Town of Winthrop : Record of Deaths 1940, Part 58

Author: Winthrop (Mass.)
Publication date: 1940
Publisher:
Number of Pages: 494


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 58


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IMPORTANT PHYSICIAN Underline the cause to which death should be charged sta- tistically. C


20 Was disease or injury in any way related to occupation of deceased? 200


If so, specify


(Signed).


(Address) 105 8 plum 81


Jay


M. D.


Date Rok. 19


21 Winthrop Cemetery~ Winthrop


Place of Burial, Cremation or Removal.


(City of Town)


DATE OF BURIAL.


October 22


1940


19


22 NAME OF


FUNERAL DIRECTOR.


Charles R. Bennison


ADDRESS


Winthrop ....... Mass


Received and filed 19


(Registrar)


CAUSE OF VEMIII in plain terms, so that it may be properly classined. Exact statement of OCCUPATION information should be carefully


is very important. See instructions and extracts from the laws on back of certificate.


100m-2-'40-D-729-a


1


DUVCIAI A MIO


FYACTIV


(If U. S.


War Veteran,


specify WAR)


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or institution.


(Specify whether)


(write the word)


6 Age of husband or wife if alive.


Due to


arteiro - scheinsão.


Due to.


Other conditions ..


chimica nepfrutas


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 perinit 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 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 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 inake 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 anotlier 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 heaith, 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 physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from dlsease resulting from injury or infection related to occupation, tlie 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


M R-301


..


Suffolk. (County)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


..........


(City or town making return)


197


Registered No.


(If death occurred in a hospital or institution, .St. { give its NAME instead of street and number)


2 FULL NAME


(If deceased is A married, widowed or divorced woman, give also maiden name.)


78 Ingleside Que


St.


(a) Residence. No ...


(Usual place of ahode)


Length of stay: In hospital or institution


(specify whether)


years


months


days.


(If nonresident, give city or town and state) In this community /15 YTS. mos. days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX Male


4 COLOR ORARACE


Where


5 SINGLE


MARRIED


WIDOWED


oz DIVORCED


(write the word)


manid


5a If married, widowses or diz HUSBAND of


routine Corbett


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


6 Age of husband or wife if alive.


80


.. years


7 IF STILLBORN, enter that fact haro.


If less than 1 day


.Months


..... Days


.......


Hours


Minutes


9 Occupation:


Contracting


Industry


10 or Business:


1I Social Security No. nonen


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


John Terry


14 BIRTHPLACEOF


FATHER (City)


Tralefax


(State or country)


15 MAIDEN NAME


OF MOTHER


Budal Kelley


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Informant.


(Address)


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Thu. D. Clubdriver. (Signature of Agent of Board of Health or other)


10/26/40 (Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Thursday October 24, 1946


(Month)


(Day)


(Year)


HEREBY CERTIFY. ThatA attended deceased from


hoventes J 1938 October 24 1940 y to. I last saw h. foto.alive on October 24- 1940, death is said Duration to have occurred on the date stated above, at / USP Immediate cause of death. ...


Brauchist pneumonia


...


......


3days ........... ......


7 dos


Generalized arterio sehr Suility


Due to


Chrome ney scanditi


Other conditions


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Of autopsy


What test confirmed diagnosis ?


unscultation


20 Was disease or Injury In any way related to occupation of deceased ? 200


If so, specify.


Amote Mussrack


... M. D.


(Signed)


620/BeachST Nured Date 16- 2 1940


(Address).


21


Place of Burial, Cremation co Bemsval.


DATE OF BURIAL ...


204.26


9 ....


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


Wetterck Mais


Received and filed. 19


A TRUE COPY ATTEST:


(Registrar)


1 PLACE OF DEATH PARENTS 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. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual


200m-10-'39. No. 8427-d


17 Raclow Thomay (Site)


Relativa, if Any


J


No ....


(City or Tak) 18 inducido Que. Edward Harney


(H U. S. War Veteran. specify WAR)


Kity or Town)


PHYSICIAN Underline the cause to which death should be charged sta- tistically.


Date of ................


...


.....


Due to


Ceresal thrombosis


........


8 AGE ... 81 Years


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, furnisb 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 tbe physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there sball 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, wbicb sball be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one toww 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 bas 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 tbe clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until be has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funcral 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- ncss 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 deatbs 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 deatbs 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 mcans 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 bealthfulness 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 wbo bad no 'occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


NR-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.) of death should be transmitted on Form K-302 to the clerk of the city or town in which the deceased resided as soon as possible PARENTS


PLACE OF DEATH


MIDDLESEX


(County)


SOMERVILLE, (City or Town) 24 Highland Ave.


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


SOMERVILLE


(City or town making return)


Registered No.


724


(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)


2 FULL NAME


{If deceased is a married, widowed or divorced woman, give also maiden name.) Proble Avenue,


St. Winthrop, Mass.


(a) Residence. No ....


(Usual place of abode)


Length of stay: In hospital or institution Nurse's Homeyears


1


months


6 days.


In this community


yrs.


mos.


days.


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE: 5 SINGLE


MARRIED


WIDOWED


or DIVORCED


Widowed


(write the word)


White


18 DATE OF


DEATH


October 25, 1940


(Month)


(Day)


(Year)


5a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Frederick B. Chanman


(Husband's name in full)'


6 Age of husband or wife if alive .Years


7 IF STILLBORN, enter that fact here.


3 AGE 87 Years 8 .. Months. Days


If less than 1 day


Hours.


.Minutes


Usual


9 Occupation:


Housewife


Industry


At Home


10 or Business:


Due to


11 Social Security No.


Providence


12 BIRTHPLACE (City)


(State or country)


R. I.


13 NAME OF


FATHER


Stephen W. B. Crowell


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass.


Milton,


15 MAIDEN NAME


OF MOTHER


Sarah B. Smith


16 BIRTHPLACE OF MOTHER (City) (State or country) Mass.


17 Chester B. Chapman


Relation, if any


Informant.


.. Son,


(Address) Preble Ave, Winthrop Wass


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


October 28,1940


19


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 In any way related to occupation of deceased ?


no


If so, specify ..


(Signed)


Herbert Cholerton,


M. D.


(Address) .Somerville Masg.Date.10/26.19 110


21 PLACE OF BURIAL.


CREMATION OR REMOVE


Canton Cem. , Canton, Mass.


DATE OF BURIAL


October 28, 1940


19


22 NAME OF


FUNERAL DIRECTOR


John S. McGowan,


ADDRESS.


Somerville, Mass


Received and filed


19


(Registrar of City or Town where deceased resided)


1


No. Emma F. Chapman


(Crowell)


(If U. S.


War Veteran,


198


specify WAR)


(If nonresident, give city or town and state)


That I attended deceased from


19 | HEREBY CERTIFY,


Jan. 1 1940


.......


19


October 25.


2.79740


to


I last saw h ......... alive on ...


October 25191 911 death is said


to have occurred on the date stated above, at .... ] ........... )mit Duration


Immediate cause of death


Diabetes Mellitus


10 years


Due to


Diabetic Coma


2 days


PHYSICIAN


Underline the cause to which death should be charged sta- tistically.


Needham


(Cemetery) (City or Town)


6


THE OR MARS


NOV-61040 AM


R-303


PLACE OF DEATH


buffoch. (County)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


(City or town making return)


Registered No.


199


HI death occurred in a hospital or institution,


NAME instead of street and number)


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also priden name.) (a) Residence. No 100 Cliff are, theintenog luciachance


(Usual place of abode) Length of stay: In hospital or institution ... (Specify whether)


years


months


(If nonresident, give city or town and state) days. In this community 2 5 yrs. mos. days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


male


4 COLOR OR RACE 5 SINGLE


(write the word)


colate


MARRIED


WIDOWED manus


or DIVORCED


5a If married, HUSBAND of


Ciday ) or diverted Muhase (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.


8 AGE 48 bars. Months .. Days


If less than 1 day Hours Minutes


Usual salesman


9 Occupation:


Industry


General Importing Go


10 or Business:


Il Social Security No. 021-03-25/20


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


Peter Levas


PARENTS


14 BIRTHPLACE OF FATHER (City) (State of country)


15 MAIDEN NAME


OF MOTHER


Stella Borrar


16 BIRTHPLACE OF MOTHER (City) (State or country)


17 Informant. Levar ( urge


Relation, if any (Address) 100 Cliff ane Wlasituation, La DATE OF BURIAL


I HEREBY CERTIFY that o satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued. Www. D. Children + 10/29/40 (Signature of Agent of Board of Healthfor other) Health Affects (Official Designation) (Date of Issue of Permity


MEDICAL CERTIFICATE OF DEATH


18 DATE OF DEATH October 26, 1440 (Day)


(Month)


(Year)


19 | 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.)


Lac Houleuse


20 Accident, Suicide Chode cada


Date of occurrence. 19


Where did Injury occur ?.


(City or town and State)


public places elected


(Specify type of place)


Manner of


Injury


Nature of Injury


While at work?


Was there an autopsy?


21 Was disease or Injury In any way related to occupation of deceased ? If so, specify 2


(Skreddecelui


L/M. D.


to 10/20/4/19


22 Woodlawn am New Anul n.L Place of Burial, Cremation or Rentoval. (City of Town)


Get 31,


.19


23 NAME OF FUNERAL DIRECTOR 1654 Wadwytry St. Bouton ADDRESS.


Received and filed. 1


À TRUE COPY ATTEST:


(Registrar)


y


information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF


DEATH in plain terms, so that it may be properly classified under the International Classification of Causes


50m-10-'39. No. 8427-h


of Death. See reverse side for extracts from the laws relative to the return of certificates of death.


1


City of Town)


(If U. S. War Veteran. specify WAR) ..


.........


39 Years


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 deccased, 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 hy the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall hury 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 hoard of health or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall be issued until there shall have heen de- livered to such board, agent or clerk, as the case may he, a satisfac- tory written statement containing the facts required hy law to he returned and recorded, which shall be accompanied, in case of an original interment, hy 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 he 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 hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human hody, 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 hody 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 hy 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 heen 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 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 by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.




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