USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 26
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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 hoard 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. . . . Chop. 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 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 hy traumatism (including resulting septicemia), and hy 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 deathis of persons not disabled 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.
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 aa 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-302
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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12.
50m-10-'39. No. 8427-f
17
Informant.
John C Ashworth
Relation, if any s.o.n ..... ....
(Address)
A TRUE COPY.
ATTEST:
(Registrar of city of town where death occurred)
DATE FILED ...... 4/29/41 19
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
4 COLOR OR RACE| 5 SINGLE
MARRIED
WIDOWED
(write the word)
white
or DIVORCED
widowed
5a lf married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Robert S Ashworth
(Husband's name in full)
years
6 Age of husband or wife ff alive
7 IF STILLBORN, entor that fact here.
AGE
8
84
Years
1.
.Months.
8 .Days
lf less than 1 day
Hours ....
Minutes
Usual
9 Occupation:
et home
Industry 10 or Business!
11 Social Security No.
12 BIRTHPLACE (City)
Newton .... Mas.s.
(State or country)
13 NAME OF
FATHER
Richard Kennedy
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
Of autopsy
What test confirmed diagnosis ?
20 Was disease or lojory lo any way related to occupation at deceased ?
If so, specify.
(Signed)
EH Beaum
M. D.
(Address)
Date
4/25/041
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
(City or Town)
DATE OF BURIAL
April 27 1941
.....
.. 19.
22 NAME OF
FUNERAL DIRECTOR
H ... S .... Reynolds
ADDRESS
1. AT I
Received and fled.
19
f
(Registrar of City or Town where deceased resided)
OSTON
(City or town making return)
Registered No ....... 12.0.
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
75
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Orlando Ave
St.
Winthrop
(If nonresident, give city or town and state)
......
years
months
days.
In this community
yrs.
mos.
days.
18 DATE OF
DEATH
April 25 1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
1/21/41
19
to ....
That I, attended deceased from
4/25/41
19.
.....
1 last saw h .......... alive
4/25/41
19.
death is said
to have occurred on the date stated above, at.
10/30A
Duration
Immediate cause of death
arteriosclerotic heart dis
unk
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Underline the cause to which death should be charged sta- tistically.
PARENTS
PLACE OF DEATH
SUFFOLK
1 BOSTON (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
No. Boston State Hospital
Annie H
Ashworth
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ......
(Usual place of abode)
Length of stay : In hospital or institution ...
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
12. G. L.)
15 MAIDEN NAME
OF MOTHER
Elizabeth Hawkins
16 BIRTHPLACE OF
MOTHER (City)
(State of country)
Ireland
Boston Teake Waltham
M R-301 A
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
PLACE OF DEATH
Surflok (County)
Winthrop
(City or Town)
No. 45 Lowell Road
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,
St. ¿ give its NAME instead of street and number)
2 FULL NAME.
George Linley Knipe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
43 Lowell 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 33 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
OF DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of.
Edith Knipe (Murray)
(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.
8
AGE.6.60
Years
Months.
23 Days
Minutes
Usual
9 Occupation Comercial ..... Representative
Industry
10 or Business:
Amercian Tel. & Tel.
11 Social Security No .....
None.
12 BIRTHPLACE (City)
Norristown
(State or country)
Penn
13 NAME OF
FATHER
Jacob O Knipe
PARENTS
17
Relation, if any
Informant
Edith Kni pe
Wire
V
(Address)
43 Lowell Road Winthrop
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Nu D. Clubdress
(Signature of Agent of Board of Health or other)
Le altre officer 4/39/41
(Official Designation) (Date of Issue of Permit}
I HEREBY CERTIFY mag That I attended deceased from
Lectover 14 1936
I last sawh un alive on
april 24, 1941, death is said to
have occurred on the date stated above, at. Duration IMPORTANT 5:30a. Immediate cause of death Carcinoma of left lung 5 years.
Due to.
Several
Carcinomatosis
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 ?. 7.000
If so, specify
Jacob Chasus M.V.M.
M. D.
(Signed)
res) 56 2 HundeSt
Date 4/2014
21 Puritan Lamia
Chantal/ Peabody
Place of Burial, Cremation or Removal.
(City or Town)
194I
DATE OF BURIAL
April
29
22 NAME OF
Howard S Reynolds
FUNERAL DIRECTOR
ADDRESS
Winthrop
Mass.
Received and filed 19
MAY 1 .1941
(Registrar)
2 years.
Major findings:
Of operations.
no operation
Of autopsy.
not done
g .. Date of ......
What test confirmed diagnosis? X-ray clinical & labilatiny
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Penn.
15 MAIDEN NAME
OF MOTHER
Clara Poley
16 BIRTHPLACE OF
MOTHER (City).
(State or country)
Penn .
18 DATE OF
DEATH
April
26 1941.
(Month)
(Day)
(Year)
19.5 ...
62
If less than 1 day
Hours
1
(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 whoin 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 deccased, 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 hy 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 hury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not heen huried, until he has received a pernit front the hoard 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 tomh to another in the saine 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 huried. No such permit shall be 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 by law to he 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 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 by it or hy 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 cominonwealth 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 be returned to the town from which it was removed within thirty-six hours after such removal, unless a perinit in the usual forin 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 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 he ohtained as to the deceased, or as to the manner or cause of the death, 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 aslies thereof 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, froin 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 iu which the interment is made. . . . Chop. 114, Sec. 46, G. L., (Tercenter.ory 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 physiclans will certify to such deatlis only as those of persons who, though disabled hy 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 hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized dlsease, 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.
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 changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husiness, 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 hy the appropriate terms, as housekeeper-private fomily. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A Suffolk Winthrop
(City or Town) 2) Somerset 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)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 2) Somerset Are
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
In this community 3
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Widowed
5a If married, widowed, or divorced HUSBAND of Thomas T.
Burke
(or) WIFE of
(Husband', name in full)
deceased
.. Years
6 Age of husband or wife if alive. 7 IF STILLBORN, onter that fact here.
3 84 Years. Months. Days
If less than 1 day
Hours.
Minutes
Usual 9 Occupation:
1 touse work
10 or Business:
own home
Il Social Security No. none
12 BIRTHPLACE (City)
Lee Gross
(State or country) England
13 NAME OF
FATHER
Charles Fielding
14 BIRTHPLACE OF FATHER (City)
(State or country) England
15 MAIDEN NAME
OF MOTHER
Mary Merrigan
16 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
17 Joseph & Burke
Relation, if my son
Informant (Address) 21 Stemmerser Are, Wine,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Chil dress (Signature of Azent of Board of Health or other)
/ Realthe Officee 5/1/4/
(Official Designation) (Date of Issue of Fermity
18 DATE OF DEATH. April 29 1941 (Year)
(Month)
(Day)
That I attended deceased from
1 last saw h ........ alive on ... aprile 28, 204/, death is said
Duration IMPORTANT 48 hrs
2-3 gra ......
1year .....
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury In any way related to occapatioa of deceased? 200
If so, specifyl.
Yacob Obsamo Il
M. D.
(Signed).,
562 Slenley Str. 4/30 het
(Address)
Joseluis, 13 ostori
21 St.
Place of Purial, Cremation of Removal.
(Citypor Town)
DATE OF BURIAL
19
41
22 NAME OF
M. J Relly
FUNERAL DIRECTOR
ADDRESS
11 meridian 5x, E. B.
Received and filed. 19
(Registrar)
100m-10-'39. No. 8427-e
1 AGE PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry
15 A HEREBY CERTIFY Decentes 10 1940 to april 29 ., 1944 to have occurred on the date stated above, at Gim. Immediate cause of death ........ Cerebral Hemorrhage
Due to
arteriosclerosis
Due to
Senility
Other conditions none (Include pregnancy within 3 months of death)
Major findings :
Of operations
none
„.Date of ...
Of autopsy not clove
What test confirmed diagnosis ? clinical
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
Elizabeth J. Burke
St. {
(If U. S. War Veteran, specify WAR)
.St.
Winthrop
(If nonresident, give chty or town and state)
(Give maiden name of wife - full)
PLACE OF DEATH
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 deccased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted. the duration of his last illness, when last 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 receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment. by a satisfactory certificate of the attending physician, if any, as required by law. or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be burled or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (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 septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to Illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
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