USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 5
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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 bas 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 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 discase 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 voman 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-303 B
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) . 364 Winthrop St. Nathrop No.
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 12
Margaret Ellie Jackson. (Mencan)
(If deceased is a Odbied, widowed or divorced woman, giye also (maiden name.
(a) Residence. No 364 Truthobst. Mencarp Se.
(Usual place of ahode)
Length of stay: In hospital or institution
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE| 5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
(Give maiden name of wife in full)
(or) WIFE of Albert
.Griggs .... Jackson
(Husband's name in full)
6 Age of husband or wife if alive .Years
8 AGE 69 Years. 10 Months 28 Days
If less than 1 day
Hours.
.Minutes
9 Occupation:
House work
12 BIRTHPLACE (City)
(State or country)
Prince Edwards Island,
Unable to obtain
14 BIRTHPLACE OF
Unable to obtain
(State or country)
Unable to obtain
Unable to obtain
Unable to obtain
5m-10-'39. No. 8427-j
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burigl/or transit permit was issued: Www. D. Childress (Signature of Age of Board of Health or other) Health Officer
(Official Designation) (Date of Issue of Rermic)" 1/23 /40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January- 22 -1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MAIINER thereof are as follows: (If an injury was involvedz state fully.) Acute Cardiac Facteura Angina Pectoris chronic hugocandentes
Found dead on floor of her bath
Was there an autopsy?
no
(See reverse side for description for unknown person)
20 Where did
injury occur ?.
(City or town and State)
21 Was ólseaso or
patan degases .
If so, specify
(Signed)
M. D.
(Address)
Muss. - 22
Date
1940
Mt. Auburn
Cambridge lass
DATE OF BURIAL.January 24
19.
40
23 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
Winthrop Mass
ADDRESS
Received and filed. 19
(Registrar)
17 Carl I .Nelsom Kelation, if any Place of Daniel, Cremation or Removel. (City or Town)
son
(Address]0 Marshall St Winthrop
1 2 FULL NAME 3 SEX Female White 5a If married, widowed, or divorced HUSBAND of 7 IF STILLBORN, enter that fact here. Usual Industry 11 Social Security No .... 13 NAME OF FATHER FATHER (City) 15 MAIDEN NAME OF MOTHER 16 BIRTHPLACE OP MOTHER (City) (State or country) Informant. 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 of Death. See reverse side for extracts from the laws relative to the return of certificates of death. PARENTS N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 10 or Business: Own home
§ (If death occurred in a hospital or institution. .St. ( give its NAME instead of street and number)
(lf U. S. War Veteran, specify WAR)
(If nonresident, give city of town and sta c)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or reglalered 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 vermit 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 sball have been de- livered to sueh board, agent or elerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and reeorded, 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 certifieate 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 eannot 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 reeital, 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, Sec. 45, G. L., as amended.
DESCRIPTION (for unknown person)
No undertaker or other person shall bury a human body or tbe 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 sueh 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. as amended.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died hy 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 place 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 tbe place where the deceased died his name 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) Altending 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 physiclans 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) Modleal Examiners will investigate and certify to all deaths supposably due to Injury. These Inelude 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 certifyIng 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 production 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- eident." "Pistol sbot wound of the chest with assoclated hemor- rhage, homicidal," "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal Injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If Inves- tigation shows the deatb to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under man- ner, 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 sclerosis. (Sudden death) ."
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
R-301 A Suffolk
1
PLACE OF DEATH
fourty) Whithrok
(City or Town) 125 Hermon
The Commonswealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To bo fled for burial permit with Board of Health or its Agent.
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR) 200
(If deceased is a married, widowed or divorced woman, give also maiden name.) 25 Plummer Are
St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ..
years
months
days.
In this community 2 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male White
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Married
Ja If married, widowed, or divorced Susay L. M. GalphaDo 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 7 IF STILLBORN, enter that fact here.
59
Years
8 6% AGE Years
Months.
Days
Hours
Minutes
Usual Retired Engraver
9 Occupation:
Industry Steel Plate
10 or Business:
Il Social Security No. none
12 BIRTHPLACE (City)
East Boston
(State or country) masor.
13 NAME OF
FATHER
Thomas. M: War
14 BIRTHPLACE OF
FATHER (City)
Gast Boston
(State or country) Wasst.
15 MAIDEN NAME
OF MOTHER
Ellen O'leary
Boston
16 BIRTHPLACE OF MOTHER (City) (State or country) casa.
17 Susan h. M: Manus( wife
25 Plummer Are, Withup
I HERETY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the guard! or bansit permit was issued:
Um. D. Child Adresse
(Signature of Agen of Board of Heatsor Health Officer (Official Designation)
1/27/40
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
That I attended deceased from
I HEREBY CERTIFY. 23 19.40 ....
Azm 26 , 19 40
last saw h. hvalive off Afin is, 19. YO, death is said to have occurred on the date stated above, at ....... DA ... m. Immediate cause of death .. Duration IMPORTANT Central Embolism
3 days
Due to
antero Delussis
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings : Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?
20 Was disease or Injury ly any way related to occupation of deceased? 40
If so, speci alar (Signed)
. M. D.
(Address)
Relation, if any
21
Winthrop
Winthrop
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL. January 28, 40 ......
22 NAME OF FUNERAL DIRECTOR
M. J. Kelly
ADDRESS 11 Merideda St., 2.0 TB
Received and filed
19 ....
(Registrar)
100m-10-'39. No. 8427-e
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.
No ...
St.
2 FULL NAME
Edward Patrick M: Manus
(a) Residence. No ..
(Usual place of abode)
(Specify whether)
26 1940 (Year)
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
16,40
Informant
PARENTS
If less than 1 day
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- tratlon 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, ocfined 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 & 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 issuc such permits, or if there is no such board, from the clerk of the town where the person dled ; 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. & 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 forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so glven 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 deccased, 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- anee 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 diseasc 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- mla), 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
R-301 A
PLACE OF DEATH
Suffolk (County)
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, give its NAME instead of street and number)
2 FULL NAME
Jane( Gray) Doig
(If deceased is a married, widowed or divorced woman, give also maiden name.)
23 Almont
....
.St.
(If nonresident, give city or town and state)
In this conimunity20
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
1
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than I day
Hours.
Minutes!
House work
15 MAIDEN NAME
OF MOTHER
Annie Sharpe
16 EIRTIIPLACE OF
MOTHER (City)
(State or country)
Scotland
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with ma BEFORE the bufful or transit permit was issued:
Chil dress
(Signature of Agent of Board of Health orphe)
Health officer
1/31/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Con
27
(Month)
(Day)
1940 (Year)
19 I HEREBY
CERTIFY
That I attended deceased from
19.1.2, to .....
27
19 40
I last saw h .. alive on .. teen 27, 1944, death is said to have occurred on the date Stated above, at/ .. Q .: 52Am. Duration IMPORTANT Immediate cause of death .. mittal umeoffering ? che
Due to
Due to
Other conditions Che moterstated reflects
(Include pregnancy within 3 months of death)
10 4m
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was diseaso er injary in any way related to occupation of deceased?
If so, specify ..
MP. W. hay ton
(Signe
(Address) 270 Cm
Date
1/27
..
M. D.
1970
21
Winthrop Cemetery Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Feb. 1/40
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop .... Mass
Received and aled 19 .....
(Registrar)
V
Winthrop
(City or Town)
No.
23 Almont
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