USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 37
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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 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 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 sucli 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 by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disahled 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 husiness, 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
1 R-301 AJ
Suffolk
(County)
Winthrop
(City or Town)
No. 125 Cliff Ave.,
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 Agents
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
St.
2 FULL NAME
Anita C. Enholm Dahlgren
(If deceased is a married, widowed or divorced woman, give also maiden name.)
150 Quincy Ave. Winthrop
St.
(If nonresident, give city or town and state)
months
days.
In this community 30yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Temale
4 COLOR OR RACE
1
5 SINGLE
MARRIED
White
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8
AGE
74
Years
3
Months.
20 Days
Hours.
Minutes
Usual 9 Occupation:
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State 'or country)
Moss
Norway
13 NAME OF
FATHER
John E. Inholm
14 BIRTHPLACE OF
Moss
FATHER (City)
(State or country)
Normy
15 MAIDEN NAME
OF MOTHER
Karen Giljuescadatter
16 BIRTHPLACE OF
Moss
4
MOTHER (City)
(State or country)
Norway
17 Informant (Address) 150 Quincy ve., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or fangt permit was issued: Www. S. Children of Signature of Agent, of Board of Healthkou Seattle Officer KOfficial Designation
(Date of Issife of Fermit)
6/19/40
18 DATE OF
DEATH
June
18, 1940
(Month)
(Day)
(Year)
19
Kimill
HEREBY CERTIFY. That I attended deceased from
19 Ya, to .....
......
mult
19
...
.m. last saw halive on .. , 19 20 death is said to have occurred on the date stated above, at 2.35P Immediate cause of death ..........
Duration IMPORTANT
Due to Permisions an
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings : Of operations
Underline the cause to which death should be charged sta- tistically.
28 Was disease or Injury in my way related to occupation of deceased?
If so, specify
(Signed)
M. D.
(Addross)
21 Woodlam
Everett, Mass ..
Place of Burial, Cremafon P& Reproval. 1940(City or Town) DATE OF BURIAL 19
22 NAME OF
FUNERAL DIRECTOR.
Richard 26 White
ADDRESS
147 Winthrop St., Winthr O p
Received and filod 19
(Registrar)
1
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
100m-10-'39. No. 8427-e
Mra. James Hamilton
Relation, if any Daughter
(If U. S. War Veteran, specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
years
John P. Dahlgren
of wife in full)
If less than 1 day
PARENTS
.Date of.
Of autopsy
What test confirmed diagnosis ?.
19 40
PLACE OF DEATH
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. 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 thercafter 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 burlal 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 hy recognized disease un- related to any form of injury, have dicd 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 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 housekceper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
PLACE OF DEATH
SHEFOLK (County), BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOŚT ......
(City or town making return)
Registered No
5560
5 (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
120
2 FULL NAME
Frederick ... A
Simson
(If deccased is a married, widowed or divorced woman, give also maiden name.)
44 Buchanan
............. .St.
Winthrop
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
white
or DIVORCED
married
5a If married, widowed, or divorced
HUSBAND of
Rebecca B. Margeson
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. .years
7 IF STILLBORN, enter that fact here.
8
ÅGE ...
.64 Years.
Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
maintenance man
Industry
wholesale provisions
10 or Business:
11 Social Security No ..
024-01-1239
12 BIRTHPLACE (City)
(State or country)
Grand Pre
13 NAME OF
FATHER
Nova Scotia
14 BIRTHPLACE OF
FATHER (City)
....
James ... L .... Simson
(State or country)
15 MAIDEN NAME
OF MOTHER
Harriot Rounseville
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
17
Informant
(Address)
wife ( ..
A TRUE COPY.
ATTEST:
James Q. OBrante
(Registrar of city or town where death occurred)
DATE FILED
6/21/40
.. 19.
18 DATE OF
DEATH.
June 18 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
4/27/40
19
.... , to ....
6/18/40
19 ......
Duration
I last saw h ... 1m .. alive on.
6/18/40, 19, death is said
to have occurred on the date stated above, at ..... 1.O ... 1.5}
Immediate cause of death ....... arterio .... s.clerotic
...
hypertensive .... heart .... disease ...
cerebral .... embolism
4 yrs
5 dys
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupatica of deceased ?
If so, specify
(Signed)
G.F. Houser
M. D.
(Address)
Boston
Dat
6/19/40
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Winthrop
Mass
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
W J Kelly
ADDRESS
Boston
Received and filed.
19
(Registrar of City or Town where deceased resided)
www. city of sowe lu cent uje deceased resided in another city or town at the time
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.)
5Om-10-'39. No. 8427-f
1
-
No ... Mass .... General Hospital
.......
(II U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
(Specify whether)
(a) Residence. No.
(Usual place of abode)
Length of stay : In hospital or institution.
(write the word)
PARENTS
Relation, if any
June 21 1948ity or Town)
19
Of autopsy
That I attended deceased from
TI
1
A
15
6
A
HROP.
JUL -31940 MM
R-302
(or) WIFE of
AGE
Usual
9 Occupation:
PARENTS
50m-10-'39. No. 8427-f
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
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
1944sus Vecdisse IA yowl city of towir If case the deceased resided in another city or town at the time
Industry
10 or Business:
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
4 COLOR OR RACE 5 SINGLE
white
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH.
June 19 1940
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
5/23/40
, 19 ........ , to ....
6/10/40
19
That I attended deccased from
...
I last saw h ... @ ..... alive on
6/19/40
, 19 ..
..... , death is said
to have occurred on the date stated above, at .. & .... 2.5P ... m. Immediate cause of death ..
Duration
Lupus .... erythematos.i.s disseminatis
8 mos
Due to
Due to
11 Social Security No.
Boston Mass
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
William Cohen
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Flora Walgomoth
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Herbert Cohen
Relation, if any
Informant
(Address)
above
A TRUE COPY.
ATTEST:
0,00
(Registrar of city or town where death occurred)
DATE FILED
6/24/40
19
The Commontucalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
B6857 (City or town making return)
Registered No.
5574
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
121
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
411 Shirley
.......
St.
Winthrop
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
married
5a If married. widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
Isaac .... Blcok
(Husband's name /h full)
45
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
41 Years
Months. .. Days
If less than 1 day Hours Minutes
...
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings : Of operations
Date of.
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?.
20 Was dlsease or Injury In any way related to occupation of deceased ? If so, specity
(Signed)
W .B Osgood
M. D.
(Address)
Boston
Date ..
6/19/ 40
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Everett
(Cemetery)
June
20 1940
19
(City cr Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
M Stanetsky
ADDRESS.
Boston
Received and filed.
19
1
PLACE OF DEATH
STUFFFOLK
(County)
(City or Town)
-
No. Peter Bent ... Brigham ... Hospital
Anna P
Block
(If U. S. War Veteran. specify WAR)
(If nonresident, give city or town and state)
(Registrar of City or Town where deceased resided)
at home
Of autopsy
ri
6
JUL-31940 AN
R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Towe) 30 Dolphin ave No ... Ellen King
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 Non
§ (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.)
30 Dolphin ave
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
nome
years
months
days.
In this community 30
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of ...
(Give maiden name of wife in full)
(or) WIFE of.
Harry King
(Husband's name in full)
6 Age of husband or wife if alive ... .years
7 IF STILLBORN, enter that fact here.
AGE
Months
Days
If less than 1 day
Hours.
Minutes Due to.
Usual
9 Occupation :..
at Home
Industry
10 or Business :.
11 Social Security No ...
nome
12 BIRTHPLACE (City)
menton
(State or country)
maso
13 NAME OF
FATHER
Harry Work
PARENTS
14 BIRTHPLACE OF
Tarrytown
FATHER (City) .......
(State or country)
new york
15 MAIDEN NAME
OF MOTHER
Ellen Bursaell
16 BIRTHPLACE OF
MOTHER (City) ...
newton
(State or country)
mago
17
Informant ..
Frank Riting
... )
(Address)
19 Saratoga de Ciertas
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: WWW.D. Couldress
(Signature of Agent of Board of Health or byher) Realite Mit 6/24/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
JUNE-
22
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
January 1,
1939, to.
JUNE
I last saw h ............ alive on.
UNE 22, 191/1, death is said to
have occurred on the date stated above, at 11,45/1 m
Immediate cause of death
Chronic
Myocarditis
GENERAL
arterio. Sclerosis
Duration IMPORTANT JEGIs ......
... . EA. S.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
....
IMPORTANT
PHYSICIAN
Major findings:
Of operations.
Date of.
Of autopsy
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related le occupation of deceased?
If so, specify ...
(Signed)
(Address) Dagli0 14
Date.
M. D.
19
.......
21 ..
Place of Burial, Cremation or Reinoral.
(City or Town)
DATE OF BURIAL.
June 25
19 40
...
22 NAME OF
FUNERAL DIRECTOR.
R.C. Ifinly
ADDRESS ..
17 Bennington su Un Boton
Received and filed. 19
(Registrar)
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.
100m-2-'40-D-729-&
Relation, if any
1
(a) Residence. No ..
(Usual place of abode)
(If U. S. War Veteran, specify WAR)
22 1910
8
89 Years
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiclan 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, definded 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 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 tomb other than the receiv- ing 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 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 by law to he returned and recorded, which shall he 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 he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed hy 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 he 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 hody 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 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 hoard 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 he 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).
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