USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 29
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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 he 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 observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who. though disahled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia). and hy the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled hy recognized dlsease, 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 conditions, 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 business, 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 hy 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 A1
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No .....
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Alfred Ernest Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
57 Birch Road
.......
SE.
(If nonresident, give city or town and state)
months
days.
In this community22 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
Sa If married, widowedpor giroused Viola Urquhart HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
49
.years,
If less than 1 day
Hours
Minutes
9 Occupation:
Combustion Engineer
11 Social Security No.
010-09-9154
Gust on
(State or country) Mead County, Kentucky
13 NAME OF
FATHER
George W. Smith
FATHER (City)
(State or country)
Mead County Kentucky
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF Unable to obtain MOTHER (City) (State or country)
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Now.8 . Chil dress (Signature of Agent of Board of Health & other)
Health Officer
(Official Designation)
(Date of Issue of/Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
May
14
1948
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY
12
19.3.2 .. , to ....
May 14
19 40
Vlast Saw h ...... alive on Man 14
19 40, death is said
to have occurred on the date stated above, at 5 A
...... m.
Duration
IMPORTANT
Immediate cause of death ... ANGI
Due to Con Cedo
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
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?
If so, specify,
(Signed) Hay ward
(Address) Written Man
, M. D.
Date 5/14
19 .. X.
21 Oak Grove Cemetery
Medford Mass
Place of Burial, Crematiop or Removal.
DATE OF BURIAL
194'e or Town)
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
winthrop Mass
Received and filed 19
(Registrar)
(County)
1
inthron
(City or Town)
(a) Residence. No ..
(Usual place of abode)
Length of stay : In hospital or institution ..
3 SEX
Male
4 COLOR OR RACE
White
(or) WIFE of
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
AGE
58
Years
11
Months
8
Days
Usual
10 or Business:
12 BIRTHPLACE (City}
14 BIRTHPLACE OF
Guston
PARENTS
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.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
Construction: '
PLACE OF DEATH
No 57 Birch Road
........
Relation, if any
17 Informant Florence V. U. Smith .wife ..... )
(Ad 5% Birch Rd. Winthrop Mass
5/14/40
(If U. S. War Veteran, specify WAR)
years
(Specify whether)
That I attended deceased from
4 year
Of autopsy
What test confirmed diagnosis Lehumation
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 anthorlzed 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 bellef the name of the deceased, his supposed age, the disease of which he dicd, defined as required by section one, where same was contracted, the duration of his last illness. when last seen alive hy 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 & human body in a town, or remove therefrom a human hody which has not been huried, 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 hody and remove it from a town, from one cemetery to another, or from one . grave or tomh 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 hody is buried. No such permit shall be issued until there shall have been dc- livered to such hoard, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to he returned and recorded, which shall be accompanled, in case of an original interment, by a satisfactory certificate of the attending physiclan, if any, as required hy 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 carly enough for the purpose, or is Insufficient, a physician who is a member of the hoard of health, or employed hy 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 hy 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 ohtalncd 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 shail 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 hy 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 ax to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, See. 43, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have heen hrought Into the cominonwealth 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 hody Is to he huried or the funeral is to be held, or from a person appointed to have the care of the cenietery 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 these 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 disahled by recognized disease un- related to any forni of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(8) Medical Examiners will investigate and certify to all deaths supposably duo 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 ocrupa. 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 fallure, 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 complleation 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 busl- 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, 88 housekeeper -- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
2 FULL NAME
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
female
white
----
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE.45
Years
Months.
Days
Usual
at home
9 Occupation:
Industry
10 or Business:
II Social Security No ..
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Mary E Quinn
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17
Informant.
(Address)
above
50m-10-'39. No. 8427-f
of death should be 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.)
Copies 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)
Boston Mass
(write the word)
single
(Give maiden name of wife in full)
(Husband's name in full)
.. Years
If less than I day
Hours.
Minutes
12 BIRTHPLACE (City)
(State or country)
Boston Mass
13 NAME OF
FATHER
James S McFague
Relation, if any
Arthur L McFague ( bro ..
A TRUE COPY.
ATTEST:
O Branche
(Registrar of city or towp where death occurred) 5/20/40
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
May16 1940
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. . That I attended, deceased from
4/27/40
19.
to ...
5/16/40
19.
I last saw h .. Or ..... alive on.
5/16/40
19.
..... death is said
to have occurred on the date stated above, at. 1.56P m.
Duration
Immediate cause of death. congestive ... heart ... failure
2
mos
Due to .. rheumatic ... heart ... disease
10 yrs
Due to
Other conditions cardiac cirrhosis of liver unk (Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to
Of autopsy
What test confirmed diagnosis ?..... autopsy
which death should be charged sta- tistically.
20 Was disease or Injury le any way related to occupatloo of deceased ?
If so, specify
(Signed)
W .... B. Osgood
M. D.
(Address)
P ... B.B .... Hosp
Date.
5/16/1940
21 PLACE OF BURIAL.
CREMATION OR REMOVAL ......
Winthrop
Mass
(Cemetery)
(City or Town)
DATE OF BURIAL
May .... 20 ..... 1940
19
22 NAME OF
FUNERAL DIRECTOR
W ..... J .... Cassidy
ADDRESS
Boston
Received and filed
J
19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
1 SUFFOLK
(County) DOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No ..
459.9.
(If death occurred in a hospital or institution,
St. give its NAME instead of street and number)
·MoFaguo
(If U. S. War Veteran, specify WAR)
95
(a) Residence. No ....
(Usual place of abode)
Length of stay : In hospital or institution.
(Specify whether)
39 ... Fairview
St.
Winthrop Mass
(If nonresident, give city or town and state)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Peter Bent Brigham Hosp
No ......
Kathloon ... A
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Boston Mass
Date of.
TOWN
مل
C:
6
HROP
JUN-71940
I R-301 A
PLACE OF DEATH
Suffolk (County)
Tint' roo
(City or Town)
No 34 Fremont St
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)
2 FULL NAME
Simson Joseph
Rock
(If deceased is a married, widowed or divorced woman, give also maiden name.)
34 Fremont St
St
(If nonresident, give city or town and state)
40
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Vidowed
5a If married, widowed, or divorced
Mary A Mccarthy
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.
years
7 IF STILLBORN, enter that fact here.
If less than 1 day
AGE
Years.
Months ..
Days
Hours.
.Minutes
9 Occupation :
Retired
10 or Business:
Town Employee
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Joseph Rock
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Vermont
15 MAIDEN NAME
OF MOTHER
Mary Cyr
16 BIRTHPLACE OF MOTHER (City) (State or country) Canada.
Relation, if any
mery Rock ( Daughter 21. Winthrop Winthrop
Informant.
(Address)
34 Fremont St.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Jau. D. Children (Signature of Agent of Board of Health orother) Match Officer 5/20/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH. may
18
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from n nhar, 1938, to may 18 19 40
I last saw him alive on may 18 19 40, death is said to have occurred on the date stated above, at .... 10 3 P.m.
Immediate cause of death apparently
Duration IMPORTANT
aranan occlusion
Due to
Due to.
Other conditions.
Diabetes mellitus
(Include pregnancy within 3 months of death) Recent computational chiale
3. sylar IMPORTANT
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease of injury in any way related to occupation of deceased? no
If so. specify
M. D.
(Signed)
(Address) 287 Shirley DX
Date 5-19
19:40
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL. Mey/ 220 1948 19
22 NAME OF FUNERAL DIRECTORA, ADDRESS
John J. OMalen
Received and filed
19
(Registrar)
100m-2-'40-D-729-a
1
3 SEX
Male
8
68
Usual
PARENTS
17
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
AGE should be stated EXACTLY. PHYSICIANS should state
information should be carefully supplied.
Major findings: Of operations.
Date of.
Of autopsy
What test confirmed diagnosis? Bloods maluca
Cambridge
St.
(If U. S.
War Veteran.
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community
yrs.
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 registration a standard certificate of death, stating to the hest of his knowledge and belief the name of the deceased. his supposed age, the disease of which he died. defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive hy 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 hody 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 hoard, 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 tomh other than the receiv- ing tomh 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 huried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to he returned and recorded, which shall be accompanied, in case of an original interment, hy 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 in- sufficient, a physician who is a member of the board of health, or em- ployed by it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 he 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 re- moval of such body has heen 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., (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 hoard of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to he huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial 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 observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), 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 Infectlon related to occupation, the sudden deaths of persons not disabled hy recognized dlsease, 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 morhid conditions, 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 business, report the usual occupation prior to retirement. Children not gainfully employed may he 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
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