USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 7
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1
No.
14 Egleton Park
(Specify whether)
(a) Residence. No ....
(Usual place of abode)
That I attended deceased from
1/12
19.5-1.
have occurred on the date stated above, at.
Immediate cause of death.
Filemy Jungs
PARENTS
16 BIRTHPLACE OF
MOTHER (City) ....
(State or country)
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 deccased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccased, his supposed agc, 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 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 the attending physician, If any, as required by law, or in licu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall 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 re- moval of such body has been sooner obtained hercunder. 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 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 buricd or the funcral 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 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 infectlon related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very 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 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-302
Som-10-'39. No. 8427-f after the close of the month in which the death escurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time PARENTS
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
2
(City or town making return)
Registered No ....
5.7.7
19
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Francis O
Ball
(If deceased is a married, widowed or divorced woman, give also maiden name.)
287 Main
.......................
St.
Winthrop
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
......
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE 5 SINGLE
MARRIED
W
WIDOWED
or DIVORCED
(write the word)
married
18 DATE OF
DEATH.
Jan 13 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
1/7/47
19
That I attended deceased from
, to ..
1/13/4]
, 19 ......
I last saw h .... 1.m .. alive on.
2/13/41 19, death is said
to have occurred on the date stated above, at ....
9/58Am
Duration
Immediate cause of death
cerebral ... hemorrhage
dys
AGE
8 66 Ye Tears 1 Months. 8 Days
If less than 1 day Hours. Minutes
Usual 9 Occupation:
Industry
10 or Businesst
insurance - retired.
disease
yra
Due to
Il Social Security No ......
office
12 BIRTHPLACE (City)
(State or country)
Hyde Park Mass
13 NAME OF
FATHER
Francis 0 Ball
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Eunice Rogers
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston Mass
17 HenryE Keough
Relation, if any
friend.)
A TRUE COPY.
ATTESTI
(Registrar of city or town where death occurred)
DATE FILED
1/17/41
19
Other conditions
(Include pregnancy within 3 months of death:)
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?.
28 Was disease er Injory In any way related to occupation of deceased ?
If so, specify
W O'Connell
(Signed)
M.
P.
(Address)
B.o.s.ton
21 PLACE OF BURIAL,
Winthrop
Mass
DATE OF BURIAL.
Jan 15 1941
19
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
C R Bennison
ADDRESS
Winthrop
Received and fled 19
(Registrar of City or Town where deceased resided)
1
-
No ..
Boston ... City .... Hospital
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and state)
(Specify whether)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Trances ..... W.
(Husband's name in full)
58
.years
6 Age of husband or wife If alive.
7 IF STILLBORN, enter that fact here.
Due to
.... arteriosclerotic ... heart
Date of.
Underline the cause to which death should be charged sta- tistically.
CREMATION OR REMOVAL
(Cemetery)
Date.1. 1.3./19 ...
47
Informant.
(Address)
78 Waldemar Ave Winthrop
1
FEB131941 AM
M R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop.
(City or Town)
No. 20 Sagamore 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.
20
Registered No.
§ (If death occurred in a hospital or institution,
St.
¿ give its NAME instead of street and number)
2 FULL NAME
Adoniram Judson Young
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
20 Sagamore venue
St
.... ........
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
(If nonresident, give city or town and state)
In this community 66
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
0
(Month)
0
17
1941
(Year)
19
I HEREBY CERTIFY
nev 30
, 194.d., to .....
Som 17
19 4%
I last saw him alive on.
John 16
.. , 194// .. , death is said to
have occurred on the date stated above, at
9 45
A
.m.
Duration
IMPORTANT
Immediate cause of death ..
Chronic Endocarditis
3 yrs
Due to.
gangrene of right food
2 weeks
Due to.
asterio Sclerosis
3 yrs.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify .....
Louis 7. Salerno
(Signed)
M. D.
(Address) 175 Pleasant St Date 1,271
.194%
21.
Winthrop Cemetery Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL
January 19, 1941
19
22 NAME OF
Charles R. Bennison
ADDRESS.
Winthrop Mass
19
(Registrar)
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D. Childress
(Signature of Agent of Board of Health or other)
1/18/41
Health oficer (Official Designation) (Date of Issue of Permit)/
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widoged.er dartedlda Robertson
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
6.9
.years
7 IF STILLBORN, enter that fact here.
AGE
Years
5
Months
4
Days
Hours
.Minutes
If less than 1 day
Usual
9 Occupation:
Real Estate (retired)
10 or Business:
Office
11 Social Security No ...
Corinna
12 BIRTHPLACE (City)
(State or country)
Maine
13 NAME OF
FATHER
Alvin Young
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
Wiscasset
15 MAIDEN NAME
OF MOTHER
Martha Winchester
16 BIRTHPLACE OF
MOTHER (City)
St Albins
(State or country)
Maine
17 Relation, if any
Informant Mrs. Susie M. Young wife) (Address)20 Sagamore Ave Winthrop
(City of Town)
FUNER
Received and filed
Underline the cause to which death should be charged sta- tistically.
.Date of
(Day)
That I attended deceased from
6 Age of husband or wife if alive.
4 COLOR OR RACE
White
1 3 SEX Male 8 89 PARENTS 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 Industry
(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 forthwith, after the death of a person whom be 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 naine of the deceased, his supposed age, the disease of which he died, definded as required by section one, where saine 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 buman body in a town, or remove therefrom a human body wbich hag 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 buman body and remove it from a town, from one cemetery to anotber, 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 sball 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 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 deatb is caused by violence, the medical examiner shall make such certificate. if such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for sucb removal; provided, that such body shali be returned to the town from which it was removed within thirty-six bours after sucb removal, unless a permit in the usual form for tbe re- moval of such body bas 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 sball appear upon tbe permit. The board of health, or its agent, upon receipt of sucb 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 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 bave 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 tbe following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is 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 tbe disease, or complication which causes death, not the mode of dying, e. g., lieart 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 bad 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 wbose only occupation was that of home bousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by tbe 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
To be filed for burial permit with Board of Health or its Agent. 21
Registered No
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME.
augusta Walton
(If(deceased is a married, widowed or divorced woman, give also maiden name.)
124 Circuit Road
St
Winthrop
(If nonresident, give city or town and state)
years
months days.
In this community 20 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Widowed
5a If married, widowed, or divorced
HUSBAND of ...
(Give maiden naine of wife in full)
Samuel Walton
(Husband's name in full)
6 Age of husband or wife if alive
.year's
7 IF STILLBORN, enter that fact here.
If less than 1 day
8 73 Years Months Days Hours
Ueual
9 Occupation :..
Swedish masseur
11 Social Security No ..
Whatis
12 BIRTHPLACE (City)
(State or country)
W. Vailmia
13 NAME OF
FATHER
?
Jericho
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City).
(State or country)
Germany
100m-2-40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Childrenxx (Signature of Agent of Board of Health or other)
Malthe Officer 1/20/41 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH January 18 1941 (Year)
(Monthy
(Day)
19
I HEREBY CERTIFY.
nov 30, 1940,
That I attended deceased from
Jo January 18, 1941
I last saw her alive on Hammany $5,19 41, death is said to have occurred on the date stated above, at. 2:30 a.m. Duration IMPORTANT 2 Immediate cause of death. Carcinoma of Lungo
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT PHYSICIAN
Major findings: Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis ?..
Underline the cause to which death should be charged sta- tlstically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed)
(Address)
Evento
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
January
20
19.54/
22 NAME OF
FUNERAL DIRECTOR
Q.C. Kinky
ADDRESS
EBoston
Received and filed
19
(Registrar)
,
Date
18
M. D.
1941
21 Woodlawn
17 Jums Flora In Walton (Sister-In-Law)
Relation, if any
(Address) Stillriver Harvard, mars.
CERTIFICATE OF DEATH
Winthrop Community Hospital
St.
(If U. S.
War Veteran,
specify WAR)
home
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
1 No 3 SEX temale (or) WIFE of PARENTS 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 Induetry 10 or Business :.
Minutes! Due to.
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, definded as required by section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not heen huried, 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 hoard, 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 cemetcry to another, or from one grave or tomb other than the receiv- ing tomh 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 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 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 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 body, 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 he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such hody has heen 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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