USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 66
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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, front 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 medicalattendance or wliose 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, astbenia, 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
AR-301 A
Every ilem of
8 .... 100m-2-'40-D-729-a N. B. WRITE PLAINLY, WITH UNFADING BLACK INA-7THIS IS A PERMANENT RECORD. PARENTS
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 ..
223
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
William Henry Sawyer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
52 Fairview
St
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
(If nonresident, give city or town and state)
In this community 53 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
DEATH.
18 DATE OF december
8
(Month)
(Day)
1
1940
(Year)
19 I HEREBY CERTIFY, That I attended deceased from October 15, 1940, to december 8, 1940 I last saw him alive on December 7, 1940, death is said to have occurred on the date stated above, at 3:15 A .m. Duration IMPORTANT Immediate cause of death.
Bronchopneumonia (terminal)
1 day
6 weeks years (?)
Other conditions.
(Include pregnancy within 3 months of death).
Hypertrophy of prostate
Major findings: Of operations. none
Date of -
Of autopsy more
What test confirmed diagnosis ?. clinical
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Sign
(Address) Marathon Man Date 12/9
1940
21 Winthrop Cemetery Winthrop Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL ...
December 10
1940
19
22 NAME OF
FUNERAL DIRECTOR.
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed.
19
(Registrar)
1
Winthrop
(City or Town)
No .. 52 ... Fairview.
(a) Residence. No.
(Usual place of abode)
3 SEX
Male
4 COLOR OR RACE
White
(or) WIFE of
Usual
Industry
10 or Business :.
11 Social Security No ...
None
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
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
AGE
66Years
3
Months
22
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowel
Sa If married, widowed, or divorced,
HUSBAND of
Grace May Webster
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
Days
Ifless than 1 day .Hours Minutes Due to Cerebral hemorrhage
9 Occupation :.
Furniture mover
12 BIRTHPLACE (City)
Che Isea
(State or country)
Massachusetts
13 NAME OF
FATHER
John F. Sawyer
OF MOTHER Frances A. Burrill
Bangor
17 Relation, if any
Informant.
Evelyn F. Ballon ( daughter
(Address)
52 Fairview St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Www. D. Cluldress (Signature of Agent of Board of Health oy ofher
(Realite Officer 70/1140 (Official Designation) (Date of Issue of Pefmit)
Due to Aspertension
IMPORTANT PHYSICIAN
Underline® the cause to which death should be charged sta- tistically.
M. D.
St.
(If U. S.
War Veteran,
specify WAR)
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 whoin 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 helief the name of the deceased, his supposed age, the disease of whichi he died, definded as required by 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 bury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not heen 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 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 hody is buried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall he 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 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 hy 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 shali 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 he 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 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 whoni 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 ohtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chop. 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 perinit so to do from the hoard 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 he 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 hedside 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 hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 ahortion, hut 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 he 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
AR-301 A: Suffolk County)
1
PLACE OF DEATH
Winthrop (City or Town) 42 Myrtle
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. 224
Registered No
(If deatlı occurred in a hospital or institution, give its NAME instead of strect and number)
2 FULL NAME
Philip Riley
(If deceased is a married, widowed or chyorced woman, give also maiden name.)
42 Myrtle
Are St. Winthrop
..
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ...... (Specify whether)
years
months
days.
In this community / yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
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
(Husband's name in full)
deceased
.. years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
If less than I day
Hours.
Minutes
Usual
9 Occupation:
Retired Barber
Industry
10 or Business:
Barber
1I Social Security No. none
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
Anthony Riley
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Rose warknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17 Mrs. Killian & Bishop stel-daughter
Relation, if any &# 21
Informant.
(Address)
42 Ul qulle Are, Winthropf
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Chil dress (Signature of Agent of Board of Health orother) Seattle Officer 12/13/40 (Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
December
11
1940.
(Month)
(Day)
(Year)
That yattended deccased from 19 I HEREBY CERTIFY cumber 11 1940 January 27 193.,
4 last saw buM alive on. December 10 1940, death is said to have occurred on the date stated above, at 7:15am Immediate cause of death, Cerebral Hemorrhage
Duration INFORTANT 12/8/40 ......
Due to arteriosclerosis
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings : Of operations none
Date of.
Of autopsy
What test confirmed diagnosis ?.
clinical
20 Was disease or Injury la any way related ta occupation of deceased? no
If so, specify .............
(Signed ) Deob
wintherp . M. D.
(Address) 562 Stanley St.,
Winthrop
Winthrop
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
December
19 40
22 NAME OF
24. J. Kelly
FUNERAL DIRECTOR
ADDRESS
IM Maridinho St., dar 13.
Received and flad 19
(Registrar)
1937.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
Date 12/11/1040
8 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 N. B .- WRITE PLAINLI, WITH ORFADING DLACA 14-11IS IS A PERMANENT RECORD. Everv item of PARENTS
No.
Are. St.
(IE U. S. War Veteran, specify WAR) no.
(a) Residence. No ..
(Usual place of abode)
Mary Jannow
AGE
77
Years
Months
Days
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 be bas 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, bis supposed age, the disease of which be 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 bury or otherwise dispose of a human body in a town, or remove therefrom a human body which bas not been buried, until he has received a permit froin the board of bealth, 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 sball be issued until there shall have been dc- livered to such board, agent or clerk. as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as bereinafter provided. If there is no attending physician, or if, for sufficient reasons, bis certificate cannot be obtained early enough for the purpose, or is insufficient, a physician wbo 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 hy 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 tbe possession of the undertaker desiring to make such removal sball constitute a permit for such removal ; provided, that sueb body sball 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 bercunder. 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 bealth, or its agent, upon receipt of such statement and certificate, shall fortbwith 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 deatb, 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 burled or tbe 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 hedside 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 witbout 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 to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Canse 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 deatb. 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 Ocenpation .- 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 deatb, report tbc 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 wbose only occupation was that of home housework, write housework. For a person engaged In domestic service for wages, however, designate tbe 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
MR-301 A
1
PLACE OF DEATH
0 County) Winther (City or Town) 156 Somenet an No ...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To, be filed for burial permit with Board of Health or its Agent.
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and_number) -
225
(lf U. S. War Veteran, specify WAR) mane
(If deceased is a married, widowed or divorced woman, aike also maiden name.) 156 SomersetAn
.. St.
(If nonresident, give city or town and state)
Length of stay : In hospital or institution ..
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
1
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
5a If married. widowed, or divorced
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.
53
7 IF STILLBORN, enter that fact here.
If less than 1 day
8
AGE 7.2
Years
Months
.Days
Hours
Minutes
Usual Sales
10 or Business:
9 Occupation:
Industry
Custom Shirt manufacturer
11 Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Jauges Ce. Higgins
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Lacturine Ryan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mr. beangaut Higgins, nife
)
Relation, if any
17 Informant. (Addres 156 Anidet Av. Muchop
1 HEREBY CERTIFY that a satisfactory standard certificato of death was filed with me BEFORE the burial or /transit permit was issuod: Wm. D. Clubdes.& Signature of Agent of Board of Health or other)
(Official Designation
12/19/40 (Date of Issue of Pekinft)/
MEDICAL CERTIFICATE OF DEATH
DEATH
(Month)
(Dấy)
1940
(Year)
19 I HEREBY CERTIFY
That I attended deceased, from
Jan., 1938 0
DEC. 17
1940
I/last saw h WWlive on HEC-16
13 ... 4/0 death is said
Duration
IMPORTANT
to have occurred on the date stated above, at .......
Immediate cause of death
Cerebral Hemous Curage.
2 yrs
Due to
Due to
Other conditions
asterio Scleroses
(Include pregnancy within 3 months of death)
Major findings : Of operations
Dale of
Of autopsy
What test confirmed diagnosis ?
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was dlsease or lajury, la any way related to occupation of deceased?
No-
li so, specify ...
(Signed) Edwi), Grainger
M. D.
(Address) 200 Wartungen Date.
12. 10 19 110
Nut Rixchay
Stirruphis Center Place of Burial Cremation or Removal. DATE OF BURIAL .... (City or Town) Dec. 26 20 19 40
22 NAME OF
May E. Burke
FUNERAL DIRECTOR
ADDRESS
750 Charles St, Boston
Received and filed. DEC SO. 19 0 19
(Registrar)
V
100m-10-'39. No. 8427-e
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 £4112
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