USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 38
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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 lias 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 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 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 by recognized disease unrelated 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 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 disabled hy 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 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 by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffolk (County)
OSTON NOTIFIE
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
77 Frescoor
St
Brator
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
Hospital
(Specify whether)
years
months
/
days.
In this community 3 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
Whit
5 SINGLE
(write the word)
MARRIED
WIDOWED
OF DIVORCEDMarried
Sa If married, widowed, orrlivresh A. AlMides HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
46
.years
6 Age of husband or wife if .live
7 IF STILLBORN, enter thet fact here.
8 54
AGE
Years
Months.
Deys
If less than I day Hours Minutes
Usual
9 Occupation :..
Candymaker
Industry
Candy Manufacturing
10 or Business:
11 Social Security No ...
none
12 BIRTHPLACE (City)
(State or country)
Greece
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Greece
15 MAIDEN NAME
OF MOTHER
Maria unknown
16 BIRTHPLACE OF MOTHER (City) (State or country) Greece
17
Informant ..
Mrs. Helen A. Stoumbelis
(Address)
77 Prescott St .. E. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: m. D . Childrens (Signature of Agent of Board of Health'or other)
Health aplicar 6/26/40
(Official Designation (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF June 25,
DEATH ......
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY.
That I attended deceased from
June 8, 19 Ya, to Jene 25, 1940 I last saw haha alive on Jeche 20,, 1940, death is said to .m. have occurred on the date stated above, at 2004 Duration IMPORTANT Immediate cause of death .... Circusis ) lives unqualifica 1939 Cardine Decompensation
5 days
?
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
asuite- Jaundice
ascites
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 to occupation of deceased ?.. no
If so, specify.
(Signe
a. nathan Caplan
M. D.
(Address) 186/saucetin 81
13: Date 6/25/ 1940
Relatlon, if any 21. Mt . Hope, Boston Place of Burial, Cremation or Remoyal (City or Town) DATE OF BURIAL June 27, 1940. 19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Boston
Received and filed 19
(Registrar)
100m-2-'40-D-729-8
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.
I
Winthrop (City or Towny
Winthrop Community Hospital No .. Peter ¿ Strumbelis
To be filed for burial permit with Board of Health or its Agent.
(a) Residence. No ..
(Usual place of abode)
(If U. S.
War Veteran,
specify WAR)
none
1940
Due to .....
Chemin myocarditis
IMPORTANT PHYSICIAN
13 NAME OF FATHER Estratios Stoumbelis
wife
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 best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, definded as required by section one, where same was contracted, the duration of his last illness, wben 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 exbume a human body 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 bas received a permit from the board of health or its agent aforesaid or from the clerk of the town wbere the body is buried. No such permit shall be issued until tbere 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 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 bereinafter 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 by the selectmen for the purpose, shall upon application make tbe certificate required of the attending physician. If death is caused by violence, the medical examiner shall make sucb 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 deatb made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, tbat 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 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, sucb recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall fortbwitb countersign it and transmit it to tbe clerk of the town for registration. The person to whom tbe permit is so given and the physician certifying the cause of death shall thereafter furnisb for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, wbich tbe 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 wbich bave been brought into the commonwealth until be has received a permit so to do from the board of health or Its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or 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 bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to sucb deaths only as those of persons wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of deatb 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 septicemia). 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 occupation, the sudden deaths of persons not disabled by recognized dlsease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes deatb, not tbe 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 tbe 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 bad 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 bousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301
1
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(If death occurred in a hospital or institution,
....... St. ¿ give its NAME instead of street and number)
2 FULL NAME
( Male ) Hannaford
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
35 Fremont St
St.
(If nonresident, give city or town and state)
(Usual place of abode)
ength of stay: In hospital or institution
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If marred, widowed. or divorced
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, onter that fact here.
Stillborn
If loss than 1 day Hours. .Minutos
Usual 9 Occupation :. Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Tinthron
(State or country)
Massachusetts
13 NAME OF
FATHER
Joseph D. Hannaford
14 BIRTHPLACE OF
FATHER (City)
Boston
(State or_country) Massachusetts
15 MAIDEN NAME
OF MOTHER
Gertrude McAuliffe
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Massachusetts
17
Informant.
Joseph D. Hannaford
father
(Address)
35 Fremont St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of doath was filed with me BEFORE the burial or transit permit was issued: Www. D. Children
ASignature of Agent of Board of Heart of other)
Health Office 6/28/40 (Official Designation (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
...
June
27,
(Month)
(Day)'
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
19
.. , to.
19.
I last saw h ............ alive on.
19
death is said
to have occurred on the date stated above, at ..
... m.
Duration
.......... .........
Due to
...
mallorquin of placent
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of
Of autopsy ..
What test confirmed diagnosis ?
20 Was disease or Injury In any way related to occupatioo ol deceased ?
If so, specify ..
(Address).
Date ..
6/22/1944
21
Winthrop
Tinthron
Place of Burial, Cremation or Removal. (Fity or Town) DATE OF BURIAL .19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Wirthron, Massachusetts
Received and filed ....
19
A TRUE COPY ATTEST:
(Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
CAUSE OF DEATH in plain terme, 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.
200m-10-'39. No. 8427-d
PLACE OF DEATH
Suffolk (County)
No Winthrop Community Hospital
(II U. S.
War Veteran.
spocity WAR)
1940
Immediate cause of death.
Still Born Baby
8 AGE. .Years. Months. Days
PARENTS
Relation, if any
Underline the cause to which death should be charged sta- tistically.
(Signed)
270 Shelley St.
M. D.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physirian 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 sball 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 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 bereunder. 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 fur- nish for registration any other necessary information which can be
obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person sball bury a human body or the ashes thereof which have heen 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 dcatbs caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Causo of Doath .- 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, ctc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-305
uriolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No ...
5898
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
125
(If U. S.
War Veteran,
specify WAR)
Winthrop
.St.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
(oz) WIFE of
AGE
9 Occupation:
PARENTS
25m-10-'39. No. 8427-g
Copies of returns of deaths which occurred in your city of town in case the deceased resided in apowier city of town at the time
Industry
10 or Business:
of death should be transmitted on Form R-305 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.)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
(write the word)
DEATH
June 28 1940
(Month)
(Day)
(Year)
19 I 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.) Fractured .... skull .... across cribri form .... slate ..... of ethenoid ..... Pneumococ .cus ... meningitis. Cirrhosis.of liver alcoholism
20 Accident, suicide, or homicide (specify)
Date of occurrence. 19
Where did Injury occur? (City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place ?
Manner of
Injury
Nature of
Injury
While at work ?
Was there an autopsy?
yes
21 Was disease or lajury in any way related to cccupation of deceased ?.
If so, specify
(Signed)
T Leary
(AddresBoston
Date
6/29.440
M: D.
22. Mt Hope Boston
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
July 2 1940
19
23 NAME OF
FUNERAL DIRECTOR A C Hasiotis
ADDRESS
Bo.s.ton
Received and filed ..
19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
(County) Boston
(City or Town)
Boston .... City ..... Hospital
Nicholas
..... Doudoumis
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
55 Wave Way Ave
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
W
married
5a If married, widowed, or divorced
HUSBAND of
(Give fra Ye Stamamadou
(Husband's name in full)
6 Age of husband or wife if alive.
Years
7 IF STILLBORN, enter that fact here.
8 44 Years Months. Days
If less than I day
Hours
Minutes
Usual
restaurant owner
II Social Security No.
12 BIRTHPLACE (City)
(State or country)
Greece
13 NAME OF
FATHER
James Doudoumis
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Greece
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Greece
17 Informant (Address)
wifeRelation, if any
A TRUE COPY.
ATTEST:
James Q. Burke
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