USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 17
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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 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-302
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 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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50m-10-'39. No. 8427-f
17
Informant. Mrs Gladys Stevens(
Relation, if any dau
(Address)
above
A TRUE COPY.
ATTESTI
(Registrar of city or town where death occurred)
DATE FILED 2/27/47 .19
MEDICAL CERTIFICATE OF DEATH
3 SEX male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
(write the word)
widowed
Sa If married, widowed, or divorced
HUSBAND of
...
(Give maiden name of wife Anferson
(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 AGE 67 Years. 3. Months 27 Days
If less than 1 day Hours Minutes
Usual
9 Occupation:
Industry 10 or BusinessI
house
11 Social Security No.
Great ..... Falls .... NH
Other conditions broncho .... pnoumonia (Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to which death
Of autopsy
What test confirmed diagnosis?
autopsy
should be charged sta- tistically.
20 Was disease or Injury in any way related to occupation of deceased ? no
If so, specify
(Signed)
H Benjamin
M. D.
(Address)
Boston
Date.
2/24 / 47
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Winthrop
Winthrop
(Cemeter eb 26 19}]] or Town)
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
H .... Reynolds.
ADDRESS
Winthrop
Received and Blod.
19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
DU(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
48
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Nathan .... W. Eaton
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Villa Ave
.St.
Winthrop Mass
(If nonresident, give city or town and state)
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
18 DATE OF
DEATH.
Feb 24 1941
(Month)
(Year) (Day) That I attended deceased from
19 I HEREBY CERTIFY.
2/13741
19.
....... , to ....
2./24/41
....
, 19.
I last saw h ..¿. m .... alive on ......
2/24/41, 19, death is said
to have occurred on the date stated above, at .... 2 .... 30 .... A Immediate cause of death.
Duration
.caroinoma ... of ..... o.sophagus .... with metastases.
2 ..... y.ns
Due to
Due to
2 .... w.ks
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Roland Eaton
14 BIRTHPLACE OF
FATHER (City)
....
-Marne
(State or country)
15 MAIDEN NAME
OF MOTHER
Martha Goodall
18 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
PARENTS
No.
(City or Town) Peter Bent Brigham Hospital
St.
Registered No ..... 2184
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
Abbie H
painter
Date of.
,
RM R-301 A:
PLACE OF DEATH
Suffolk .... (County) Windthor (City or Town)
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. 49
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden Fame.) 350 Winthrop St
(a) Residence. No ..
( Usual place of abode)
Length of stay : In hospital or institution.
(Specify whether)
years
months
days.
(If nonresident, give city or town and state) In this community 45 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ..
Fel.
(Month)
(Day)
1941 (Year)'
19 I HEREBY CERTIFY. That I attended deceased from
Fat. 25
19.41, to Feb. 25
1941
I last saw h. AM alive on.
706.25
19.41, death is said
to have occurred on the date stated above, at 11.15
arteriosalumia
...
Duration
IMPORTANT
Immediate cause of death ..
1430 .... quel my o cordial Infractions Coronary Aclerosis Fab, 2 5,41 1937.
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
none
Of autopsy
8 de abore.
What test confirmed diagnosis? pathological
tistically.
20 Was disease er Injury In any way related to occupation of deceased? ..... no
If so, specify ............
(Signed) Vardle W. Bushmeans
, M. D.
(Address) Winthrop, mand
Date 2/26, 1941
17
Couscous
Charlesk Day
Relation, if any
21
Woodlawn Cm.
Everettmasa
Place of Burial, Cremation or Removal,
DATE OF BURIAL
Feb. 28
(City or Town)
19 4/1
FUNERAL DIRECTOR
22 NAME OF
Charles E. D. margeson
ADDRESS
77 Summer St
malden
Received and filed 19
(Official Designation) (Date of Issue of Permit) (Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
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.
1 3 SEX HUSBAND of 8 Usual 9 Occupation: PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Industry 10 or Business:
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
InMobildiero
(Signature of Agent of guard of Health or other)
Pef. 2.8/4-1
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
(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.
years
AGE
68 Years
6
Months.
2
Days
Hours.
If less than I day
Minutes
artteacher Retirer
Winthrop Publis schul
Il Social Security No.
12 BIRTHPLACE (City)
Barton
(State or country)
man.
13 NAME OF
FATHER
Charlott. Day
14 BIRTHPLACE OF
FATHER (City)
(State or country)
maine
IS MAIDEN NAME
OF MOTHER
Harriet n. ichols
16 BIRTHPLACE OF
MOTHER (City)
Cannot be learned
(State or country)
Informant.
(Address)
33 Worstbourkes Tan
PHYSICIAN
.. Date of.
Underline the cause to which death should be charged sta-
Winthe Community Hopital St. No. Harriet mand Day
St.
(If U. S. War Veteran, specify WAR)
25
4 COLOR OR RACE
What
EXTRACTS FROM THE LAVIS 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 thic deceased, furnish for regis- tration a standard certificate of death, stating to the hest of his knowledge and belief the name of the deceased, hls supposed agc, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last iliness, 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 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 tomh 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 he 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 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 be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed hy it or hy 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 possesslon 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- slx hours after such removal, unless a permit in the usual form for the removal of auch 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 certifylng 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, See. 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 burlal ground in which the interment is made .... Chap. 114, Seo. 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- nesa from disease unrelated to any form of Injury.
(2) Board of Hoalth physicians will certify to snch 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 deatlı Is needed.
(3) Medical Examiners will Investigate and certify to all deatha snpposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of 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 carlier morbid con- ditions, if any, related to the principal eause 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, cool-hotel, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM 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. 50
Registered No. [ (If death occurred in a hospital or institution. St. ( give its NAME instead of street and number)
2 FULL NAME
Timothy J. Barry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
171 Cottage Park Road
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community
2
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
march
2
(Month)
(Day)
(Year)
19 LHEREBY CERTIFY.
That I attended deceased from
28
1941, to
march 2
1941
I last saw ham alive on.
march 2, 1941, death is said to
have occurred on the date stated above, at.
10.30 A
Immediate cause of death .. Cerebral Masmorrhage
Duration IMPORTANT 1 day 1 ...
1936
Due to
arteriosclerosis
1934
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.
Story & Stummer.
M. D.
(Signed)
(Address)
726 Saratoga St
Date.
19 ......
21 ..
New Calvary
Boston
Place of Burial, Cremation or Removal. 5.
DATE OF BURIAL
(City or Town) 41
.19
22 NAME OF
FUNERAL DIRECTOR
15:34 Tremont St., Boston
ADDRESS
Received and filed.
19
(Registrar)
1
Winthroo
(City or Town)
(Usual place of abode)
3 SEX
Male
4 COLOR OR RACE
White
Sa If married,
HUSBAND of.
(or) WIFE of.
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
65
10
AGE.
Years
Months.
.Days
Usual
9 Occupation:
Machinist
10 or Business:
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
Cork
13 NAME OF
FATHER
Thomas Parry
14 BIRTHPLACE OF
FATHER (City) ...
(State or country)
Ireland
Cork
15 MAIDEN NAME
OF MOTHER
Mary Murphy
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Cork
(State or country)
Ireland
17
Katherine Parry
, Informant.
(Address)
17I Cottage Park"
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
Ireland
100m-2-'40-D-729-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Industry
City of Boston
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Marriel
Kreisine O'Leary
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than 1 day
Hours
Minutes
Relation, if any
WIfo
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Childress (Signature of Agent of Board of Health or other) / Health Oficir 3/3/41
(Official Designation) (Date of Issue of Permit)
Due to.
Hypertension
Major findings: Of operations.
Date of
Of autopsy.
What test confirmed diagnosis ?. Paralysis
No .. 171 Cottage Park Road
(If U. S.
War Veteran,
specify WAR)
1941
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail 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 knowicdge 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 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 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, willch 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 sufficlent 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 shali 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 recltal, 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 shali 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 burlai 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 ali 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, asphyxla, asthenla, etc. As principal cause name the disease causing death. As related causes, name earlier morbld 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.
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