USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 63
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Length of stay: In hospital or institu
(Specify whether)
100m-2-'40-D-729-a
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Ada Bunker
16 BIRTHPLACE OF
MOTHER (City)
Augusta
(State or country)
Maine
Major findings:
Of operations.
none
Date of.
Of autopsy.
See diagnosis above
What test confirmed diagnosis ?. Pathological
Usual
Industry
WPA
..
3
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 inember 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 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 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 inarine 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 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 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
VR-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No 779 Shirley
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.
213
Registered No § (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
2 FULL NAME
Lena Sarah (Butler) Simmons
(If deceased is a married, widowed or divorced woman, give also maiden name.)
South .. Thomas.t.on ...... Main
St
(If nonresident, give city or town and state)
years
months
days.
In this community yrs. mos. 27 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Zebedee Simmons
(Husband's name in full)
6 Age of husband or wife if alive. .. years
7 IF STILLBORN, enter that fact here.
8
AGE .... 81 ... Years ..
6
.Months.4
Days
Ifless than 1 day Hours Minutes Due to.
9 Occupation :
At home
Industry
10 or Business:
11 Social Security No.
South Thomaston
12 BIRTHPLACE (City)
(State or country)
Maine
13 NAME OF
FATHER
William R. Butler
PARENTS
14 BIRTHPLACE OF
South Thomaston
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Julia Sartell
16 BIRTHPLACE OF MOTHER (City). (State or country) Maine
17 Relation, if any Jennie C Bowers. ( sister ... )
Informant (Address) 779 Shirley St Winthrop Hass
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burialor transit permit was issued: Www. D. Children (Signature of Agent of Board of Health or other) Health officer 11/21/40
"(Official Designationy (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH november 20
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from a.m. October 31, 1940 to november 20, 1940 I last saw har .... alive on how, &Q 19, 194), death is said to have occurred on the date stated above, at 3.15 Immediate cause of death ....... cancer
Duration IMPORTANT ?
stomach
Due to.
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? no.
If so, specify
(Signed)
Jennie & Portman
-
M. D. (Address) 47 Washington ave Date 11-201940
SoThomaston Cemetery So. Thomaston Place of Burial, Cremation or Removal, (City of Town) Me.
DATE OF BURIAL
Nov. 23. 1940
19
22 NAME OF FUNERAL DIRECTOR. Charles R. Bennison ADDRESS Winthrop .... Mass.
.19
(Registrar) V
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.
Major findings: Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis ?..
Camden
St.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
(If U. S. War Veteran, specify WAR)
Received and filed
1
Usual
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 sanie 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 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 meinber 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 inade 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 ariny, 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 cominonwealth 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 Heaith physicians will certify to such deatlis 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
NR-301 All Suffolk
(County)
Winthrop
(City or Town)
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 A:21 4
Registered No ....
St.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Mary A. Duncan nae' Whyte
(If deceased is a married, widowed or divorced woman, give also maiden name.)
108 Waldemar av.,
.....
St.
(If nonresident, give city or town and state)
23
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH
November
24
1940
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
William Duncan
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Years
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
90
11
21
If less than 1 day
AGE
Years
Months
Days
Hours
Minutes
Usual
9 Occupation:
none
Industry
at home
II Social Security No.
none
Dundee
12 BIRTHPLACE (City)
(State or country)
Scotland
13 NAME OF
FATHER
Alexander Whyte
Major findings :
Of operations
14 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Jean Miller
16 BIRTHPLACE OF
MOTHER (City)
Unknown
(State or country)
Scotland
17 Justin A. Duncan Relation, if any son
Informant (Address) 52 Lowell Rd, , Winthrop Mass,
V
I HEREBY CERTIFY that a satisfagfory standard, certificate of death was filed with me BEFORE the burial or transit permit was issued: i. D. Children of (gignature of Agent of Board of Health or offer) Health affleur 11/26/40 (Date of Issue of Permit)
(Official Designation)
20 Was disease or injury lo any way related to occupatian of deceased? no
(Signed)
(Ad
) Winthrop Mass Date 11/2-19/0
M. D.
21 Woodlawn
Everett
....
Place of Burial, Cremation or Removal.
ember 27City or Town)
DATE OF BURIAL
19
40
22 NAME OF FUNERAL DIRECTOR ADDRESS 300 Meridian St. , E. Boston, Mass
Received and filed.
19
(Registrar)
2 days
Due to Cerebral hemorrhage
2 months
Due to Generalized arteriosclerosis Means
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
Date of.
Of autopsy
What test confirmed diagnosis ?.
......
-
1 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. 100m-10-'39. No. 8427-e EN. B. WRITE PLAINLY, WATT UNFADING SLACK INN TITHIS IS A PERMANENT RECORD. Every itein of PARENTS
PLACE OF DEATH
No .. 108 Waldemar av ..
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay : In hospital or institution ..
(Specify whether)
years
months
days.
In this community
yrs.
Widow
That I attended deceased from
19 I HEREBY CERTIFY. Sept. 20 19.9.Q .. , to. november 2 4, 1940 I last saw ber alive on november 22, 1940, death is said to have occurred on the date stated above, at ... / .... 3.0 ......... m. Duration IMPORTANT Immediate cause of death Terminal broncho - pneumonia
10 or Business:
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 otber authorized person or of any member of the family of the deccased, 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 sball hury or otherwise dispose of a human body in a town, or remove therefrom a human hody 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 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 huried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may he, 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, hy 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 by the selectmen for the pur- posc, 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 ahove 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 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 bave 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 snch 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 beld, 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 disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disahled by recognized disease un- related to any form of injury, have died without recent medical attendance or wbose 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 hy 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 morhid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
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