULL NAME
(If U. S.
War Veteran,
specify WAR)
No
(If nonresident, give city or town and state)
4 yrs.
mos. - days.
DEATH
(Month)
----
M. D.
Foster
Foster
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 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 regls- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age. the disease of which he died, defined as required by section one, where same was 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 buricd, 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 lts 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- iner 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 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 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 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.
DESCRIPTION (for unknown person)
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 funcral Is to be held, or from a person appointed to have the caro of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L. as amended.
Medical examiners shall make examinatlon upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
. .. Hle 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 man- ner of death .- General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Allending 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 such deaths only as those of persons who, though disabled by recognized disease 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 supposabiy due to injury. These include not only deaths caused directly or Indirectly by traumatism (including resulting septice- mia), 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 relaled lo occupa. tion, the sudden deaths of persons nol disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences ; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway ac- cident." "Pistol shot wound of the chest with associated hcmor- rhage, homicidal." "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustalned under circumstances unknown.“
If disease or injury was related to occupation, specify. If Inves- tigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature ; and (2) under man- ner, Indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed) ." "Heart disease, presumably coronary sclerosis. (Sudden death) ."
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
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