USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 36
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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 husi- 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
(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. 10%
Registered No
35, Thousand Park Watching If death occurred In a hospital or institution, No .. Agive its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
35 Thouton Park
St ..
(If nonresident, give city or town and state)
Length of stay: In hospital or institution. (Specify whether)
years
months
days.
In this community O yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
S SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of ...
Richard Frames Canton
(Give malden name of wife in full)
(Husband's name in full)
6 Age of husband os wife if attve.
57
.years
7 IF STILLBORN. enter that fact here.
8 56 2. Months /3 Days
If less than 1 day Hours Minutes
Usual
9 Occupation :...
ax home
11 Social Security No ...
12 BIRTHPLACE (City).
(State or country)
13 NAME OF
FATHER
Quelling. Wehner
14 BIRTHPLACE OF
FATHER (City) ......
(State or country)
15 MAIDEN NAME
OF MOTHER
Marques Jesum
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
Brooklyn
17 Rusland. Fr. Cantal
Relation, if any Son.
Informant .. (Address) 35 Thouda PKTB. Wurdey
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Nau D. Children
(Signature of Agent of Board of Health or other)
He allte Africa 6/24/41
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
time
22
1941
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY.
That I attended deceased from
October 28, 1938, to
Mine 22
., 19 .... 5
I last saw her alive on
march 27, 1941, death is said to
have occurred on the date stated above, at.
1:254
„.m.
Immediate cause of death.
Duration IMPORTANT 1
...
1 hour
Due to.4 ... 1
Chronic muvanità
3 years ...... 1
Due to .... Hypertension
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- tistically.
he Was disease or injury in any way related to occupation of deceased ?......... 2/1
If do, specify ...........
(Signed) Motion 1mars
, M. I
(Address) Winthro Mais Date 6/23
.19.2.6 ..
21.
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
24
19.6 ...
22 NAME OF FUNERAL DIRECTOR CR. Ya
ADDRESS
20,000
Received and filed. JUN 3 0 1941
19
(Registrar)
100m-2-'40-D-729-8
1 3 SEX (or) WIFE of AGE. PARENTS CAUSE OF DEATH in plain terms, so that it may he 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 EXACILI. PHYSICIANS should state Industry 10 or Business :.
PLACE OF DEATH
Louise. Wehner
anton
......
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
-
e primonam edema
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, 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 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 hoard, 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 hoard 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 hy 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 herelnafter provided. If there Is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is In- sufficient, a physician who is a member of the hoard of health, or em- ployed by it or hy the selectmen for the purpose, shall upon application make the certificate required ofthe 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 he obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker deslring 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 ohtalned 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 he 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 hury a human body or the ashes thereof which have heen 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 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 burla! 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 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 by 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 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 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 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 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 |
1 PLACE OF DEATH Usual PARENTS information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Industry 200m-10-'39. No. 8427-d
Juffack (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Whenthrop. Mare (City or town making return)
Registered No.
......
(City or Town) .. 50 Milabine St No
-
(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
Hovey Rand
(If deceased is a married, widowed or divorced woman, give also maiden name.)
thattrop Mass
(a) Residence. No. (Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
.........
years
months
days.
In this community 2 7 yrs. / mos.
7 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male Colite
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
Visound, & divorce Brenda Banks
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. 71
years
7 IF STILLBORN, enter that fact here.
8 AGE 73 Years
4
.. Months.
7 Days
If less than 1 day
Hours
Minutes
9 Occupation:
electrotyper
10 or Business:
Electrolyping
II Social Security No.
12 BIRTHPLACE (City)
Charlestown
(State or country)
mass.
13 NAME OF
FATHER
James Horey Rand
14 BIRTHPLACE OF
Charlestown
(State or country)
15 MAIDEN NAME
OF MOTHER
Haniet Bodge
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
mass.
17 Bessie Rand, Rel Relation, if any Informant (Address) 50. Wilshire It
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. S. Childress
(Signature of Agent of Board of Health or other)
Health Officer 6/27/41
(Official Designation) (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
25
(Month)
(Day)
( Year)
A HEREBY CERTIFY. That I attended deceased from
19 June 1
19.20 to June 25, 1941
last saw h ........
unalive on ...
Jude 25, 1941, death is said
to have occurred on the date stated above, at.
100.
Duration
Immediate cause of death
Cerebral
Нетоннаде
3/1/4)
...... 1940
Due to
Other conditions
none
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations.
none
Of autopsy
none
What test confirmed diagnosis ?!
cliqueal x
20 Was disease or Injary la aoy way related to occupation of deceased ?
If so, specify.
Jacob Chamus
M. D.
(Signed)
(Address) 56 2 OPhiley Date
6/26,641
wife) 21 Sharon tourthup mall
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL que 28 1941
22 NAME OF
FUNERAL DIRECTOR Youph H 19000006
ADDRESS
147 marcavz ashughes
Received and filed JUN 3 0 1941
19
....
TOUTE PADU ATTEST
CHI U. S.
War Veteran.
specify WAR)
108
50 Ullaline
St.
(If nonresident, give city or town and state)
1941
...
Due to arteriosclerosis
none
FATHER (City)
Maso
.Date of.
Underline the cause to which death should he charged sta-
Charlestown
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered bospital 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 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 discase of which he died, defined as required by section one, where samc 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 hercinafter 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 tbe at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificatc. 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 a 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, Seo. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Scc. 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 carc during a last ill- ness from disease unrelated to any form of injury.
(2) Board of lienith 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 hy 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 infeclion 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.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A Suffolk
PLACE OF DEATHI
County) Handbook (City or Town)
No. 245 Praskgusten are
The Commonlocalth 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. 09
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)
(a) Residence. No. (Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
In this commurit 3 0 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE | White
5 SINGLE MARRIED WIDOWED or DIVORCED
(write the word)
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
If less than I day
Months.
Days
Hours
Minutes
Retired Carpenter
Industry 10 or Business: self.
none
16.1. Elizabeth (was
n.f
Relation, if any
17 Her B Machen (sin)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
William D. Childus (Signature of Agent of Board of Health or other) agent June 28/41
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Summe 2.6
1941
(Year)
19 HEREBY CERTIFY . Samman,19 /6, 10 19 41 I last saw h comealive on Scene 26, 194, death is said to have occurred on the date stated above, at 100 .m.
Immediate cause of death ...
Duration IMPORTANT
Cerebral hemownage
I WR
Due to 2 ....... Hypertension
Menos
Due to Generated artenoderas neus
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
0
Date of.
Of autopsy
0
What test confirmed diagnosis ?.
Chimica
PHYSICIANI Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury In any way related to occupation of deceased? 100
ecity 2et 02 (Signe (F)ess){.
, M. D. Pinturas Rules Pate Keiner 19 Y
21 Pane große
Place of Burial, Cremation or Removal. (City or Town)
.... DATE OF BURIAL
22 NAME. OF
FUNERAL DIRECTOR Acc
ADDRESS
Received and filed
19
-JUIN :3 0 .1941
1
(Specify whether)
S
St.
Gehen BM ac Penna
(If deceased is a married, widowed of divorced voman, give also maiden name.)
245 WashingtonQue St. (If nonresident, give city or town and state)
(Month)
(Day)
That I attended deceased from
Maria Luck
.Years
1 2 FULL NAME 3 SEX Male 5a If married, wideye HUSBAND of (or) WIFE of 8 AGE 84 Years Usual 9 Occupation: Il Social Security No. 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) Informant (Address) 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 CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION 100m-10-'39. No. 8427-e N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK -- THIS IS A PERMANENT RECORD. Every item of 14 BIRTHPLAOZ OF FATHER City) (State or country)
...
1
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 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, Sce. 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- posc, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- incr 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 carly 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 thic 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.)
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