USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 14
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(Signature of Agent of Board of Health or other) Health Officer
3/17/4/
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
(Month)
16
1941
(Year)
19 I HEREBY CERTIFY. 1
19
to
A last saw halive on.
Feb. 15, 194, death is said to
have occurred on the date stated above, at. Immediate cause of death ....
7 A
.m.
Duration IMPORTANT
Due to. cutero sicura
Due to.
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations
Date of.
Of autopsy.
What test confirmed diagnosis ?..
20 Was disease er injury in any way related to occupation of deceased ?... tão
If eo. specify
(Signed)
UWish To in Date 2/16
(Address) .........
21. Holy Cross Maiden
Place of Burial, Cremation or Removal.
DATE OF BURIAL ...
Feb 18 1941
(City or Town)
.. 19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Hinthrop
Received and filed. .. 19 ....
(Registrar)
100m-2-'40-D-729-a
(County)
1
Winthrop
(City or Town)
....
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
3 SEX
Female
4 COLOR OR RACE
White
6 Age of husband or wife if alive.
7 IF STILLBORN. enter that fact here.
8
AGES5
Years
.Months
Days
Usual
9 Occupation :
Housewife
Industry
11 Social Security No ...
PARENTS
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
10 or Business:
Own Home
(If U. S.
War Veteran,
specify WAR)
St.
(If nonresident, give city or town and state)
years
months
days.
In this community.O
yrs.
mos.
days.
(Day)
1941
That J attended deceased from
1.16
Underline the cause to which death should be charged sta- tistically.
M. D.
19 45
St. Johns
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 hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, definded as required hy 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 body which has not been buricd, until he has received a permit from the hoard 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 person died; and no undertaker or other person shall exhume a human hody 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 lias received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the hody is huried. No such permit shall be issued until there shall have been delivered to such hoard, 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 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 hy 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 hody 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 body 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 hoard 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 ohtained 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 hury 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 disahled 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 hy traumatism (including resulting septicemia), and hy the actlon 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 ls 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 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 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 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
ORM R-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.
40
Registered No
§ (If death occurred in a hospital or institution, St. \give its NAME instead of street and number)
2 FULL NAME
Sarah Booth
(Turner)
Haigh
(If deceased is a married, widowed or divorced woman, give also maiden name.)
217 Cliff Avenue
St
(If nonresident, give city or town and state)
years
months
days.
In this community 34
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
February
16
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
That I attended deceased from
1920, to Feb-16
19
41
I last saw h & alive on
Feb16
, 194%, death is said to
have occurred on the date stated above, at .....
12 noon m.
Immediate cause of death ..
Duration -IMPORTANT 2 day
Due to ....
attilio Securi
Due to
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations.
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 .....
1
M. D.
(Signed)
(Address) wCncafter
Date 2/16
19 .. 41.
Cambridge
Place of Buriel, Cremation or Romovat.
(City or Town)
DATE OF BURIAL.
February 18 1941
19
22 NAME OF
FUNERAL DIRECTOR.
Charles R. Bennison
ADDRESS.
Winthrop
.... Mass
Received and filed
19
(Registrar)
MARGIN RESERVED FOR BINDING
1
Winthrop
(City or Town)
No.
217Cliff Avenue
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Thomas Hallas Haigh
(Husband's name in full)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
AGE.
Years.
7?
1]
Months.
14 Days
Usual
9 Occupation :
At ..... home
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Huddersfield
(State or country)
England
13 NAME OF
FATHER
Edward Turner
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Susanna Booth
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
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
100m-2-'40-D-729-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
....
(Official Designation)
(Date of Issue of Permity
5 SINGLE
(write the word)
Widowell
years
If less than 1 day .. Hours .Minutes
17 Relation, if any
Inf
Christopher Haigh (son
(Address) 217 Cliff Ave Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Www. D. Childreng. (Signature of Agents of Board of Healthfor other) He altri Officer 2/17/41
21. Mount Auburn
Date of.
Of autopsy.
What test confirmed diagnosis ?.
1941
(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, 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 therefrom 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 permit shall be issued until here shall have been delivered to such board, agent or clerk, as the case nay 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, fany, as required by law, or in lieu thereof a certificate as hereinafter provided. 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 who 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 made 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 perinit in the usual form for the re- noval of such body has been sooner obtained hereunder. 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 s 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 n person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation Is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
PLACE OF DEATH
(County) Winthrop (City or Town)
270 cean No
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.
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR).
27 Ocean
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community 18 yrs. ~ mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Make
4 COLOR OR RACE
White
5 SINGLE (write the word) MANTIED WIDOWED Married or DIVORCED
5a
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.
45
.years
7 IF STILLBORN, enter that fact here.
8 AGE 53 Years .Months. Days
If less than 1 day Hours Minutes
Usual
PERRY-Fountain Pen
SERVICE " for himself
10 or Business:
11 Social Security No. 023-63-6981
12 BIRTHPLACE (City) (State or country) nadia
13 NAME OF
FATHER
Henry a.
14 BIRTHPLACE OF
FATHER (City)
Queria
(State or country)
15 MAIDEN NAME
OF MOTHER
Bella Bershad
16 BIRTHPLACE OF
MOTHER (City) ...
Russia
(State or country)
.17 Leah Perry (wite) Relation, if any
Informan€ (Address) 27 Oceanat Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFOREthe burial or transit permit was issued: Nu. D- Cheil dres (Signature of Agent of Board of Health or other) Health Officer 2/18/41
Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
(Month)
18, (Day) .... 1941 (Year)
19 EHEREBY CERTIFY to 2/ 18/44, 199
That I attended deceased from
I lest saw b Zalive on 2/18/ 19.66 .. , death is said to n. have occurred on the date stated above, at 2:304. Duration Immediate cause of death ..
IMPORTANT 2 days
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, speck beatles Libero ......... , M. D. (Signed) (Address) 26 Waye Way Date 211 .......
... 19 ...
21 Poland Com: Woburn, has. Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
Feb 18
19
22 NAME OF
FUNERAL DIRECTOR ..
ADDRESS ..
10 Washington St. Donc healing
DR. Manuelstanetal
Received and filed
19.
(Registrar)
Major findings: Of operations
Of autopsy.
220
clinical
Date of
What test confirmed diagnosis ?.
St.
2 FULL NAME
albert Parry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If nonresident, give city or townand state)
1 PARENTS 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 is very important. See instructions and extracts from the laws on back of certificate. 100m-2-'40-D-729-& N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry
9 Occupation :.
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, defined as required hy section one, where same was contracted, tbe duration of his last illness, when last seen alive by the physician or officer and the date of bis death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a buman hody in a town, or remove therefrom a human body which has not heen buried, until he has received a permit from the hoard 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 person died; and no undertaker or other person shall exhume a human hody 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 hoard of health or its agent aforesaid or from the clerk of the town where the body is huried. 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 be returned and recorded. which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required hy law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of bealth, or em- ployed hy 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 hody, 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 sucb removal, unless a permit in the usual form for the re- moval of such hody has heen 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 heen engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwitb 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 ohtained as to the deceased, or as to the manner or cause of the deatb. 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 tbereof which have been brought into the commonwealth until he lias received a permit so to do from the hoard 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 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).
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