USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 43
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No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has received a permit so to do from the board of health or Its agent appointed to issue such permits, or if there Is no such board, from the clerk of the town where the body is to be buried or the funeral Is to 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 discase 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 snpposably 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 lo 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 wagcs, 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
RM R-3011
Suffolk
(County)
1
Winthrop
(City or Town)
No.
I27 Quincy Ave
PLACE OF DEATH
(a) Residence. No.
(Usual place of abode)
length of stay : In hospital or institution
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female
White
5a If married, widowed, or divorced
HUSBAND of
Fre Give maiden name of wife in full)
63
derick J. Jenney
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
AGE
63
Years.
.Months
Days
If less than 1 day
Hours
Usual
9 Occupation:
Housewife
Industry
10 or Business:
Own Home
11 Social Security No.
12 BIRTHPLACE (City)
St. John
(State or country)
N.B.
13 NAME OF
FATHER
Daniel Donovan
14 BIRTHPLACE OF
FATHER (City)
St. John
15 MAIDEN NAME
OF MOTHER
Marie Hasson
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
St. John
(State or country)
N.B.
17
Alice Denovan
Informant
(Address)
I27 Quincy Ave
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
(Signature of Agent of Board of Health or other)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
(State or country)
N/B.
200m-10-'39. No. 8427-d
(write the word)
.years
Minutes
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William S. Childress
agent July 21/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
20
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from October 24
I last saw been alive on ...
July 20
19.40
......
death is said
to have occurred on the date stated above, at 11 am
... m.
Duration
Iimmediate cause of death encours
mitral
....... 1927 .....
Due to
Rheumatic Heart Disease
1927
Due to
acute Coronary
Hyrorbasis
Other conditions
arteriosclerosis
(Include pregnancy within 3 months of death)
1935 PHYSICIAN
Major findings :
Of operations
nove
Date of
Of autopsy
200ml
What test confirmed diagnosis ?
Clinicalx la charged sta.
tistically.
20 Was discase or Injury In any way related to occupation of deceased ? 200
If so, specify4.
Jacob abraces
M. D.
(Signed) ....
(Address) 362 Plusley S
Date
7/20 19/0
21
Winthropbac/Maxcon
Place of Burial, Cremation of Removal
DATE OF BURIAL ...
July
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Winthrop
ANY OF Town )
John M) Mala
Received and filed ...
19
A TRUE COPY ATTEST:
(Registrar)
Registered No. (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Mary A. Donovan Jenney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
127 Quincy Ave
...........
.. St.
(If nonresident, give city or town and state)
years
months
days.
In this community 30 yrs.
mos.
days.
5 SINGLE
MARRIED
WIDOWED
or DIVORCEDarried
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
(If U. S.
War Veteran.
specity WAR)
1927, to July 20
1940
.... 7/201 140 ...
Underline the cause to which death should be
Relation, if any
Sister
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 hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive 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 huried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is 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 hy 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 hy law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physician who is a member of the hoard of health, or employed hy it or hy 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 ahove 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 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 removal of such body has been sooner ohtained 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 he
ohtaincd 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 hury 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 hody is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the 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, thoughi disabled hy recognized discase un- related to any form of injury, have died without recent medical attendance or whose physician is absent from hone 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 hy traumatism (including resulting septice- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut 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 - a disease causing death. As related causes, name earlier morhid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precisc 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 heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husi- 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 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-302
PLACE OF DEATH
... (County)
1
Danvers
(City or 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, St. { give its NAME instead of street and number)
2 FULL NAME
(If deceasedl'is a marfied, Widowed or thiforced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
.......
......
.St.
months
1
days&
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
(write the word)
female white
widowed
19 I HEREBY CERTIFY.
That I attended deceased from
Tun .. 14 ... , 19.
July 20) ... 19 ......
40
I last saw h ........... alive on ...
.... , death is said
to have occurred on the date stated above, at
8 F
.m.
Duration
Immediate cause of death ... Myocardial faliure
day
Arteriosclerosis
10
vears
Due to -Nephrosol ... rosis
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?.
Clini.
20 Was disease or lojury In any way related to occupation of deceased ?
If so, specify
(Signed)
Petar B. Hagopian
M. D.
(Address).
Dato.
17 Informant (Address)
M.K.toPhillips
Relation, if any
A TRUE COPY.
ATTESTI
(Registrar of city of town where death occurred)
DATE FILED 7/29/40
............. 19
18 DATE OF
DEATH
JulyPC 1940
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
6 Age of husband or wife if alive.
years
8 AGE ears
Months.
Days
If less than I day
Hours.
Minutes
Usual
9 Occupation:
none
Industry 18 or Business:
Il Social Security No. nonc
12 BIRTHPLACE (City)
Brandon,y.
VI.
(State or country)
13 NAME OF
FATHER
John Desordy
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Cunada
15 MAIDEN NAME
OF MOTHER
Julia
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
50m-10-'39. No. 2427-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 www pode city of town in case the deceased resided in another city of town at the time
21 PLACE OF BURIAL.
CREM
(Cemetery, ford (City or Town)
DATE OF BURIAL July23 .......... 04.0.19 .....
22 NAME OF
FUNERAL DIRECTOR
Daria.Hudge ....... Son, Inc.
ADDRESS
"Somerville:
.. 19.
Received and fled. 1
(Registrar of City or Town where deceased resided)
Date of.
Underline the cause to which death should be charged sta- tistically.
7 IF STILLBORN, enter that fact here.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
years
-
محمد
CF
IR-301 A
Suffolk (hunty) Winthrop
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. 2.
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is)a married, widowed or divorced woman give also maiden name.) 186 Pauline
.St.
(If nonresident, give city or town and state)
Hospital
years
months
7
days.
In this community 30 yrs.
mos.
days.
(Specify f:hether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
0 (Give maiden name of wife in full)
(or) WIFE of
Herbert
(Husband's name in full)
6 Age of husband or wife if alive
63
.Years
7 IF STILLBORN, enter that fact here.
8
74
Years
5
.Months.
16.
Pays
If less than I day
Hours.
Minutes
9 Occupation:
Housewife
Industry
10 or Business:
our store
Il Social Security No .. northport
12 BIRTHPLACE (City)
(State or country)
mane
13 NAME OF
FATHER
Jason Ware
14 BIRTHPLACE OF
FATHER (City) ...
dincoloville
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Sarah Field
IS BIRTHPLACE OF
MOTHER (City)
(State or country)
maine
17 Herbert Reed
Relation if any ( Nuchaud)
Informant. (Address) 186 Pauline St, hruthrop man
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bugigy or trensiy permit was issued: Www. D. Children & (Signature of Agent of Board of Health brother)
The althe Officer
(Official Designation)
(Date of Issue of Permit)
7/25/40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
23
(Day)
1940 (Year)
(Mopen
That I attended deceased from
19
40
I last saw h .. C.Ralive on .. July 231, 1940, death is said to have occurred on the date stated above, at .. $la.30.[ .. m. Duration IMPORTANT Immediate cause of death .. Branches. purumonia
3 days
Due to
Due to
Other conditions
atrophic cirrhosis
(Include pregnancy within 3 months of death)
of the lives
Major findings : atrophic cirrhosis Of operations othe lives Date of July 1740 which death should be charged sta- tistically.
3 yrs
PHYSICIAN Underline the cause to
Of autopsy
What test confirmed diagnosis? pathological
26 Was disease er injury lu asy way related to occupation of deceased?
If so, specify
y. Workingu
(Signed)
M. D.
(Address) Winthrop
Date July -1940
21
Wwwthrop
or Towny
Place of Burial, Cremation or Removal.
DATE OF BURIAL
1940
July 26 th
Kortare S. Reynolds
...
Received and filed 19 .........
(Registrar)
100m-10-'39. No. 8427-e
V
PLACE OF DEATH
(City or Town)
CERTIFICATE OF DEATH
Winthrop Community Hospital No .. annie Sarah (Ware) Reed
St.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution ..
.....
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Northrop 0
1 3 SEX AGE PARENTS information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual 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.
19 | HEREBY CERTIFY O 23 may3, 1940 to.
.....
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 discase of which he dicd, 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 sball 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 tbc 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 tbe 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 appcar 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 burlal ground in which the interment Is made. . .. Chap. 114, Sec. 46, G. L., (T'ercentenary 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 iiealth physicians will certify to such deaths only as those of persons who, though disabled by recognized discase 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. Thesc include not only deaths caused directly or indirectly by traumatism (including resulting scptice- mla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion. but also deaths from diseane 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 discase 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 hcalthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 ycars 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 wbose only occupation was that of home housework, write kousework. 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.
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