USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 62
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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 buricd 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 lastillness 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 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 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, asthenla, 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 Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employcd 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 terins, as housekeeper-private family, cook-hotel, etc. 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)
62 Main
The Commontoralth 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.
190
[ { If death occurred In a hospital or Institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Ellen (Bleakley) Graham
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
62 Main
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 31 yrs. - mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
John (Gire maiden name of -xite in full)
(Tlusband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN. enter that fact here.
8
AGE
8.3 Years
8
Months
1 ... Days
If less than 1 day
Hours.
Minutes
Usual
9 Oocupation :
At home
Industry
10 or Business :
11 Social Security No.
Killcorrah
12 BIRTHPLACE (City)
(State or country)
Ireland
(Include pregnancy within 3 months of death)
IMPORTANT Physician
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Esther Copeland
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
M. D. "4
(Address) 562 JulyUT
Date 10/17/1911.
21 Winthrop Cemetery winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
October
18.
1941
19
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was Issued:
M. D. Children
(Signature of Agent of Board of Healthy or other) .
Health affecter 10/18/41
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
October
15
1941
(Month)
(Day)
(Year)
19
HEREBY CERTIFY,
July 16
19.35
October 15 1941
That L altended deceased from
.alive on
Mast saw h.
er
October 15, 04/
death Is sald to
have oocurred on the date stated above, at
11:30am.
Immediate cause of death
Cerebral Hemontage
Duration 10/12/41
Due to.
arteriosclerosis
Due to
Senility
2yra. ......
13 NAME OF
FATHER
Robert Bleakley
Major findIngs :
Of operations.
none
Date of.
Underline the cause to which death should be
What test confirmed diagnosis?
Clinical x labi
charged sta-
tistically.
20 Was disease or injury in any way related to occupation of deceased20
If so, specify ........
Jacob, Lebraque Apto
('Signed),
22 NAME OF
FUNERAL DIRECTOR.
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed .....
19
(Registrar)
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physiolans to Insert a reoltal to that effect.
100m (d)-1-41-4667
17 daughter Informant .. Henrietta Graham Relation, if any (Address) 62 Main St Winthrop Mass
Other conditions ...
none
Of autopsy
noul
PARENTS
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 forthiwith. after the deall 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 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 bis death ... Cen. 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 hest of his knowledge and belief, served In the army, navy or marine corps of the I'nited 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 sud the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with auty provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he 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. Cltap. 46, Sec. 10.
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 buriedl, 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 otlier person shall exliume a human body and remove it from a town. from one cemetery to another, or from oue grave or tomb other than the receiving tomb to another in the same cemetery, until be 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 he returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as 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 hoard of health, or employed by it or by the selectinen 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 linnan 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 permit in the usual form for the reinoval 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 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 forthwitb 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 nece 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 health or its agent appointed to issue such permits, or if there is no such hoard, 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).
Medical examiners shall make examination 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 forthiwith go to the place where the body lies aud 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 atterlance 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 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 .- Canse 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 ou account of the discase causing death, report the usual occupation prior to illuesa. 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 terma, 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
Suffolk (County)
Winthrop
(City or Town)
125 Cliff Ave
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.
191
Registered No (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Rose Flather Hoffses
(If deceased is a married, widowed or divorced woman, give also maiden name.) 125 Cliff Are
St
(If nonresident, give city or town and state)
In this community
25
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
emale
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
Sa If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
James S. Koff
(Husband's name in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
AGE
Years
29
If less than 1 day
Hours .....
Minutes
Usual 9 Occupation:
Abuse work
Industry
10 or Business:
(Retired)
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
London
England
13 NAME OF
FATHER
Osborn T Flather
PARENTS
/15 MAIDEN NAME
OF MOTHER
non and 1 team
Lunay Bailey
16 BIRTHPLACE OF/ MOTHER (City) .. (State or country) England
17 Douise Paul
Daughter
Informant
(Address)
125 Cliff Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was ffled with me BEFORE the burial or transit permit was issued: Wie, D, Children
(Signature of Agent of Board' of Health or other)
Vialete Officer 10/17/4/
... (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ..
October
15 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from april 1, 1941, to. October 15, 199/ ..... I last saw h ....... A .. alive on. Oct .15, 19%, death is said to have occurred on the date stated above, at ........ .. m. Immediate cause of death Carcinoma
Duration IMPORTANT 1940
Due to.
Due to
Other conditions.
antonio- Schranz
1935 IMPORTANT
PHYSICIAN Underline the cause to which death should be ยท charged sta- thetically .
20 Was disease or injury in any way related to occupation of deceased? 20
If so, specify.
(Signed)
M. D.
(Address)
726 Varalonga 8.
Date .. 02816 1941.
21. Winthrop
Winthrop
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL Oct. 17 1941 .19
22 NAME OF FUNERAL DIRECTOR Richard Shthilo
ADDRESS 147 .... Winthrop .... st .... Winthrop
Received and filed
.19
(Registrar)
100m-2-40-D-729-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.
Y
Major findings: Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis
(Include pregnancy within 3 months of death)
( per mr 2 hete)
1
No.
(If U. S.
War Veteran,
specify WAR)
Winthrop
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
years
months
days.
Relation, if any
14 BIRTHPLACE OF FATHER (City) (State or country) Ing land
8 75 1 .Months. ...... Days
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 whoin he has attended during his last illness, at the request of an undertaker or other autborized 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 by section one, where same was contracted, tbe duration of his last illness, when last seen alive by tbe physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the 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 tbe 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 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 witbin the commonwealth cannot be obtained early enougb for the purpose, the certificate of deatb 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 witbin thirty-six hours after such removal, unless a permit in the usual form for tbe re- moval of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter 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 tbe 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 Ilealth physicians will certify to such deaths only as those of persons wbo, though disabled 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), therinal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not tbe mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name tbe 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 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 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 bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A Suffolk
(County )
1
.....
(City or Towny
The Commnouforalth 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.
192
[ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
munity (Hewett)
woman, give also maiden name.)
St.
( If nonresident, give city or town and State)
Length of stay: In hospital or Institution ( Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word) .
Married
Sa If married, widowed, or divorced 2. HUSBAND of
(or) WIFE of
Theo love manden name of which were
(Ilusband's name in full)
6 Age of husband or wife if alive 52
years
7 IF STILLBORN, enter that fact here.
8 AGE 22 Years Months. Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
at Home
Industry
10 or Business :
Force
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
Chelsea. Lass.
13 NAME OF
FATHER
John Q. Hewitt
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston, Lass.
PARENTS
15 MAIDEN NAME
OF MOTHER
Mary @ Broux
16 BIRTHPLACE OF
MOTHER (City)
Para tertia
(State or country)
O Canada
Reletion, is any
21
(City of Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Get. 184.
.19.5
I HEREBY CERTIFY thatz hasatisfactory standard certificate of death was filed with me BEFORE The buHat of transit permit was issued : Www. D. Childrenzx
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