USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 9
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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, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burlal ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (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 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 Examniners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, c. g., heart failure. asphyxia, asthenia, etc. As principal cause namc the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make somne entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-303 B
PLACE OF DEATH
Suffolk (County)
Metros
(City or Town)
No Martheir Community Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 23
ยง (If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME
yee
Hee
(If deceased ima married, widowed or divorced woran, give also maiden name.)
(a) Residence. No 139 Shirley St. Fronthits
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
ears
months
1
days.
In this community
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE| 5 SINGLE
Chinese
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
HUM ......... SHEE
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
54
6 Age of husband or wife if alive.
Years
7 IF STILLBORN, enter that fact here.
8
AGE .. 54
... Monilis ............ Days
If less than 1 day Hours. .Minutes
Usual
9 Occupation:
Laundryman
Industry
10 or Business:
Laundry
Il Social Security No ..
NONE
12 BIRTHPLACE (City)
(State or country)
China
13 NAME OF
FATHER
Yee Bing Wah
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
China
15 MAIDEN NAME
OF MOTHER
Lee Shee
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
China
17 YEE FOOK HING
Informant
(Address)
4a Hudson St., Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
FOUNTAIN (Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit) 5766
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
February - 4 -1940
(Day)
(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.).
arterio Scleroses chrome he phritis
Was there an autopsy ?.
(See reverse side for desCiption for unknown person)
20 Where did
injury occur?
(City or town and State)
21 Was disease or lojury in any way related to occupation of deceased?
Il so, specify. Am Brinkley
(Signed)
M. D.
(Address)
Bester
Jebio - 5-
1940
22
Mt ....... Hope ..... Cemetery .......... Boston
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
February 6, 1940
19
23 NAME OF
FUNERAL DIRECTOR
Gly C. P mc Caffrey
ADDRESS
75 Albany St., Boston
Received and filed 19
(Registrar)
1
5m-10-'39. No. 8427-j
1
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
(If U. S.
War Veteran,
NO
specify WAR)
St.
(If nonresident, give city or town and sta!e )
....
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 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 geen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there Is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or lts agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, 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 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 town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith countersign It and transmit it to the elerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 15, G. L., as amended.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until be bas received a permit so to do from the board of health or Its agent appointed to issue such perniits, or if there is no such board, from the clerk of the town where the body Is to be burled or the funeral Is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment Is made .... Chap. 114, Sec. 46. G. L. as amended.
Medical examiners shall make examination upon the vlew of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ; ... - General Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar In the place where the deceased died his name and residence, if known ; otherwise a description as full as may be, with the cause and man- ner of death .- General Laws, Chap. 38. Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) 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 physlelans will certify to auch deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will Investigate and certify to all deaths supposably due to Injury. These Include not only deatbs caused directly or Indirectly by traumatism (including resulting septice- mia), and by the actlon of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from Injury or infection relaled to occupa. tion, the sudden deaths of persons not disabled by recognized discaso, and those of persons found dend.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences ; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas hacillus) caused by a steam railway ac- cident." "Pistol shot wound of the chest with associated hemor- rhage, homicidal." "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupatlon, specify. If Inves- tization shows the death to have been due to disease, specify : (1) Under cause, its known or presumable nature ; and (2) under man- ner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed) ." "Heart disease, presumably coronary sclerosis. (Sudden death)."
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-301 AI Suffack
PLACE OF DEATH
(County) Stanthrop
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(li U. S. War Veteran, specify WAY ... maso
(If nonresident, give city or town and state)
months
7
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
write the word)
Suple
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than I day
Months.
... Days
Hours
Minutes
a Home
Cornelio Lynch
Dicland
15 MAIDEN NAME
OF MOTHER"
Janana Lynch
Ireland Fathernie Learn Bei Rebellion if any
17 Informant (Address) 15 marzo De. EB
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bundl or kansit permit was issued: Www. D. Children (Signature of Agent of Board of Health & others Healthe Office
2 /4/40 (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH (Month)
February 5. 1940
(Day)
(Year)
HEREBY CERTIFY at.
, 19 Y ... 0, to.
1940
I last saw h. w alive on ..
to have occurred on the date stated above, at ....
1/ A. m.
Duration IMPORTANT
2 Days
Due to
acute Cardiac Dilatation
and passing congestion.
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Of autopsy
Une Date of.
What test confirmed diagnosis?
20 Was disease or Injury In any way related to occupation of deceased?
= , specify Send It Schwartz (Signed)
M. D.
2/6
40
(Address) Valy trong halten .Date ... 21
City & Town)
10 .....
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Bookan
Received and filed. 19
(Registrar)
100m-10-'39. No. 8427-e
(Official Designation)
Boston vatifiene 3/2/40
To be filed for burial permit with Board of Health or its Agent. 23
(City or Town) Hautkrop Immunity Nost. No. HE Jani Lunch
(If deceased is a married/ widowed or diverged woman, give also maiden name ) 75 marris St. .
St.
years
1 2 FULL NAME (a) Residence. No .. (Usual place of abode) Length of stay : In hospital or institu 3 STKX 4 COLOR OR RACE Of. F. 5a If married, widowed, or divorced HUSBAND of (or) WIFE of 6 Age of husband or wife if alive 7 IF STILLBORN, enter that fact here. 8 75 % AGE Years Usual 9 Occupation: 11 Social Security none 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) (State or country, PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry 10 or Business: none is very important. See instructions and extracts from the laws on back of certificate.
Boaton
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
Place of Burial, Cremation or Removal DATE OF BURIAL
.....
hat I att ded deceased from
19 ...... " death is said
Immedi
Broucho - Prsummer
4 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 he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, dcfined 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, Scc. 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 onc cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, & satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending 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 town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hercunder. 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 trangmit 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 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., (T'ercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Ilealth physicians will certify to such deaths only as those of persons who, though disabled by recognized discase un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
-
1 R-301 Al
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. 30
No Winthrop Community Hospital
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Lillie D. ( Johnstone ) Stewart
(If deceased is a married, widowed or divorced woman, give also maiden name.)
48 Beacon St.
St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institutio
Hospital ars
(Specify whether)
months
2
days.
In this community 39 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February-
7
1940
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
Februaryo
..... ,
, 19 .. 5.2., to ...
February.), 1940
That I attended deceased from
I last saw h .... ) .... alive on ..... showing 7, 19 40 death is said to have occurred on the date stated above, at 1 2:40 Pm. Immediate cause of death ......! Coronary Thrombosis
Duration IMPORTANT 48 hours
years.
Due to
Other conditions Cancer ofa Stomach! (Include pregnancy within 3 months of death)
3 MOS
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury In any way related to occupation st Enceased? No
If so, specify.
(Signed) ..
Edward D' tranger
M. D.
(Address) 200 Waldenstay Due Date Fab 8 1940.
21 Winthrop
Winthrop
Place of Burial, Cremation of Removal. DATE OF BURIAL
(City of Town ) 40
22 NAME OF FUNERAL DIRECTOR TOMU
ADDRESS Winthrop Mass
Received and filed ........ 19
(Registrar)
100m-10-'39. No. 8427-e
17 Benj. F. Stewart
H Relation H any Informan 48 Beacon St. "inthrop (Address)
I HEREBY/CERTIFY that a satisfactory standard, certificate of death was filed with me BEFORE the bunch of transit permit was issued: Www. D. Chil dress og (Signature of Agent of Board of Health or other).
realthe Officer 2/9/40
(Official Designation) (Date of Issue of Dermit)
(write the word)
Married
(Give maiden name of wife in full)
Benjamin Franklin Stewart
(Husband's name in full)
77
6 Age of husband or wife if clive.
.Years
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