USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 48
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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. I .. , (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashcs 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 board, from the clerk of the town where the body is to be huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurlal 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 hedside 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 discase un- related to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. Thesc include not only deaths caused directly or indirectly hy traumatism (including resulting septice- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut 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 Canne 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 .- Precisc 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 husi- ness, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation 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
PLACE OF DEATH
Su.f.f.o.l.k (County)
Winthrop (City or Town) 233 Pleasant
The Commonfocalth 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. 146
( ( If death occurred in a hospital or institution, St. i give its NAME instead of street and number)
2 FULL NAME
Josiah P. McLaren
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
233 Pleasant
(Usual place of abode)
St.
( If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community 10
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACEj
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDidowed
Sa If married, widowed. for divorce Currie
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
years
7 IF STILLBORN, enter that fact here.
8
88
AGE
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Wood Turner
Industry
Will Work
10 or Business :
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
Prince Edward Island
13 NAME OF
FATHER
Archibald Mclaren
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Margaret Stewart
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
17 Ira J. McLaren
Rettttom if any
( Address) "253.Preasant St- Winthrop
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : Nr. D . Culdress
(Signature of Agent of Board of Health or other) dealthe Mplucer 8/14/41
(Official Designation) (Date of Issue of /Permft)
18 DATE OF
DEATH
August 14, 1941.
( Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
august 11
NYTI
19.
......
to ..
august 14
1941
I last sawh Iam alive on
august 14 0041
death Is sald to
have ocourred on the date stated above, at.
100 0
.m.
Immediate cause of death
Duration IMPORTANT
4 days -
Due to
Due to ..
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Of autopsy
What test confirmed dlagnosis?
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? NO
If so, specify
Edward J. Grainger
(Signed)
M. D.
(Address) 200 Washington Ats Date Av9-14-1941
winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL
August 16
John F. O Malley
(City or Town)
19
41
22 NAME OF
FUNERAL DIRECTOR ...
ADDRESS
Winthrop, Massachusetts
Received and filed
.19
( Registrar)
100m (d) -1-41-4667
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS extracts from the laws on back of certificate.
1
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so speolfy WAR)
MEDICAL CERTIFICATE OF DEATH
per tel . call
That I attended deceased from
Cerebral HEmarinage
Date of
IMPORTANT Physician
21
Winthrop
Informant.
No.
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 atandard 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 re- quired 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.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person sliall 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 tonib to another in the same cemetery, until he has received a permit from the board of health or its agent aforcsaid or from the clerk of the town where the body is buried. 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 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 physi- cian who is a member of the board of health, or employed by it or hy the aelectinen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal 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 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 acctiou ten of chapter forty-six, that the deceased aerved in the army, navy or marine corps of the United States in any war In which it haa 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 ia so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary 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 conimouwealth until he has re- ceived 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 cenictery or burial ground in which the interment is made. .. . Chap. 114. Sec. 46. G. L., (Terccutenary Edition).
Medical examiners shall inake examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ...- General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observanca of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persona to whom they have given bedside care during a laat illneas from disease unrelated to any form of injury.
(2) Board of Health physiclans will certify to such deaths only aa tbose of persons who, though disahled hy recognized disease unrelated to auy form of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deathis 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 im- portant, 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, writa housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
PLACE OF DEATH
Norfolk (County)
Braintree (City or Town) 93 Oakland Road
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Braintree
(City or town making return),
147
Registered No (If death occurred in a hospital or institution, St. l
give its NAME instead of strcet and number)
2 FULL NAME
Theodore H. Bartels
(If deceased is a married, widowed or divorced woman, give also maiden name.)
98 Reed
St.
Winthrop ........
Mass.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Male
4 COLOR OR RACE 5 SINGLE
MARRIED
White
WIDOWED
Or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced HUSBAND of
Lillian Aberle
(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.
AGE
8
64
Years
Months.
.Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Manufacturer Surgical
Supplies
Industry 10 or Business:
11 Social Security No ..
None
12 BIRTHPLACE (City)
(State or country)
Germany
13 NAME OF
FATHER
Cannot be learned
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Cannot be learned
15 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17
Informant.
Dr. Charles M. Tyler
Relation, if any
(Address)
14 Ridge Bd. Milton
A TRUE COPY.
ATTEST:
1. Woods.
(Registrar of city or town where death occurred)
DATE FILED
August 15,
.19.
41
18 DATE OF
DEATH.
August
15,
1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
August 13.
19.4.3., to
August 15
That I attended deceased from
I last saw h .... l.m .. alive on.
Aumust 1519 41
death is said
to have occurred on the date stated above, at.
11:00AM
Duration
Immediate cause of death. Intestinal Obstruction
8/13/41
Due to
Due to
Other conditions
Arteriosclerotic
(Include premacy ritin postle afgisth)
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?
20 Was disease or Injury In any way related to occupation of deceased ?
No
If so, specify.
(Signed)
Harold W. Ripley
M. D.
(Address).
Braintree
Date.
8/151941
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ..
Mt. Hope,
Boston
DATE OF BURIAL
August 18,
(Cemetery)
(City or Town)
41
19
22 NAME OF
FUNERAL DIRECTOR
J. S. Waterman & Sons
ADDRESS
Boston Mass ...
Received and filed
19
(Registrar of City or Town where deceased resided)
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 wwwmy vi atatng fraich occurred in your city of town in case the deceased resided in another city or town at the time
1
No
.....
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
years
months
days.
Date of ..
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
PARENTS
19.
.....
A R-301 A
PLACE OF DEATH
Suffolk County) Winthrop (City or Town) 171 Therese
The Commonwealth of Massarquarttu 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.
148
Registered No. ยง (If death occurred in a hospital or institution, .St. [ give its NAME instead of street and number)
No ... Charles 5. Broussard
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
...
(If nonresident, give city or town and state)
months
days.
In this community 33 yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
41
19 8/75
HEREBY CERTIFY.
1941, to.
8/17
I last saw his alive on.
8/17
19.41, death is said to
have occurred on the date stated above, at .....
........ m.
Immediate cause of death
Cento gustulis
Duration IMPORTANT 24 his.
Due to.
gastric
Due to.
endocarditis
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.
20
Was disease or injury in any way related to occupation of deceased?
If so, specify.
Ham
(Signed) ...
M. D.
(Address) ....
21
.........
Storeplus, Boston
Place of Burial, Cremation of Removal.
(City or Town)
DATE OF BURIAL August 20,
19.
41
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
11 tevidial
my. R. Kelly
Received and filed
AUG 2 2 1941
19
(Registrar)
100m-2-40-D-729-a
1
2 FULL NAME
171 Tevere
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
MARRIED
WIDOWED
or DIVORCED
Male White
Sa If married, widowed, e
IJUSBAND of ..
(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.
8
AGED0 Years.
...... Months
Days
Usual
Manager
9 Ocoupation :..
Industry
Diner (Lunch)
11 Social Security No.
12 BIRTHPLACE (City)
Halifax
(State or country)
3.5.
14 BIRTHPLACE OF
Halifax
FATHER (City).
(State or country)
11.5.
16 BIRTHPLACE OF
Halifax
PARENTS
MOTHER (City) ....
(State or country)
0 41.5.
Informant .............
(Address)
171 Revere St., Win.
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.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
10 or Business :
010-10 -0707
6 SINGLE (write the word) Married
diretta E. Lynch
.years
If less than 1 day Hours ........ .. Minutes
13 NAME OF
FATHER
Charles E. Broussard
15 MAIDEN NAME
OF MOTHER
Mary Mc Grath
17 Mrs. Loretta E Broussard Relatlon, If any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Childreng
(Signature of Agent of Board of Health or other) Health Officer 8/19/4/
(Official Designation) (Date of Issue of Permit)
8
17
(If U. S.
War Veteran.
no
specify WAR)
Whenthrow
years
18 DATE OF
DEATH.
per drontbel 9-9-41
(Year)
(Day)
That I attended deceased from
19 41
Date ........
0/19
19.41
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 discase of which he died, 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 hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been huried, until he has received a permit from the hoard of health, or its agent appointed to issue such permits, or if there Is no such board, 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 tomh 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 body is huried. 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 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 hy law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot 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 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 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 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 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 ahsent from home when the certificate of death is needed.
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