USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 40
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Major findings:
Of operations.
none
Date of ..
Of autopsy ..
What test confirmed diagnosis? Clinical
M. D.
(Signed).
(Address)
Duration IMPORTANT 1931 1937
Usual
6 Age of husband or wife if alive.
PLACE OF DEATH
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
(If U. S. War Veteran, specify WAR)
1940
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for 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, 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 perinits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhumne 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 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 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 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 by 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 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 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 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 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 physiclans 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 abortion, but also deaths from disease resulting from injury or infection related to occupation, 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 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
f
R-302
50m-10-'39. No. 8427-f after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) PARENTS
PLACE OF DEATH
Middlesex (County)
Malden Town)
No 14 ... Rockland .... A.v.e.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Malden
(City or town making return)
Registered No.
1 (If death occurred in a hospital or institution, St. l give its NAME instead of street and number)
2 FULL NAME
...........
507 PleasantSt.
..........
St.
Winthrop
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ..
years
months
days.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
July 6, 1940
DEATH.
(Month)
(Day)
(Year)
19
IMFOFRECERTIEN.
That Ittended deceased fro40
Ilast saw
h
er
19.
19
......
(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 86
AGE
Years
10
13
Days
If less than I day
Hours.
Minutes
Usual
9 Occupation:
At Home
Industry 10 or Business:
II Social Security No.
12 BIRTHPLACE (City)
New Haven
(State or country)
13 NAME OF
FATHER
Edwin F. Merwin
14 BIRTHPLACE OF
Woodbridge
FATHER (City)
(State or country)
Com:
15 MAIDEN NAME
OF MOTHER
Lucy Baldwin
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Conn.
17
Informant.
144 Loring Rd. Winthrop
(Address)
A TRUE COPY.
ATTEST:
Dessie L. Holdes
(Registrar of city or town where death occurred)
DATE FILED
July 15, 1940
19
21 PLACE OF BWLALgreen,
New Haven, Conn.
CREMATION OR' REMOVAL ..
(Cemetery)
(City or Town)
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
ADDRESS
"inthrop, Mass ..
Received and filed.
19
-
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Female
White
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give myerleswifrancis Graves
to have occurred on the date stated above, at.
.m.
Duration
Immediate cal
ChrUnd deaMyocarditis
.1.930 ....
1925
Due to
Generalized arteriosclerosis ...
Due to
Carcinoma right breast 1939
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to which death
Of autopsy
exam
What test confirmed diagnosis ?.
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify.
Roland P. wilder
(Signed)
(Address)
440 Pleasant StDat.
7/7/40°
& D.
DATE OF BURIAL
July 9, 1940
19
Date of ..
should be charged sta- tistically.
Charles E.Graves
Relation, If any
Wy wmountity of putin K-302 to the clerk of the city or town in which the deceased resided as soon as possible
1
(If U. S.
War Veteran,
specify WAR)
(Specify whether)
woman, give also maiden name.)
(Registrar of City or Town where deceased resided)
alive on
1.01940-Pdeath is said
AUG1:11340 All
JE ?
i.
M R-301 |1
ayu notified 8/13/40
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
Diane AGNES COMERFORD
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No
Quarters/7 B.Et ... Devens .... Jass.
St .-
WW"Aver Massachusetts
(Usual place of abode)
i.ength of stay : In hospital or institution
-
............ y.k ...
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
5a If married, widowed, or divorced
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. yours
7 IF STILLBORN, enter that fact here.
10 Months.
.19 Days
If less than I day
Hours
Minutes
II Social Security No.
12 BIRTHPLACE (City)
Flattsburg, New York
13 NAME OF
FATHER
Aloysius J. Comerford
14 BIRTHPLACE OF L'ow Rochelle, New York
FATHER (City)
15 MAIDEN NAME
OF MOTHER
DorothyStephens
16 BIRTHPLACE OF MOTHER (City) (State or country)
Plattsburg, New York
Relation, if any (Address) r3 7 B. Ft Devons,Lass
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 carecer Y 8140 7 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
7th
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
June 30
19 .. 40 to.
July 7th
19.40
I last saw h& ?........ alive on
July 7th
19.44Q., death is said
to have occurred on the date stated above, at ...
12:07Pm.
Immediate cause of death.
Encephalitis post
measles
.... 8 days
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or lojery in any way related to occupation of deceased ? 10
If so, specify,
(Signed)
M. D.
(Address)
Fort Dans, Lass
Date
July 719 40
....
21 . Port Devens Cemetery ver Maas
Place of Burial, Cremation or Removal. atjon or Removal. ] (City or Town) I9
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
Charles R. Dennison
ADDRESS
inthron :200
Received and filed 19
A TRUE COPY ATTEST: (Registrar)
1 PLACE OF DEATH 3 SEX l'erale HUSBAND of (or) WIFE of 8 AGE 7 Years Usual 9 Occupation: Industry IO or Business: (State or country) PARENTS Informant .. 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 INA-THIS IS A PERMANENT RECORD. Every item or (State or country) 200m-10-'39. No. 8427-d
Suffolk
(County)
Winthrop
(City or Town)
No Stalion hospital, Port Banka .... lass ...
..........
Date of.
July 7
Of autopsy ( .... jagnosis confirmed)
Spinal. puncture
What test confirmed diagnosis ?.........
Duration
I7 Aloysius J. Comerford
CH U. S. War Veteran. specify WAR)
(If nonresident, give city or town and state)
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 heaith 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 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 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 sectlon 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 funerai Is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the Interment is madc .... Chap. 114, Sec. 46, G. L., (Tercontenary Editimm.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .--- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .-- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1
R-302
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50m-10-'39. No. 8427-f
17 Mary K . McPhilips Relation, if any
Informant
(Address)
A TRUE COPY.
ATTESTI
(Registrar of city or town where death occurred)
DATE FILED ........ 7/23/40
...... 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
July 7, 1940.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
July .7 ,19 ..... 40
I last saw h ....... £alive on .........
4death is said
to have occurred on the date stated above, at ...
5.151
.. m.
Duration
Immediate cause of death.
Brain .. atrophy
...... rs
Lb .... yr
8
AGE
B.Years.
Months
Days
If less than 1 day
Hours ....
.Minutes
Usual
9 Occupation:
housework
Industry 10 or Businessı
11 Social Security No.
none.
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
John l'. Mckenzie
14 BIRTHPLACE OF
FATHER (City)
(State or country)
P.S. Island
15 MAIDEN NAME
OF MOTHER
Euphemía
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
P. E. Island
(Address)
Date
7/79
40
21 PLACE OF BURIAL
CREMATION OR REMOVAL.
(Cemetery)
(City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
Kirby Brothers
ADDRESS
Received and Klod.
aug. 13-
19
0
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
(Count;)SUX
(City of Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No
(If death occurred in a hospital or institution, $
give its NAME instead of street and number)
2 FULL NAME deceased is a married videres 8.1 or,divorced woman, give also maiden name.)
(If U. S. War Veteran, specify WAR)
(a) Residence. No .......... (Usual place of abode) Harbor view Ave.
St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ...
(Specify whether)
year 55
months
C
days183
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
Or DIVORCED
(write the word)
female white
widowed-
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of .... Cannotbe.brrrrr
(Husband's name in full)
.years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
Generalizeti arterioscierisis
Due to
Bronchopneumonia
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to which death
Of autopsy
asstlitet above
What test confirmed diagnosis ?.
autopsy
should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?
If so, spocity
(Signed)
Melvin ... Goodzan
M. D.
Canton
4 1990
Winthrop
-
PARENTS
SWith A'vos to the clefs of the city of town in which the deceased resided as soon as possible
No ..... Denvers State Hospital
St.
...........
L
٠٠
٠.
C
M R-301 A Suffolk."
PLACE OF DEATH
KCounty) Winthrop
(City or Town) 29 Neptune are. No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
CERTIFICATE OF DEATH
Registered No .. -1
1 (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR). Lewiston me.
(If nonresident, give city or town and state)
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
5a If married, widowed, or divorced
HUSBAND of
....
Max Monolitsin
(Husband's name in full)
.years
If less than I day
Hours
Minutes
Industry at home.
Il Social Security No. none
12 BIRTHPLACE (City)
(State or country)
Runic
13 NAME OF cui FATHER Medição Rosenthal
14 BIRTHPLACE OF
FATHER (City)
Rumi
15 MAIDEN NAME
OF MOTHER
Minnie Sedershy
Runic
17 Mar Mendelson. Relation, if any
......
Informant (Address) 25/howard are rendition men
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filed with me BEFORE the bufal or transit permit was issued: Children x
(Signature of Agent of Board of Health or other) Health Officer 7/10/40
(Official Designation )
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day) /
1940 (Year)
19 1 HEREBY CERTIFY.) That I attended deceased from Freue 26, 19 40 to July 9 19 40 I last saw bef alive on July 9, 1940 death is said to have occurred on the date stated above, at .m. Immediatause of death Coronary I kroulois
Duration IMPORTANT 2 wk
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?.
Date of ... Clinical charged sta- tistically. should be
20 Was disease or Injury In any way ralated to occupation of deceased? none
If so, specify.
ocity Charles Liberay M. D.
(Signed).
(Address) 26 W que Way
Date /201940
21 monat
SchonRemoval.
DATE OF BURIAL Thely 10
1940
22 NAME OF
FUNERAL DIRECTOR
Sarael Einstein
ADDRESS
32 Wenenabert. Rex
Recoived and filed
19
# 21 morets are le (Registrar)
1 2 FULL NAME 3 SEX Female (or) WIFE of AGE Usual 9 Occupation: 10 or Business: PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-10-'39. No. 8427-e N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)
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