USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 52
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Daysl.
Usual
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15
16 BIRTHPLACE OF
MOTHER (City) .....
PARENTS
(State or country)
17
Informant.
Fred Gillespie
(Address)
16 Wilshire St
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
FATHER
Samuel Garrett
5 SINGLE
(write the word),
MARRIED
WIDOWED
or DIVORCED
Widow ed
5a If married, widowed, or
HUSBAND of.
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than 1 day
.Hours
Minutes
9 Occupation :.
Laborer
(retired)
St
New Brunswick
OF MOTHER Mary McJunkin
Unable to obtain
( .... nephew ..... )
Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death wag filed with me BEFORE the burial or transit permit was issued: VINv. D. Childress x, (Signature of Agent of Board of Health bor other) Health Officer 8/29/4
.... (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug
27
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)-f inforate Pulmonary Infarction, for illy> honcho- pneumonia & absces formation
20 Accident, suieido or homicide (specify)
Date of occurrence.
Time 14
19 .//
Where did
Injury occur?
Winthrop, me
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place? Shal
Manner of
(Specify type of phce)
Injury
Struck by auto
Nature of
Facture-18 leg & thrombosis
Injury ..
While at work? Wasthere an autopsy ?.
21 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
10 24 Lattina
M. D.
(Address)
Date
Asy IT 1937
Relation, if any
22.
Winthrop Cemetery
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
August 30, 1941
.19
23 NAME OF FUNERAL DIRECTOR .... Charles R Bennison ADDRESS ...... inthrop .... Mass
Received and filed
19
(Registrar)
25m-2-'40-D-729-b
PLACE OF DEATH
Suffolk
Him Community Hostitel
The Commonwealth of Massarquartîn OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
156
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
John Satuft (John M, Garrett
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 Wilshire
St.
(If nonresident, give city or town and state)
years
2
months
13
days.
In this community
15yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
(Specify whether)
St.
..........
(If U. S.
War Veteran,
specify WAR)
1941
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer 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, 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 hody in a town, or remove therefrom a human hody which has not heen buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to be returned and recorded, which shall he accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physiclan, 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 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 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 froin which it was removed within thirty-six hours after such removal, unless a permit In the usual form for the re- moval of such body has been sooner obtained hereunder. If the death certificate contains a 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 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 thercafter 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 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 la no such hoard, from the clerk of the town where the hody 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).
Medical examiners shall make 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 hody 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.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may he, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 whoin 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) Medlcai 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 dlsease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas hacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumahle nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the hrain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-301 A
1
PLACE OF DEATH
uffolk (County) Withart
The Commonforalth 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.
157
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
379 - Shirley
(Usual place of abode)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months days.
In this community 2 2 yrs.
>
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACEJ
white
5 SINGLE
(write the word)
married
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
August
30
194-1
(fonth)
(Day)
(Year)
5a 1
HUSBAND of
idivide Campbell Butter Haus( 28, 194)
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
-70 -
years
7 IF STILLBORN, enter that fact here.
AGE ..
8
64%
X .. Months.
18
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Recurit
10 or Business:
Industry
Retail Procesos
11 Social Security No.
12 BIRTHPLACE (City)
( State or country )
Thomaston man
13 NAME OF
FATHER
George. W. Bowers
14 BIRTHPLACE OF
FATHER (City)
Thomaston"
(State or country)
Man
15 MAIDEN NAME
OF MOTHER
Ellen, Mark
16 BIRTHPLACE OF
MOTHER (City)
unable to obteni
(State or country)
17 Informant (Address)
Relationcif any Io. Geo. Fr. Bowers 329 Shirly Ph counting me
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE/the burial or transit permit was, Issued :
22 NAME OF
FUNERAL DIRECTOR Cha R Banana
ADDRESS
.....
Received and filed.
19
(Official Designation) (Date of Issue of Permity
19 | HEREBY CERTIFY,
That I attended deceased from
I last saw h.
IM alive on
August 1381941.
ath Is sald to
have occurred on the date stated above, at.
4.30 P
m.
Immediate cause of death
ACUTE INTESTINAL Obstruction
240
2401
Due to.
Vatrala.
Other conditions.
Branche PNEUMONIA
36
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Volvulus
Date of.
Hugo51346
Of autopsy
What test confirmed diagnosis ?
IMPORTANT Physician Underline he 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
(Signed)
Edward . rayages
Į .. , M. P.
(Address) 200
١٠
150 +1.19
21
Pa. Thomastaw,
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL Self 3-41
So Tomatin-LE
19.
100m (d) -1-41-4667
extracts from the laws on back of certificate. 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, Seotion 10, requires physicians to insert a reoital to that effect. PARENTS
Nunchuk Community Hospital No. Scores, Hederick Powers
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
St.
(If nonresident, give city or town and State)
to ..
auguri 30, 1941
Duration
IMPORTANT
-
Due to
Volvulus
(Siguature of Agent of Board of Ilealth or other) Healthe Officer 9/2/4/
( Registrar)
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 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, Sec. 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 aud nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a huntan body which has not been buried, until he has received a perinit from the board of health, or its agent appointed to issue such permits, or if there is no such board, froin 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 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 buried. No such pernrit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, 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 carly enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen 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 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 perniit 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 aerved 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 ia so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary 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 bury a human body or the ashes thereof which have been brought into the commonwealth 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 froin a person appointed to have the care of the cenietery or burial ground in which the interment is made. ... Chap. 114. Sec. 46. G. L., (Terccutenary Edition).
Medical examiners shall make 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 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 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 traumatiem (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 .- l'recise 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, 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 AI Auffret
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial perutit with Board of Health or its Agent.
1584
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
St.
No. Hilda thenow Thompson
(If deceased is a married, widowed or divorced woman, giye also maiden name.)
16 Stheclock
.St.
(If nonresident, give city or town and state)
years
months
days.
In this community /5 yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
august
31
1941
Month)
(Day)
(Year)
19 I HEREBY CERTIFY. Que 14
That I attended deceased from
2. 194 to Ong 3120
19.4 ... /
I last saw h ...
....... alive on.
aug 30 30, 1941, death is said
to have occurred on the date stated above, at ... Immediate cause of death. Hypostatic pneumonia
6.459
Duration IMPORTANT
24
Due to Cerebral Homemplage.
July 31,41
...
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
none
.Date of ..
Of autopsy
What test confirmed diagnosis ?
Clinical
20 Was disease or Injury In any way related to occupation of deceased? If so, specify. ......
(Signed) (Address) ...
. M. D.
Date ..
meg3 1. 194/
Stoodlawn Everett
Place of Burial, Cremation or Removal. DATE OF BURIAL. Sept. 2,
Citz_or Town)
22 NAME OF
Frank W. Brown.
FUNERAL DIRECTOR ADDRESS. 11 Pembroke It medford
Received and filed. 1941
19
(Official Designation) (Date of Issue of Permit)\"
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
Theodore Thompson
Years
Hours.
Minutes
Auvedeno
For. Elsie Chihman, daw.
Relation, if any 21
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. S. Childrenfx (Signature of Agent of Board of Health de other) Healite Officer 9/2/4/
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
....
(Registrar)
(If U. S. War Veteran, specify WAR)
ACounty)
Withrah
1
(City or Toyn)
16 )theclock
2 FULL NAME
(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
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in fusr)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
83
Years
AGE®
11
Months
If less than I day
9 Days
Usual
at home
9 Occupation:
Industry
10 or Business:
II Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Sweden
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Rivedere
15 MAIDEN NAME
OF MOTHER
?
Stang
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17
(Address)
16 Htheelack.Sh
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
100m-10-'39. No. 8427-e
N. B .- WRITE PLAINLY, WITH ONFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
13 NAME OF
FATHER
?
Sevensou
PLACE OF DEATH .
-
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
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