USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 16
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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 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 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 medical attendance or whose physician is absent from home when the certificate of death is necded.
(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- mla), and by 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 occupa. tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Doath .- Cause of deathi 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 discase 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 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 iliness. 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 housekceper-private family, cook-hotel, ctc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
-303 B
Auffach.
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 a hospita or institution,
... girRa NAME instead of street and number)
2 FULL NAME John. O. Keras
(If deceased is a married, widowed or divorced woman, give also maiden name.) 52 Lincoln St. Wil
St.
(If nonresident, give city or town and state)
mos.
days
(Specify/ whether)
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowych grodivore cousins Kn
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
69
.years
If less than 1 day
Hours.
Minutos
5m-10-'39. No. 8427-j
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with. me BEFORE the burial or transit permit was issued: Nu. D. Childreng. Signature of Agent of Board of Health of other) Health Officer 3/14/40
(Official Designation) (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March 13, 1940
(Month)
(Das)
(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.)
Generalized alexis-
said to live faller ou sidewalk
)
Was there an autopsy ?.
(See reverse side for description for unknown person)
20 Where did
injury occur ?.
Mintterap, Mars
(City or town and State)
21 Was dlsease or Injury in any way related to occupatlen of deceased?
20
If so, specify bradley Cheasyh.
D
....
(a) Alledue Date 3/ 13 19 40
22
Holderness N. H
Place of Burial, Cremation or Removal. (City or Town) DATE OF BURIAL.
March 16. 1940
19
23 NAME OF
FUNERAL DIRECTOR
Buchand To White
ADDRESS
147 Winthrop St., Winthrop
Received and filed.
19
(Registrar)
(County )
1
3 SEX
4 COLOR OR RACE| 5 SINGLE
Male
White
7 IF STILLBORN, enter that fact here.
AGE
75
Yeara.
Months-
Usual
Days
9 Occupation:
Cigar Maker
Industry
11 Social Security No.
none
12 BIRTHPLACE (City)
Newark
(State or country)
N. Y.
13 NAME OF
Joel Kerman
FATHER
14 BIRTHPLACE OF
FATHER (City)
not known
(State or country)
New York
15 MAIDEN NAME
OF MOTHER
Anna Percy
16 BIRTHPLACE OF
not known
PARENTS
MOTHER (City)
(State or country)
New York
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
10 or Business?
Cigar Factory
PLACE OF DEATH
(City, or Town) Ne Winthrop Community Mais
(If U. S.
War Veteran,
speci'y WAR)
(a) Residence. No .... (Usual place of abode) Length of stay: In hospital or institution farpital
years
months
16 days.
In this community 4
yrs.
17 Mrs. Alice Kerman Wiltin, if any
Informant.
(Address)
53 Lincoin st., winthrop
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlelan 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 deccased, 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. Laics, 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 sueh 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 physiclan, 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 seleetmen 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 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 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 hercunder. 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 certificatc, 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.
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 lis 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 lo have the care of the cemetery or burial ground in which the interment la made .... Chap. 114, Sec. 46, G. L. as amended.
Medical examnincs shall make cxamination upon the vlew 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.
... 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 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) Altending 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 physlelans 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 supposably due to injury. These include not only deaths caused directly or Indirectly by traumatism (including resulting septice- mia), and by the actlon 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. tlon, the sudden deaths of persons not disabled by recognized disease, and those of persons found deud.
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 hemor- 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 sustained under circumstances unknown."
If discase 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)."
DESCRIPTION (for unknown person)
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.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-301 A
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No
(If death occurred in a hospital or institution, give its NAME instead of street and number) 3
(If U. S. War Veteran. specify WAR).
(a) Residence. No .....
Sta ..... Hosp.Ft. .... Banks (Barracks.)
St.
(Usual place of abode)
(If nonresident, give city or town and state)
Length of stay : In hospital or institution ...
Hospital
years
months
days.
In this community
4
yrs.
mos.
days.
Deceased upon admissignifyteethpospital
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March 14, 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That i attended deceased from
19 ........ , to.
19
I last saw l ............ alive on.
19.
death is said
to have occurred on the date stated above, at.
m.
Immediate cause of death ..
Duration
IMPORTANT
AGE 28 .... Years 10 Mouths. ..... Days
Hours.
Minutes
9 Occupation:
Soldier(Staff Sgt.)
Industry
10 or Business:
U.S.A ...... Hosp.
Due to ... intent ...
II Social Security No.
12 BIRTHPLACE (City)
Sumter.South Carolina
(State or country)
13 NAME OF
FATHER
Claude B Hogan
14 BIRTHPLACE OF
FATHER (City)
unknown anderson
(State or country)
alabama
15 MAIDEN NAME
OF MOTHER
Annie Marie Veith Coned
unknown Dalzell
16 BIRTHPLACE OF MOTHER (City) (State or country) S.C.
Relation, if any
17 Fort. Banks
Informant (Address) Recarga - still
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Was . Children (Signature 9/ Agent of Board ef7Heath or other)
Official Designation 3/17/40
(Date of Issue of Permit)
20
Was disease or Injury In any way related to occupation of deceased?
If so, specify ........
None
(Signed)
(Address) Station Hospital
.Data ...
3/16 To 40
Fort Banks,
ass.
21
Place of Burial, Cremation or Remoyal.
DATE OF BURIAL
3/17/ 8und, Devono.
ayer 1940
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop, lass.
Received and filed 19
(Registrar)
100m-10-'39. No. 8427-e
1 3 SEX 8 Usual TAH CIONES DE GLEICH LAACILI. FISICIAND Should state Nale
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
PARENTS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married.
5a If married, widowed, or divorced HUSBAND of
Cora .......... Emery.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
25 -
.Years
7 IF STILLBORN, enter that fact here.
If less than 1 day
Due to .
Poisoning by Sodium Cyanide
self administered with suicidal
3/14/40
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
None
Date of.
Of autopsy ...
.Diagnosis confirmed
What test confirmed diagnosis ?
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
Ist
TON. D.
City or Town)
No. Station Hospital Ft . Banks Tass
....... St.
2 FULL NAME Robert ... E ..... Hogan.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
...
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 deccased, 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. Lais, Chup. 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 saine cemetery, until he has received a permit from the board of health or Its agent aloresaid 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 physiclan, 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 interrcd, 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. 15, 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 comnionwealth 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 cure of the cemetery or burial ground in which the interment la miade. ... Chap. 114, Sec. 46, G. L. as amended.
Medical examiner's 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 hls 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.
... 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 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 PItACTICE
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- ncss 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) Modleal 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- mia), and by the actlon 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. tlon, the sudden deaths of persons not disabled by recognized disease, and those of persons found deud.
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 hemor- rhage, homicidal." "Asphyxiatlon by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaestbetic." "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 presumablc 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.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-301 A
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.
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial pernat with Board of Health or its Agent.
Registered No ..
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ....
Sta. Hosp Ft. Banks. (Barracks.)
.St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution .... Hospital
years
months
days.
Deceased upon admissionifytapospital
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married.
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Cora ........ Emery.
2
(Husband's name in full)
years
If less than 1 day
Hours
Minutes
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