USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 4
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Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can he 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 deccased had retired from busi- ness, 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.
SPACE FOR ADDITIONAL INFORMATION
R-303 B
(or) WIFE of 8 92 Usual 9 Occupation: PARENTS Informant. (Address) of Death. See reverse side for extracts from the laws relative to the return of certificates of death. Industry 10 or Business:
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female White
MARRIED
WIDOWED
or DIVORCED
(write the word).
WidowEd
5a If married. widowed, or divorced HUSBAND of Patriclo Caide Jne durand Bryan (Husband's name in full)
6 Age of husband or wife if alive. Years
7 IF STILLBORN, enter that fact here.
AGE. Years Months. Days
If less than I day
Hours
Minutes
Housework.
Home.
II Social Security No ...... Montreal
13 NAME OF FATHER Eduard White
14 BIRTHPLACE OF FATHER (City) (State or country)
Canada.
15 MAIDEN NAME OF MOTHER May. Luimi
16 BIRTHPLACE OF MOTHER (City) (State or country)
CAnada
5m-10-'39. No. 8427-j
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the]burial or transit permit was issued: Www. D. Chil dress (Signature of Agent, of Board of Health or other) Health Officer (Official Designation) (Date of Issue of Permits 1/17/40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
January 16 -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.) Home Burns of Head, Body & Extrem- ities .
Clothing accidentally ignited at
her Doma Jan -16 - 1940
Was there an autopsy?
200
(See reverse side for description for unknown person)
20 Where did
injury occur?
(City or town and State)
21 Was diseasa or Injury In any way related to occupatien ol deceased ?.
If so, specify.
(Signed
Muito Suckleys
M. D.
(Address)
Au-16-1940
DATE OF BURIAL and 40
23 NAME OF
FUNERAL DIRECTOR COWYCH
ADDRESS
of Winthrop
Received and filed ..
(Registrar)
1
PLACE OF DEATH
Sullilk (County)
(City or Town) No. 16/ Washington ave
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
9
§ (If death occurred in a hospital or institution, St. { give its NAME instead of strect and number)
2 FULL NAME
KatherineWhiteBryan
(If deceased is a married, widowed or divor ed woman, give also maiden name.)
(a) Residence. No. 161 Washing Love Muttrop
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
years
months
days.
In this community
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
40 yrs.
mos.
days.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
17 Wunited Clapper Ceiation, MEDU 22 Cote DeanFuegen montreal 82. Place of Burial, Cremation or Remove. (City or Town)
12 BIRTHPLACE (City)
(State or country)
4 COLOR OR RACE| 5 SINGLE
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 regls- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or on:cer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No underlaker 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 dc- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physiclan, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously 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 fortbwith countersign It and transmit it to the elerk 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, Scc. 15, G. L., as amended.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until be has received a pernilt so to do froin 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 inade. ... Chap. 114, Sec. 46, G. L. as amended.
Medical examiners shall make examination upon the vlew of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the plaec where the body lies and take charge of the same : ... - General Laws. Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar In the place where the deceased died his naine and residence, if known ; otherwise a description as full as may be, with the cause and man- ner of death .- General Laws, Chap. 38, Sec. 7.
The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) 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) Medlenl 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
Medical Examiners In certifylng to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences ; and (2) under manner, the mode of its productlon together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway ac- cident." "Pistol sbot wound of the chest with associated hemor- rhage, homicidal." "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaestbetic." "Fracture of the skull with associated internal Injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If Inves- tigation sbows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under man- mer, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed) ." "Heart disease, presumably coronary selerosis. (Sudden death) ."
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-301 !
Suffolk (County)
inthron
(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
Flora Chase (Felton) Verney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No .....
749 Lincoln
(Usual place of abode)
J ength of stay: In hospital or institution
years
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
.Thite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Sewell Verney
(Husband's name in full)
71
6 Ago of husband or wife if alive. yoars 7 IF STILLBORN, enter that fact here.
8 AGE 68 Years
Months .......... .. Days
If less than 1 day
Hours.
Minutes
9 Occupation:
House wife
10 or Business:
Own home
II Social Security No.
12 BIRTHPLACE (City)
Roxbury
(State or country)
Massachusetts
13 NAME OF
FATHER
Benjamin Felton
14 BIRTHPLACE OF
Unable to obtain
FATHER (City)
(State or country)
New Hampshire
15 MAIDEN NAME
OF MOTHER
Angeline Moore
16 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Massachusetts
17 Arthur F. Verney
Relasjon, if any
Informant
(Address) 147 Cottage Pk. Rd Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Childress
(Signature of Agent of Board of Health/ or other),
Health Hacer
1/22/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
(Month)
19
1940
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from January 15 1940, to January 19, 1940 I last saw her alive on January 19, 1940, death is said Duration to have occurred on the date stated above, at 9:30 P.m. Immediate cause of death ..
Broncho- pneumonia
........... 4 days ...
Due to
Due to Chronic myocarditis
Other conditi
(Include pregnancy within 3 months of death)
Major findings :
Of operations
none
Date of ..
Of autopsy .
none
What test confirmed diagnosis ?
x
20 Was disease or Injury In any way related lo occupation of deceased ? Imo
If so, specify .......
Arthur@Murray
M. D.
(Sig
(Address) Winthrop Marc Date 1/19/1940
21
Winthrop Cemetery winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL ...
(City or Town)
1940
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop Mass
19
A TRUE COPY ATTEST.
(Registrar) V
200m-10-'39. No. 8427-d
1 PLACE OF DEATH Usual PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION 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. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry
No. fiathron Community Hospital
!
War Veteran.
specify WAR)
St. (If nonresident, givercity or town and state)
...
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
Received and filed.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital inedical 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 agc, 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 underlaker 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 bc 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 cnough 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 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 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) Allending 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 deccased 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
R-301 Al Suffolk
PLACE OF DEATH
(City or Town) 94 Касках No.
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, St. [ give its NAME instead of street and number)
2 FULL NAM Sample Liska
(If deceased is a prorried, widowed or divorced woman, give also maiden name.) 94 Lacuet
.......
St.
(If nonresident, give city or town and state)
Length of stay : In hospital or institution ...... (Specify whether)
years
months
days
In this community
13Ts.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
(write the word)
5 SINGLE MARRIED WIDOWED or DIVORCED
18 DATE OF
DEATH
Jan
22
1940
(Month)
(Day)
(Year)
Ja Il married, wide weg sive have Staneces HEBER (Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
years
If less than I day
AGE Years
Months
Days
Hours.
Minutes
Detree Laborer log
Sugar refinery Bone
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
austria
13 NAME OF FATHER Cannot be learned
Major findings : Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?
Was disease or Injury lo any way related to occupation of deceased?
If so, specify.
. M. D.
(Signed)
(Address) thestates on Date/mm]
2 X 1940
m+ Noqueduct. Boston
Place of Burial, Cremation of Removal
5
Informaik. 94 Lacual Và, Stanturo) 5 DATE OF BURIAL .... 19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Boston
Received and filed
19
(Official Designation).
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
HEREBY CERTIFY
1934 I ....
......
That I attended deceased from 2
19 46
I last saw h Walive on. Kull 19 .. 90 death is said to have occurred on the date stated above, at 4.45 Pm. Immediate cause of death.
Duration IMPORTANT
Due to
Due to
Other conditions (Include pregnancy within 3 months of death)
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
14 BIRTHPLACE OF FATHER (City) (State or country) Quatrea
15 MAIDEN NAME
Cannot be learned
16 BIRTHPLACE OF MOTHER (City) (State or country)
Quatrea
Relation, if any
100m-10-'39. No. 8427-e
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wine D. Childress8. (Signature of Atend of Board of Health for other) Health Officer 1/24/40
(Registrar)
(If U. S. War Veteran, specify WAR)
(a) Residence. No.
(Usual place of abode)
1 3 SEX male HUSBAND (or) WIFE of 8 80 Usual 9 Occupation: PARENTS 17 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 Industry 10 or Business: CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
salaris
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registercd hospital medical officer sball 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 discase of which he dicd, defined as required by section one, where same was contracted, the duration of his last illness, when last scen 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 buricd, 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, bis certificate cannot be obtained carly 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 sclectmen 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 witbin 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 tbe 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, sball 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.)
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