USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 2
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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 elerk 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- anee 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- ress 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 supposably 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 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. ete. As principal cause name the disease causing death. As related causes, name carlier 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 sectlon 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, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 AJ
PLACE OF DEATH No 18
Count Winthrop (City or Town) Atlantic
The Commonhealth 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)
2 FULL NAME
(Ii deceased is a married, widowed or divorced woman, give also maiden name.)
18 Atlantic
............
St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution .......
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Temale
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOVIED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
James Main
(Husband's name in full)
66 years
6 Age of husband or wife if alive 7 IF STILLBORN, enter that fact here.
8 80 Years. 6 Months / Days
If less than 1 day
Hours Minutes
Ar Home
Industry 10 or Business:
11 Social Security No ..
12 BIRTHPLACE (City) (State or country)
Dunferm Line Sortland
13 NAME OF
FATHER
John Giffords,
14 BIRTHPLACE OF unfallm Line FATHER (City)
(State or country) Scotland
15 MAIDEN NAME OF MOTHER Unknown Dunfarm Line
16 BIRTHPLACE OF MOTHER (City) (State or country) Sortland
100m-10-'39. No. 8427-e
17 Informant 76 1 05 /8 atlantic St within
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial et transit permit was issued:
. Clubdress & Signature of Agen of Board of Health or other>
Haltle Officer 1/3/40
7(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jan . 2 - 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
1939, to Jau.
25
19 40
I last saw her alive on.
Uhc 31, 1939, death is said
to have occurred on the date stated above, at.
Duration
$ 40h .m.
Immediate cause of death ...
IMPORTANT
1938
arteriosclerosis
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
Clinical
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury In any way related to occupation of deceased? no
If so, specify Charles melone M. D.
(Signed)
305 Have SCBA Date Jaw3 1940
(Address)
Relation, if any 21 Woodlawn Everest Mark Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL Friday fary 5 ..... 1940.
22 NAME OF
Fraule & Groun
ADDR
286 meridian So Earl Gosto
Received and filed 19 ....
(Registrar) V
-
St.
(If U. S. War Veteran, specify WAR)
(a) Residence. No.,
(Usual place of abode)
years
months
days.
In this community 10 yrs.
mos.
days.
1 (or) WIFE of AGE PARENTS 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. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual 9 Occupation:
Suffolk
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 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 he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been 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- posc, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the incdical 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 deslring 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 obtaincd 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 appcar 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 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 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 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 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 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
RM 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 (State or country)
200m-10-'39. No. 8427-d
1 HEREBY CERTIFY that a satisfactory standard certificate of death was Sled with me BEFORE the burig) or transit permit was issued: Um. D. Chil dress
(Signature of Agent of. Board of Health or other) / Malthe prices 1/8/40 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
1940
(Month)
(Day)
(Year)
(19 I HEREBY CERTIFY. That I attended deceased from december 29, 1939, to .. Naimary.6 1944A.
I last saw h ............ alive on ....
6
19.4h.d., death is said
to have occurred on the date stated above, at 8.25 P. m.
Duration
Iminediate cause of death ..
Cerebral Haemorrlinge
Due to
Due to
Other conditions
Digocies Mellitus
MEALS
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of ..
Of autopsy
What test confirmed diagnosis ?
20 Was disease or Injory lo any way related to occupatloo of deceased ? NA
If so, specify ...........
Edward V, tranger.
M. D.
(Address)
21 Pride Of Jacot.
Wers Rof
Place of Burial, Bemation gh or Removal. 8 (City or Town) 1940
DATE OF BURIAL.
22 NAME OF
FUNERAL DIRECTOR
OB Jacob. H. Levine
ADDRESS
1994 Nachunge ST Day
Received and filed 19
A TRUE COPY ATTEST:
(Registrar)
5
Registered No.
(If.death occurred in a hospital or institution, give its NAME instead of street and number) No.
2 FULL NAME
Annie
Simons, Nee Annie Alexander.
(If deceased is a married, widowed 'or divorced woman, give also maiden name.)
River Road
St.
1
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
DEATH
January
18 DATE OF
Widowed
ife in full)
6 Age of husband or wife if alive .years 7 IF STILLBORN, enter that fact bere.
If less than 1 day
Hours ....
Minutes
House-Mile
13 NAME OF
FATHER
Saúl alexander
15 MAIDEN NAME
OF MOTHER
Leah (Unknown)
17 Mildred Holdson Relation, if any
Informant.
(Address) 280 River Road Sethrol
Daughter)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Winthrop Com.
(City or town making return)
(If U. S.
War Veteran.
specify WAR).
(a) Residence. No 280
(Usual place of abode)
Hoefectar
years
months
i ength of stay : In hospital or institution
(Specify /whether)
days.
In this community:
24
SUFFolk.
(County)
WinThrop
Mass
(City or Town)
....
PLACE OF DEATH
3 SEX
4 COLOR OR RACE
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a lf married, widowed, or divorced
HUSBAND of
(or) WIFE of ..
(Husband's name in full)
B
71
AGE
Years.
Months.
Days
Usual
9 Occupation:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Russia
14 BIRTHPLACE OF
FATHER (City)
Tusia
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Ansia
(State or country)
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:
at Home
34225' ....
Underline the cause to which death should be charged sta- tistically.
)
(Signed)
200 Worthington Are Date lay's
1940.
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 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. N such permit shall be issued until there shall have been de- livered & such board, agen or clerk, as the case may be, a satisfac- tory fritten 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- posc, 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 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 deesascd 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 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 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 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 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 discase, 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 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 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
M R-301 Aj
PLACE OF DEATH
middlesex (County) Winthrop (City or Town) .52 Centre St. Thomas H. Edes
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.
6
Registered Na
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
52 Centere St.
years
months
days.
In this community
6
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
am
7
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY
6
19.,3.1, tg.
19 40
I last saw h .. ,4 ..... alive on ... 6 19 ...... , death is said
to have occurred on the date stated above, at 6 ............ m.
........... Immediate cause of death Cenario Sale leaf Dicen since Congestion
failure and auricula Abrillation
Due to arteria Schwerin and
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
PHYSICIAN Underline the cause to Date of ....... Of autopsy Nere which death should be charged sta- What test confirmed diagnosis ?. Electrocardiogratistically.
20 Was disease cr Injury In any way related to occupation of deceased? me allestero.
it so, specify.
M. D.
(Signed)
(Address) 153 Zelnot County
.. Date ...
Boston
Jan 8 1940
Place of Burial, Cremationvor Remoyat.
DATE OF BURIAL
Jan. 9
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
ma Cowan o son
ADDRESS
Appalden mass
Received and filed
Dr. 10
19.40
(Registrar)
V
1
2 FULL NAME
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
male
| 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
Days
73
AGE
Years
Months
If less than 1 day
Store keeper
Usual
9 Occupation:
10 or Business:
11 Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
James W. Edes
FATHER
Bath
14 BIRTHPLACE OF
FATHER (City)
(State or country)
maine
16 BIRTHPLACE OF
Dobleboro
PARENTS
MOTHER (City)
(State or country)
maine
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
Vin City of Boston
is very important. See instructions and extracts from the laws on back of certificate.
(write the word)
Widowed
Gertrude Lovejoy
6 Age of husband or wife if alive. Years
Hours.
Minutes
Charlestown
mass
15 MAIDEN NAME
OF MOTHER
Susan P. Knowlton
17 Relation, if any 21 Forest Hills
Hayes ( Sister)
(Address) Wenham, Mass Book 102
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjal pr transit permit was issued: Www. D. Children (Signature of Agent of Board of Health for other) Realthe Officer 1/8/40
(Official Designation) (Date of Issue of Permit)
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