USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 59
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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 tonib 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 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 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 conunouwealth 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-aix, 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 is 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 manuer 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 permita, 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., (Tercenteuary 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 ia 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 Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deaths only ss 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 discase 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 traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deathis 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 morbid conditions, if any, related to the principal cause and any important complication of the principal causc.
Statement of Ocoupation .- Precise statement of occupation ia 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 hiome. 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, ctc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
1
PLACE OF DEATH
SUFFOLK. (County )
Winthrop
(City or Town) 48 Plummer Avenue
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.
176
Registered No.
( If death occurred in a hospital or institution, St. [ give its NAME instead of street aud number)
2 FULL NAME
Mary A. Matthews
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
48 Plummer Avenue
(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
2
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACEJ
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Josephve Jaidenlet the wsull)
(ITusband's name in full)
6 Age of husband or wife if alive
67
years
7 IF STILLBORN, enter that fact here.
8
AGE
Years
Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
At Home
Industry
At Home
10 or Business :
il Social Security No.
12 BIRTHPLACE (City)
St. Miguel
(State or country)
Azores
13 NAME OF
FATHER
Antonio Marques
14 BIRTHPLACE OF
St. Miguel
FATHER (City)
(State or country)
Azores
15 MAIDEN NAME
OF MOTHER
Mary A. Ventura
16 BIRTHPLACE OF
St.Miguel
MOTHER (City)
(State or country)
Azores
17 InformantMIS Mary Morrison Relation hver (Address) 48 Plummer Ave. Winthrop
Place of Burial, Cremation or Remoyal DATE OF BURIAL Sept. 23, 1941 19 .....
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Cambridge ,Mass.
(Signature of Agent of Board of Health or other)
agent Seft: 22/41
(Official Designation) (Date of Issue of Bermity
MEDICAL CERTIFICATE OF DEATH
DEATH
( Month)
(Day)
1941
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
19
to
19
I last saw h ...
.. allve on
, 19 ........ , death Is sald to
have occurred on the date stated above, at
12:22 P.
.m.
immediate cause of death
IMPORTANT
Congestive heart failure
J
2 dias U
Due to ... Chimie valondan heart
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of ......
Of autopsy
What test confirmed diagnosis?
clinical
20 Was disease or injury in any way related to occupation of deceased ?.... -
(Signed)
(Address) Without Board of Health
M. D.
21
Winthrop
-
Winthrop
9/22/
.19
(Gity or Town)
Joseph ll. Toosta
Received and filed 24 1941
19
(Registrar)
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 recital to that effeot. PARENTS
IMPORTANT
Physician
Underline the cause to which death should be charged sta- listically.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : William D. Children
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
18 DATE OF
September 20.
Duration
76
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal 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, furnisb 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, eightcen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteeu and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human hody 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 froin one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit fromn the board of health or its agent aforesaid 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 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 conunouwealth 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 fortliwith 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 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 commonwealth until he has re- ceived a permit so to do from the board of lrealth 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, Q. L., (Terccutenary Edition).
Medical examiners shall make exaunnation upon the view of the dead bodies of ouly 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 physiclans 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 physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posabły due to injury. These include not only deaths eaused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical ( drugs or poisons), thermal, or electrical agents, and deathis 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 naine the discase causing death. As related causes, name earlier morbid conditions, if any, related to tbe principal cause and any important complication of the principal cause.
Statement of Occupation .- Predse 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 illuess. 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 housekceper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
HAMPDEN
(County)
SPRINGFIELD
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
SPRINGFIELD
(City or town making return)
Registered No
§ (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.)
37 Bellevue Ave
......
St.
(If nonresident, give city er town and state)
years
months
days.
In this community
yrs.
2 mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
F
4 COLOR OR RACE| 5 SINGLE
MARRIED
W
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
...
(Give maiden name of wife in full)
(or) WIFE of
Edwin Chester Johnson
(Husband's name in full)
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE.
.. 7.2Years
9
Months 13 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
None
Industry
18 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Boston
(State or country)
Mass
13 NAME OF
FATHER
Henry Noll
14 BIRTHPLACE OF
FATHER (City)
Allendorf
(State of conntry)
Germany
15 MAIDEN NAME
OF MOTHER
Not known
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17 Nrs W H Howatt
-Relation, if any
daughter
Informant
(Address)
1451 Plumtree Rd
Springfield
A TRUE COPY.
ATTESTI
CliffordTamith
(Registrar of city or town where death occurred)
DATE FILED
Sep 22 1941
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Sept
22
1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIF Spril 18
19 .......
to
Sept 22
19.
I last saw h .......... alive ofSe.p.t ...
.22
19 ... 44.], death is said
to have occurred on the date stated above, at.
7:40A
.m.
Duration
Immediate cause of death.
Splenic leukemia
History about
2 years
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injory In any way related to occupation of deceased ?
If so, specify.
Irving R Calkins
22 м. р .-
(Signed)
299 Central
DatSe pt
19
47
(Address)
21 PLACE OF BURIAL.
Winthrop Winthrop
CREMATION OR REMOVAL ...
(Cemetery) Ha's's
(City or Town)
Sept 24 1941
IS
DATE OF BURIAL
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
ADDRESS.
120 Winthrop St Winthrop
Received and flod.
0 8
1941
19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
PLACE OF DEATH
(City or Town) 1451 Plumtree Road
No ..
Carrie (Noll) Johnson
(If U. S.
War Veteran,
specify WAR)
Winthrop Mass
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
PARENTS
Major findings :
Of operations
Date of
Of autopsy
Clinical &
What test confirmed diagnosis .......... poratoryNo
46%.
That I attended deceased from2, 1
R-301 A
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
(County)
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)
(If U. S. War Veteran. specify WAR) ..
(a) Residence. No (Usual place of abode) Length of stay: In hospital or institution.
Here. Tal
years
months 2 days.
In this community
yrs.
mos.
2 days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced 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
AGE Years. Months.
2 Days
If less than 1 day Hours. Minutes Due to.
Usual 9 Occupation :..
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (Whether Theart (State or country)
13 NAME OF FAM illiam My Shoemaker
14 BIRTHPLACE OF FATHER (City) ...... (State or country)
Undeina
15 MAIDEN NAME OF MOTHER
Dementine Olioquan
16 BIRTHPLACE OF MOTHER (City) ..... (State or country)
Relation, if any
17 Willeine m Fhamoly Holley
108
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Um& Childress
Signature of AgentOf Board of Health or other)
alt Sept 24+1
(Official Designation) (Date of Issue of Permit)
(Registrar)
-
I last saw him alive on
Je fer 22, 19 X, death is said to
have occurred on the date stated above, at. 7=280. m.
Duration IMPORTANT
Immediate cause of death .. Congenital Neauf
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 soluted to occupation of deceased ?.
If so, specify (Signed)
(Address) ... 2.38 Mavenalis
Date. 9/23
M. D. ... 19444.
21
Place of Burial Cremation or Removal (City or Town) DATE OF BURIAL ettember 244 141
22 NAME OF FUNERAL DIRECTOR, ADDRE
Clancy Dilleetão
Received and filed SEP 2 4 1941
.19
1
(City or Towny Winthrop (Community
....... ....
Alarmaher er
2 FULL NAME .... (If deceased is a married, widowed or divorced woman, give also maiden name.) 184 Webster
St ......
(If nonresident, give city or town and state)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
22, 1941
(Month)
(Day) (Year) That I attended deceased from
19 I HEREBY CERTIFY, Vera 20
19/1, who 22 19.
Major findings: Of operations.
„Date of.
Of autopsy ..
What test confirmed diagnosis? Th and for
PARENTS
100m-2-'40-D-729-a
HO
Baby
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 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 huried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomh 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 huried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to he returned and recorded, which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician. if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot 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 hy it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously interred, from one town to another within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such 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 thereafter furnish 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).
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