USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 69
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No undertaker or other person shall hury a human hody 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 hoard, from the clerk of the town where the hody Is to he huried or the funeral is to he held, or from a person appointed to have the care of the cemetery or hurial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the 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 disahled 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 supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and hy 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 disahled hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease. or coinplication 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 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 he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husiness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
IR-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.
231
Registered No § (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Lillian
Lucy
Simmons
(If U. S. War Veteran. specify WAR)
St
(If nonresident, give city or town and state)
years
months
days.
In this community 57
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MARRIED
WIDOWED Single
or DIVORCED
years
If less than 1 day Hours.
Minutes
(retired)
10 or Business:
Slattery & Co.
store
15 MAIDEN NAME(Maiden name same ) as OF MOTHER Lucy M. Simmons
Informant Wallace Simmons ( brother)
(Address)
206 Oak Grove Ave, Springfield DATE OF BURIAL
December 26
.. 1940
19
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Www. D. Chil dress J. (Signature of Agent of Board of Health or other)
Health Office 12/26/40 (Official Designation)/ (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
5 SINGLE
(write the word)
DEATH
December 24 1940
18 DATE OF
(Month)
(Day)
(Year)
any HEREBY CERTIFY
19.90 to
December 24, 1940
That I attended deceased from
I last saw her alive on december 22040 death is said to have occurred on the date stated above, at. 5:30 am
Immediate cause of death Cerebine Hemorrhage
Due to. arteriosclerosis
Due to. Chronic Myocardial
Other conditions.
chronic Intentitil
(Include pregnancy within 3 months of dealing panetes
Major findings:
Of operations:
none
Of autopsy.
none
What test confirm Clinical F
laboratory
Duration IMPORTANT 12/24/40 1939 1939 1939 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 ?. 000
If so, sp
(Signe Daerb Chamo Tu.20.
(Address) 562 Pauley St.,
Date.
12/24/40
M. D.
17 Relation, if any 21 Woodlawn Cemetery Werett Place of Burial, Cremation or Removal. (City or Town)
22 NAME OF
FUNERAL DIRECTORCharles R. Bennison
ADDRESS
.Winthrop ... Mass.
Received and filed 19
(Registrar)
Date of
1
Winthrop
(City or Town)
No
213 Lincoln
(a) Residence. No.
213 ... Lincoln
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
3 SEX
4 COLOR OR RACE
White
Female
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.
7 IF STILLBORN, enter that fact here.
8
AGE.
67 Years
4
.Months.
2
Days
Usual
9 Occupation :
Seamstress
Industry
11 Social Security No.
12 BIRTHPLACE (City)
Fast Boston
(State or country)
Massachusetts
13 NAME OF
14 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country)
Massachusetts
16 BIRTHPLACE OF
East Boston
PARENTS
MOTHER (City)
(State or country)
Massachusetts
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-2-'40-D-729-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK IADDED A PERMANENT ALVORD. AVerY Item of
FATHER
William B. Simmons
(If deceased is a married, widowed or divorced woman, give also maiden name.)
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, fter the death of a person whom he has attended during his last illness, t the request of an undertaker or other authorized person or of any nember of the family of the deceased, furnish for registration a standard ertificate of death, stating to the best of his knowledge and belief the ame of the deceased, his supposed age, the disease of which he died, efinded as required by section one, where same was contracted, the uration of his last illness, when last seen alive by the physician or officer nd the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a uman body in a town, or remove tlierefrom a human body which has ot been buried, until he has received a permit from the board of health, r its agent appointed to issue such permits, or if there is no such board, rom the clerk of the town where the person died; and no undertaker or ther person shall exhume a human body and remove it from a town, from ne cemetery to another, or from one grave or tomb other than the receiv- ng tomb to another in the same cemetery, until he has received a permit rom the board of health or its agent aforesaid or from the clerk of the own where the body is buried. No such perinit shall be issued until here shall have been delivered to such board, agent or clerk, as the case hay be, a satisfactory written statement containing the facts required by aw to be returned and recorded, which shall be accompanied, in case of an riginal interment, by a satisfactory certificate of the attending physician, any, as required by law, or in lieu thereof a certificate as hereinafter rovided. If there is no attending physician, or if, for sufficient reasons, is certificate cannot be obtained early enough for the purpose, or is in- ufficient, a physician wlio is a member of the board of health, or em- loyed by it or by the selectmen for the purpose, shall upon application nake the certificate required of the attending physician. If death is caused y violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from ne town to another within the commonwealth cannot be obtained early nough for the purpose, the certificate of death inade as above provided nd in the possession of the undertaker desiring to make such removal hall constitute a permit for such removal; provided, that such body shall e returned to the town from which it was removed within thirty-six ours after such removal, unless a permit in the usual form for the re- noval of such body has been sooner obtained bereunder. If the death ertificate contains a recital, as required by section ten of chapter forty- ix, 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 ppear upon the permit. The board of health, or its agent. upon receipt of uch statement and certificate, shall forthwith countersign it and transmit tto the clerk of the town for registration. The person to whom the permit so given and the physician certifying the cause of death shall thereafter urnish for registration any other necessary information which can be btained 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 tbe 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 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 wben the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposabiy 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 deatbs 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 tbe 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 deatb, 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, bowever, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM-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
232
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St
(If nonresident, give city or town and state)
months
days.
In this community
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Widowed
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,
That I attended deceased from December 15, 1940, to December 25, 1940 I last saw him alive on December 25, 1940, death is said to have occurred on the date stated above, at 12:45 P .m.
Immediate cause of death. Terminal Bronchoneumonia 1 day
Due to. Chronic myocarditis
meand
years
Other conditions.
(Include pregnancy within 3 months of death) Porterio-sclerotic gangrene left lower leg.
Major findings: Of operations.
.Date of.
Of autopsy.
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, spe
ty Arthur C. Hurrar
(Signed)
(s) Minthaof Man Date 12/26
19 40
M. D.
21 Mt. Auburn Cemetery Cambridge Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
December 27.
1940
19
22 NAME OF FUNERAL DIRECTOR Charles R. Bennison
ADDRESS.
Winthrop Mass
Received and filed ....... ٨١٠٠٥٠٢
19
(Registrar)
(Official Designation) V (Date of Issue of Permit)
IMPORTANT
PHYSICIAN
Due to.
RR
Duration IMPORTANT
9 Occupation :
Railroad conductor (Retire)
1
Winthrop
(City or Town)
No
85 Hermon
2 FULL NAME
Edward Ashet Rhines
(a) Residence. No.
85 Hermon
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
White
Male
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
Frances Dorothy Todd
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
8
If less than 1 day
AGE.
77
Years
1.1.Months.
2.1 Days
Hours
Minutes
Usual
11 Social Security No.
12 BIRTHPLACE (City).
Quincy
(State or country)
Massachusetts
13 NAME OF
FATHER
William Rhines
14 BIRTHPLACE OF
FATHER (City)
New York
15 MAIDEN NAME
OF MOTHER
Elizabeth H. Hobart
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Lancaster
(State or country)
New Hampshire
17
Relation, if any
nephew
(Address) 46 Trenton St, Melrose Mass
Informant
Harrie S. Bates
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial of transit permit was issued:
Im.D. Childrenig.
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 OCCUPATIUN
(State or country)
New York
(Signature of Agent of Board of Heatmh or other)
Health Officer
12/24/40
100m-2-'40-D-729-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Industry
10 or BusinessBoston Revere Beach & Lynn
........
(If U. S.
War Veteran,
specify WAR)
50yrs.
december 25 1940
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 hody 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 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 he 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 hy law to be returned and recorded, which shall he 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 he 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 make the certificate required of the attending physician. If death is causcd hy 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 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 he returned to the town from which it was removed within thirty-six hours after such removal. unless a permit in the usual form for the re- moval of such hody 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 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 hurial ground in which the interment is made. . .. Chap. 114, Sec. 46, G. L .. (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the 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 hy 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 necdcd.
(3) Medical Examiners will Investigate and certify to all deaths supposahly due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons). thermal, or electrical agents. and deaths following ahortion, hut also deaths from disease resulting from injury or infectlon related to occupation, the sudden deaths of persons not disabled by recognized dlsease, 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
1
1 :- 302
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50m-10-'39. No. 8427-f
1
PLACE OF DEATH
Middle sex (County)
Cambridge (City or Town) Holy Ghost Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge
(City or town making return)
Registered No.
1745
S
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
No.
2 FULL NAME
Jennie .. Jnyco
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5 Charles St.
St.
Winthro.p.
Bonths
7S.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX F.
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
65
AGE
Years.
Months
Days
If less than I day
Hours
Minutes
Usual
9 Occupation:
At home
Industry 10 or Business:
Il Social Security No .........
none
Lewiston
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
John J Joyce
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Ellen Sullivan
What test confirmed diagnosis ?.
20 Was disease or Injury In any way related to occopation of deceased ?
If so, specify.
George W White MD.
M. D.
(Address)
6 Kupio Ave.
Date
12.21 40
17 Mra C Lane
I ech 0€ if any
Informant
(Address)
152 Medford St. Arlington
A TRUE COPY.
ATTEST:
12/30/40
(Registrar of city or town where death occurred)
DATE FILED
Frederick H. Burner
19
18 DATE OF
DEATH.
(Month)
(Day)
ISDOHEREBY CERTABY. DECI ded deceased 40m
Dec., 10.26
40
19
....
I last saw h ..........
.. alive on
12 120 ... , death is said
to have occurred on the date stated above, at ......
.m.
Duration
In abdomen skuil bones ect
Due to
primary in breast 1926
løyrs
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to which death
Date of
Of autopsy
clinical
should be charged sta- tistically.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lewiston
Muine
21 PLACE OF BURIAL
CREMATION ON FEMOFAD.
Maine
DATE OF BURIAL
12/30/40
(City or Town)
22 NAME OF
Joseph H Rockett
19
FUNERAL DIRECTOR47 M980 Ave Arlington
ADDRESS
Received and filed 19
(Registrar of City or Town where deceased resided)
(If U. S.
War Veteran,
specify WAR)
233
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
(If nonresident, give city or town and state)
years
MEDICAL CERTIFICATE.OS PFATH
(Year)
(Give maiden name of wife in full)
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