USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 2
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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 tbe 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 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 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 scptiee- mía), 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 10 occupa- tion, the sudden deathis of persons noi disabied by recognized disease, and those of persons found dead.
Stalemeni of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mede of dying, e. g., beart failure, asphyxia, astbenia. ctc. As principal causc name the disease causing death. As related causes, name carlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal eause.
Sialement 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 discase 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 ouly 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 oceupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
Suf folk (County) Windhund (City or Town) Bales
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.
4
§ (If death occurred in a hospital or institution, St. {give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR) ... Winthrop ....
No
(If nonresident, give city of town and state)
In this community
9 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCES Lede
(Give maiden name of wife in full)
(Husband's name in full)
.years
If less than 1 day Hours
Minutes
Bato
13 NAME OF
FATHER
LouisEs Smitte
14 BIRTHPLACE OF FATHER (City) ..... (State or country) N.S.
15 MAIDEN NAME
OF MOTHER
Jarabe Mc Faddin
scland Relation, if any Jarabe Smith Mother)
Informant. (Address) 62 Dates Qve Written
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: mit. tuldreist (Signature of Agent of Board of Health or other) Health office 1/3/4/
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
1941 (Year)'
19 A I HEREBY CERTIFY
1 194 to pan 3.
1941 I Just saw h. Linnalive on 3, 1941, death is said to .m. have occurred on the date stated above, at 8.45 A Immediate cause of death ..
Duration IMPORTANT
...
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis ?.
IMPORTANT PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was diseass or injury in any way related to occupation of deceased ?.
If so, specify ..
(Signed)
Tienbistro on Date 1/3
M. D.
19 4
21 ... Wieluop Lem. Place of Burial, Cremation or Removal. DATE OF BURIAL.
(City of Town)
au 5 19 .. Y ..
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
14er Wach, Il Books
And Connolly
Received and filed 19
(Registrar)
100m-2-'40-D-729-a
1 .... No. 60 2 FULL NAME Unicent of 3 SEX Male 4 COLOR OR RACE White 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 AGE .. 19 Years .. Months ...... ...... Employed .. Days ..... Usual 9 Occupation : 11 Social Security No .. 12 BIRTHPLACE (City). (State or country) 16 BIRTHPLACE OF PARENTS MOTHER (City). (State or courtry) 17 · 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 :.... General
(If deceased is a married, widowed or divomed women, give also maiden name.)
600
Bates Give
St
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months days.
-
Registered No.
3
That I attended deceased from
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 dicd, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive hy 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 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 board of health or its agent aforesaid or from the clerk of the town where the hody Is huried. No such permit shall he Issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied. In case of an original Interment, by a satisfactory certificate of the attending pliyslcian, 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 la 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 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 ohtained 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 ohtalned 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 hoard, 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 disabied by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahly due to injury. These include not only deaths caused directly or indirectly 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 infectlon 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, 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 No ......
(County) Stuithrob
(City or Toway 36 Prospect
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH are
To be filed for burial permit with Board of Health or its Agent.
5
Registered No.
St.
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR).
none
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
years
months
days.
In this community 20 yrs.
mos.
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE Female Sthite
5 SINGLE MARRIED WIDOWED or DIVORCED
(write the word) Single
Sa If married. widowed, or divorced HUSBAND of.
(Give maiden name of wife in full)
6 Age of husband or wife if alive.
.years
7 IF STILLBORN, enter that fact here.
8 AGE 54 Years
Months. Days
If less than 1 day Hours. Minutes
Usual 9 Occupation: Secretary
Il Social Security No. 01207-8422
12 BIRTHPLACE
(State or country)
Boston Maso
13 NAME OF FATHER HER John a. Hewitt
14 BIRTHPLACE OF (Gaston FATHER (City) (State or country) masa
15 MAIDEN NAME OF MOTHER R Mary Con Brown
16 BIRTHPLACE OF St. John MOTHER (City). (State or country)
П. Вчипоиск
Relation, if any 21 k
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Www. D. Children Signature of Agents of Board of Health or other Malta Officer 1/ 6/4/
(Official Designation) (Date of Issue of Permit) !
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
January 3
(Month)
(Day)
(Year)
19 01 HEREBY CERTIFY 19.70 to.
That I attended deceased from January 3 19 41
I last saw her alive on Jackmary 3 1944 death is said to have occurred on the date stated above, at 11:45 P. Immediate cause of death ........ Carcinoma il Storiache
Duration IMPORTANT 6mos.
1 month
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? 120 If so, specify./ .. ) ... faço
. M. D. (Signed) 562 hurley / Date Jums 1941 Holy Cross, malden
Place of Burial, Cremation of Removal. E OF BURIAL Je 6 (City or Town) ..........
22 NAME OF
FUNERAL DIRECTOR ...
ADDRESS
Bontani
Received and filed.
19
(Registrar) 1
1 Every item of (or) WIFE of PARENTS 17 Informant (Address) 100m-2-'40-D-729-> N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. 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 :.
2 FULL NAME
Mary Louise Hewitt
(If deceased is a iparried, widowed or divorced woman, give also maiden name.) 36 Crackers are.
St
(If nonresident, give city or town and state)
1941.
Due to.
General Carcinomatosis
Due to.
Other conditions. (Include pregnancy within 3 months of death)
Major findings: Of operations. none
.. Date of.
Of autopsy.
none
What test confirmed diagnosis ?. Chirucal &
(Husband's name in full)
Suffolk
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 by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .. . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not heen huried, until he has received a permit from the board of health, or its agent appointed to issue such perinits, 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 tomh 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 hody is buried. No such permit shall he issued until there shall have heen delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required hy law to be returned and recorded. which shall he accompanied, in case of an original interment. 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 hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy 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 ahove provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such hody has been sooner obtained hereunder. If the death certificate contains a recital, as required hy section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The 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 bury a human body or the ashes thereof which have been hrought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to he huried or the funeral is to be held, or from a person appointed to bave the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
Dr. ab
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deatbs only as those of persons who, though disahled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahied hy 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 morhid conditions, if any, related to the principal cause and any important complication of the principal cause.
& les
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 heen given up or cbanged 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 tbe occupation hy tbe 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
PLACE OF DEATH
Jorcester
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Grafton (City or town making return), 6
Registered No
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and numher)
2 FULL NAME
Alyah A. Belcher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
Not Learned
St.
Winthrop. Mass.
Length of stay: In hospital or institution
(Specify whether)
years
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
(write the word)
18 DATE OF
DEATH.
January
3,
1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
May 6,
19.40, to January 3.
19.
I last saw h ..
im
alive on
Jan. 3
death is said
to have occurred on the date stated above, at.
1:30 PM
Duration
Immediate cause of death
Uremia
Sev
Due to
Hydronephrosis
mos ....
Many
yrs.
Due to Hypertrophy of prostate
Many
12 BIRTHPLACE (City)
Winthrop
Mass.
13 NAME OF
FATHER
Samuel Belcher
14 BIRTHPLACE OF
FATHER (City)
Winthrop
15 MAIDEN NAME
OF MOTHER
Not Learned
16 BIRTHPLACE OF
MOTHER (City)
Raymond
(State or country)
New Hampshire
17
Informant Grafton State Hosp. ( Records)
(Address)
Relation, if any
No Grafton, Mass
A TRUE COPY.
ATTEST:
Toux 8 Jemand
(Registrar of city or town where death occurred)
DATE FILED
January 7,
..... ........ 19. 41
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
None
Date of
Underline the cause to which death should be charged sta-
Of autopsy
None
What test confirmed diagnosis ?
Clin. & Lab
tistically.
20 Was disease or Injury In any way related to occopation ol deceased ? NO.
If so, specify.
(Signed)
IL ....... ... Patton
M. D.
(Address) No. Grafton, Mass. Date.
1/4
.19.41
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Hillcrest, No, Grafton
(Cemetery)
(City or Town)
DATE OF BURIAL ....... January .... 7,
.4.]
22 NAME OF
FUNERAL DIRECTOR Hilton E. Temple
ADDRESS
North Grafton
Received and filed.
19
(Registrar of City or Town where deceased resided)
1
Grafton
(City or Town)
No. Grafton State Hospital
3 SEX Male Whit e 5a If married, widowed, or divorced HUSBAND of 6 Age of husband or wife if alive .. Industry (State or country) PARENTS 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 50m-10-'39. No. 8427-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 (State or country) Mass.
7 IF STILLBORN, enter that fact here.
8
AGE .. 7.8
Years
Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Fisherman
10 or Business:
Not Learned
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
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