USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 10
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(3) Medical Examiners will investigate and certify to all deaths supposebly 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 diseaso 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
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 bacillus) 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 occupation, specify. If inves- tigation 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
M R-302
50m-10-'39. No. $427-f after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time PARENTS
PLACE OF DEATH
Norfolk (County)
Medfield
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Medfield
(City or town making return)
Registered No.
21
§ (If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
Ellen Jane Keenan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St. Winthron, Ilass.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE 5 SINGLE
MARRIED
W .
WIDOWED
or DIVORCED
(write the word)
married
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
Dec. 30, 1940, to
That I attended deceased from
Ian.
25
.......
19.4 .. ]
(or) WIFE of
(Give maiden name of wife in full)
John Keenan
(Husband's name in full)
to have occurred on the date stated above, at.
10:15P.
m.
Duration
2 das.
ÅGE
81
Years
Months ..
.Days
If less than I day Hours Minutes
Usual
9 Occupation:
Housewife
Industry
18 or Business:
II Social Security No.
12 BIRTHPLACE (City)
(State or country)
Ireland
13 NAME OF
FATHER
James Armstrong
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Ann Gallagher
IG BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Medfield St. Hosp.(.
Relation, if any Records)
A TRUE COPY.
ATTESTI
Charles H. Keinetrad
(Registrar of city or town where death occurred)
DATE FILED Heb.15
19 41
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis? Phys & Lab
20 Was disease or lajury la any way related to occupation of deceased ?
If so, specify.
(Signed)
M. H. Laurence
M. D.
(Address) Harding, Mass.
Datel/27/19 47
21 PLACE OF BURIAL,
CREMATION OR REMOVALine Lake, Medfield
(Cemetery)
(City or Town)
DATE OF BURIAL.
Feb. 7
19.41
22 NAME OF
FUNERAL DIRECTOR
Joseph A. Roberts
ADDRESS.
478 Main St., Medfield, Dass.
Received and fled
el 17
19
(Registrar of City or Town where deceased resided)
(If U. S.
War Veteran,
specify WAR)
-
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ....
Hosn.
4.2
years
1 months 25
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
26
1941
5a If married, widowed, or divorced HUSBAND of
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
Immediate cause of death.
Bronchopneumonia
Due to
Arteriosclerotic heart
disease
years .
Due to
Underline the cause to which death should be charged sta- tistically. no
Informant
(Address)
(City or Town) Medfield State Hospital No.
-
I last saw h ... e.r.
..... alive on.
Tan. 26, 1947 death is said
1
M R-301 A
Every item of
100m-2-'40-D-729-8 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. PARENTS
1 3 SEX Memale AGE 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry 10 or Business:
Suffolk (County) Winthrop (City or Town) PLACE OF DEATH No 105 Ocean View
The Commonwealth of Massarhusetts 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. § (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME.
Isabella (MacDonald) Baker
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
105 Ocean View Street
St
(If nonresident, give city or town and state)
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community28
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Arthur Henry Baker
(Husband's name in full)
6 Age of husband or wife if alive. 6.0
.years
7 IF STILLBORN, enter that fact here.
8 77 Years 11 Months4. Days
If less than 1 day
Hours Minutes
Usual
9 Occupation :
At home
11 Social Security No.
Halifax
12 BIRTHPLACE (City),
(State or country)
Nova Scotia
13 NAME OF
FATHER
Alexander MacDonald
14 BIRTHPLACE OF FATHER (City) (State or country) Scotland
15 MAIDEN NAME
OF MOTHER
Elizabeth Morrison
16 BIRTHPLACE OF MOTHER (City) .. (State or country) Scotland
17 Arthur H. Baker
( ... husband )
Informant: (Address) 105 Ocean View St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was ffled with me BEFORE the burial or transit permit was issued : Mm .Ex. Childress
Signature of Agent of Board of Healthfor other) He alte officer 2/3/4/
(Official Designation) / (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
1
(Day)
1941 (Year)
19 HEREBY CERTIFY. 19 7
That I attended deceased from
Y last saw h ............. alive on
19 death is said to
have occurred on the date stated above, at. Immediato cause of death .......
Duration IMPORTANT 7 days
Due to.
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?
If so, specify
(Signed)
M. D.
(Address)
21 ..
Winthrop Cemetery Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
February 3 1941
19
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
ADDRESS
Winthrop Mass
Received and filed. 72/ 3/1-11 19
(Registrar)
19
C
4.13P
m.
Major findings: Of operations.
Date of
Of autopsy
What test confirmed diagnosis ?.
Date 2/3
1941
Relation, if any
(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 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, wlien 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 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 made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of 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 front 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., (Tercentencry Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physlclans 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 medicai 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 namne the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation Is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
Every item of
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD.
1 3 SEX Male 8 89 Usual PARENTS 17 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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 Industry
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No ... 16 Wheelock
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. 29
Registered No.
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Horace Franklin Downes
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
16 Wheelock
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution. (Specify whether)
years
months
days.
In this community 30
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF- DEATH February 2 1941
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
Clara A. Butterfield
(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.
AGE
Years
Months.
Days
Hours.
Minutes
9 Occupation :
Real Estate (retired)
10 or Business:
Office
11 Social Security No.
12 BIRTHPLACE (City).
Amesbury
(State or country)
Massachusetts
13 NAME OF
FATHER Horace Downes
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
Alfred
15 MAIDEN NAME
OF MOTHER
Susan Wheeler
16 BIRTHPLACE OF ( City or town unknown) MOTHER (City) (State or country) Massachusetts
Relation, if any
Informant Flora E. Downes ( daughter (Address) Bryant Hotel Brockton Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death wag filed with me BEFORE the burial or transit permit was issued: Www. D. Children of
(Signature of Agent of Board of Health or other)
Health Officer 2/4/41
(Official Designation) (Date of Issue of/Permit)
Oct. 19 HEREBY CERTIFY
That I attended deceased from
I last saw him alive on feb. 1
have occurred on the date stated above, at ...... 3.
P
m.
Duration IMPORTANT JiLearn
10 years
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT PHYSICIAN
Major findings: Of operations.
Of autopsy.
What test confirmed diagnosis? clinical
20 Was disease or injury in any way related to occupation of deceased?
If so, spe
(Signed).
(Address) Withrop Wars
M. D.
Date Hb.3
1941.
21.
Winthrop Cemetery
Winthrop
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
February 4 1941
.19
22 NAME OF
FUNERAL DIRECTOR ..
Charles .... R ...... Bennison
ADDRESS
Winthrop Mass
19
(Registrar)
100m-2-'40-D-729-a
-
4 COLOR OR RACE
Thite
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
19:39, to tzb- 2
19.4 1
19 41 death is said to
Immediate cause of death. Myocarditis
If less than 1 day
Due to.
Generalized arterio-
Sclerosis
Date of.
Underline the cause to which death should be charged sta- tistically.
Received and filed
(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 forthwitb, after the death of a person whom he has attended during his last illness. at the request of an undertaker or other authorized person or of any member of the family of the deceased. furnish for registration a standard certificate of death. stating to the best of his knowledge and belief the name of the deceased, his supposed age. the disease of which he died, definded as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which lias 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 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 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 forin for the re- moval of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of 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 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 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 physleians 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 physleians 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 deathis caused directly or indirectly by traumatism (including resulting septiceinia), 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, ete. As principal cause name the disease causing death. As related causes, name earlier morbid couditions, if any, related to the principal cause and any important complication of tbe 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 bad 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 domestie service for wages, however. designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION.
RM R-301 A
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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. See instructions and extracts from the laws on back of certificate.
REVERE NOTIFIED
7/8/41
Suffolk (County) Winthrop (City or Town) PLACE OF DEATH No. Winthrop Community Hospital
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