USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 6
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No undertaker or other person øball bury a human body or tbe ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of bealth or its agent appointed to izsuc sucb 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 bave tbe care of the cemetery or hurlal ground in which the interment is made .... Chap. 114, Seo. 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 deatbs only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons wbo, though disabled by recognized diseasc 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 Examiuers 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 tbc action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, c. g., heart failure, asphyxia, asthenia, etc. As principal cause name tbe disease causing deatb. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complieation of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative bealthfulness 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 deatb. report the usual occupation prior to illness. If the deceased bad retired from busl- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman wbose 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, ete. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
Suffolk (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.
16
Registered No.
§ (If death occurred in a hospital or institution. ¿ give its NAME instead of street and number)
2 FULL NAME
Katie
(Wheeler).
Orcutt
(If deceased is a married, widowed or divorced woman, give also maiden name.)
48 Bowdoin
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution. (Specify whether)
years
months
days.
In this community 41
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowe
(Give maiden name of wife in full)
(or) WIFE of.
William B. Orcutt
(Husband's name in full)
6 Age of husband or wife if alive. years
If less than 1 day
Hours
Minutes
12 BIRTHPLACE (City)
(State or country)
New Hampshire
FATHER (City)
(State or country)
New Hampshire
15 MAIDEN NAME
OF MOTHER
Gracia Kitridge
16 BIRTHPLACE OF
MOTHER (City)
Hancock
(State or country) New Hampshire
Relation, if any
daughter
(Addres 48 Bowdoin St Winthrop Mass
I HEREBY CERTIFY chat a satisfactory standard certificate of death was filed with me BEFORE the burialor transit permit was issued : Mellan D-Childrens
(Signature of Agent of Board of. Health or other)
Jan, 11/41
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Kan 10
194,
(Month)
(Day)
(Year)
19 HEREBY 1015
CERTIFY
19.9.0, to,
That I attended deceased from
1 0
19
I last saw h alive on
have occurred on the date stated above, at. Immediate cause of death.
13A m.
Duration IMPORTANT
Due to.
Due to
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed)
YWorkinglow on Date.
1-10-1941
21.
Winthrop Cemetery Winthrop Mass
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIALJanuary 12 1941
19
22 NAME OF
Charles R. Bennism
FUNERAL DIRECTOR
ADDRESS
Winthrop Mass
Received and filed.
19 -
(Registrar)
M. D.
(Address).
Major findings: Of operations.
Date of.
Of autopsy
What test confirmed diagnosis?
9
19.52 .. , death is said to
1
Winthrop
(City or Town)
No
48 Bowdoin
(a) Residence. No.
(Usual place of abode)
3 SEX
4 COLOR OR RACE
White
Female
Sa If married, widowed, or divorced
HUSBAND of
7 IF STILLBORN, enter that fact here.
8
AGE ..... 8.7 .. Years
Months.
.Days
Usual
9 Occupation :
At home
Industry
10 or Business:
11 Social Security No.
Milford
13 NAME OF
14 BIRTHPLACE OF
Hancock
PARENTS
17
Inf
Mrs. Ethel Wurtz
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
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
4.0
100m-2-'40-D-729-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
FATHER
Gilman Wheeler
(Official Designation)
St.
(If U. S.
War Veteran,
specify WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, after the death of a person whom he has attended during his last illness, at tlie 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 deatb, stating to the best of his knowledge and belief the name of the deceased, bis supposed age, the disease of which he dicd, definded as required by section one, where same was contracted, tbe 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 bas 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 otber 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 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 in- sufficient, a physician who is a member of the board of bealtb, or em- ployed hy it or by the selectmen for the purpose, shall upon application make the certificate required of tbe 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 anotber witbin 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 sucb removal; provided, that such body sball be returned to the town from which it was removed within tbirty-six hours after such removal, unless a perinit in the usual form for the re- moval of such body has been sooner obtained bereunder. 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, sucb 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 tbe permit is so given and the physician certifying the cause of death shall thereafter furnisb 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 .- Chop. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a buman body or the aslies 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 burlal 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 disahled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabied by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes deatb, 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 tbe 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 tbe disease causing death, report the usual occupation prior to illness. If the deceased bad 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 wbose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate tbe occupation by tbe appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person wbo had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
Suffolk (County)
No. 7 Myrtle Avenue
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.
17
Registered No.
§ (If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
Marguerite
....
(Harley)
Seymour
(If deceased is a married, widowed or divorced woman, give also maiden name.)
7 Myrtle Avenue
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community 1 5
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Jan 10,
1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
19.40, to Jan
9
19 41
I last saw h. Lalive on.
Jan 9
19.41, death is said to
have occurred on the date stated above, at.
8.30
A m.
Immediate cause of death ....
Cerchical Hemorrhage
Duration IMPORTANT 11/27/40
-
Hypertension
Due to.
Diabetes mellilos
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? w
If so, specify ..
(Signed).
a. Nathan Caplen
M. D.
(Address) 14 Menmand ary Win Date :///
19.6 ...
21 Winthrop Cemetery Winthrop Mass
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
January 13. 1941
19
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
ADDRESS
Winthrop Mass
.19
(Registrar)
1
Winthrop
(City or Town)
(a) Residence. No.
(Usual place of abode)
3 SEX
4 COLOR OR RACE
Colored
Female
6 Age of husband or wife if alive.
64
7 IF STILLBORN, enter that fact here.
Usual
9 Occupation :
At ..... home
Industry
10 or Business :
11 Social Security No ..
(State or country)
13 NAME OF
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Georgia
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Georgia
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
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
100m-2-'40-D-729-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
FATHER
Richard Harley
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE
Albert Edward Seymour
(Husband's name in full)
.years
If less than 1 day
8 AGE ... 5.9 Years Months. .. Days Hours Minutes
12 BIRTHPLACE (City).
"North Carolina
Unable to
Tamerobtain first
name
17 Relation, if any
Informant. Albert E. Seymour (husband (Address)7 Myrtle Ave Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial gr transit permit was issued :
(Signature of Agent of Board of Health or other) /
Health Khices (Official Designation) VV (Date of Issue of Permit)
1/13/41
Due to.
arterios clerpas
Major findings: Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
Received and filed
(If U. S.
War Veteran,
specify WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospitai medicai 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, bis supposed age, the disease of which he died, definded as required by section one, where same was contracted, the duration of bis last illness, wben 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 sliall bury or otherwise dispose of a human body in a town, or remove therefrom a buman body which has not been buried, until he bas 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 otber 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 tbere 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 interinent, 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 in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by tbe selectmen for the purpose. shall upon application make the certificate required of the attending physician. If death is caused by violence, tbe medical examiner shall make such certificate. If such a permit for the removal of a buman 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 sucb removal; provided, that such body shall be returned to the town from which it was reinoved within thirty-six hours after such removal, unless a permit in the usual form for tbe re- moval of sucb body bas been sooner obtained bereunder. if the deatb 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, sucb recital shall appear upon the permit. The board of bealth, or its agent, upon receipt of such statement and certificate, shall fortbwitb 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).
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 sucb deatbs 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 Ileaith 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 absent from bome when the certificate of death is needed.
(3) Medical Examiners will Investigate and certify to all deaths supposabiy due to injury. These include not only deaths caused directly or indirectly by traumatisin (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electricai agents, and deaths following abortion, but also deatbs from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabied by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication wbich causes death, not tbe mode of dying, e. g., heart failure, aspbyxia, astbenia, 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 tbe 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 deatb, 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, bowever, 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
PLACE OF DEATH
Suffolk (County)
Winthrop (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.
Registered No. 18
[ (If death occurred in a hospital or institutlon, St. {give its NAME instead of street and number)
2 FULL NAME.
Elizabeth atherton Tancred
(If U. S.
War Veteran,
specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
14 Egelton Park
St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ..
years
months
days.
In this community
/ yrs.
6
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
5a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Peter Tancred
(Husband's name in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN. enter that fact here.
AGE
8
Years
9
Months
8
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :.
Housewife
Industry
10 or Business :..
Own Home
11 Social Security No .. 12 BIRTHPLACE (City) South Boston (State or country)
Isdasi
13 NAME OF
FATHER
Charles French
14 BIRTHPLACE OF
FATHER (City) ...
(State or country)
15 MAIDEN NAME
OF MOTHER
Allemcampbell
Salem
17
Relation, if any
Charles Tancred( Son
Informant (Address) 14 Egleton PK, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Non. D. Childeux. (Signature of Agent of Board of Health or other)
healt,
Officer
1/13/4/
(Official Designatien)/ (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
12.1941
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,
4/20
1940, to.
I last saw h alive on
1/11
19.44, death is said to
1200
Duration IMPORTANT ....... 20ys 0
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
General Vitera Selvvisio
IMPORTANT
Major findings: Of operations.
Date of
Of autopsy.
What test confirmed diagnosis?
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
faire appelle
M. D.
(Signed)
(Address) umathur
Date 1×12
19 ...
21.
Forest Hills
Boston
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL ..
Jan . ..... 14,. .... 1941.
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS.
Newton pharrellque
Received and filed
(Registrar)
100m-2-'40-D-729-8
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 83 is very important. See instructions and extracts from the laws on back of certificate.
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