USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 72
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(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have dicd without recent medical attendance or whosc physician is absent from home when the certificate of death is needed.
(3) Medleal 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 septice- mia), 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 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, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, 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 busi- ness, 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, designatc 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
RI R-301
Lawrence" per hu. Ramme weddle name
1 F.very item of 3 SEX Male (or) WIFE of Usual PARENTS 100m-2-'40-D-729-8 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. 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 10 or Business:
PLACE OF DEATH
Suffi3k (County)
Winthrop Mass. (City or Town)
No. 334 Revere
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.
218. ...
§ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Harry Lawerence Coffin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
534 Revere
St
(If nonresident, give city or town and state)
In this community
5 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
november
17
1941.
(Month)
(Year)
5a If married, widowed, or divorced
Marion (Kendall) Coff
HUSBAND of.
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. 50
years
7 IF STILLBORN, enter that fact here.
8
AGE.57.
6
Months.
Years
2
Days
If less than 1 day
Hours.
Minutes
9 Occupation :
Night Watchman
Industry
Old South Building Boston
14 Social Security No.
023-10-6055
12 BIRTHPLACE (City)
Charlottown
(State or country)
13 NAME OF
FATHER
Duncan Coffin
14 BIRTHPLACE OF
FATHER (City)
Charlottown
(State or country)
P.E.I.
15 MAIDEN NAME
OF MOTHER
Jessie Scott
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
P.E.I.
Relation, if any
Informant.
(Address)
334 Revere St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Www. D. Childrenfx (Signature of Agent of Board of Health or other) de atthe Officer 11/19/41
(Official Designation) (Date of Issue of Permit) ?
19 May 13 4h to.
CERTIEL
(Day)
That I attended deceased from
November 17, 1944
I last saw herM alive on
november 16, 1941, death is said to
have occurred on the date stated above, at. 3 a: m.
Immediate cause of death ..... acute C 1se o Carmary
Duration IMPORTANT alucito
15 hours.
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. ...
Jacob Claus At
M. D.
(Signed),
Address) 562 Manley Date 11/7/8/1
21.Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL
NOV ...
Ï9
(City or Town)
winteresais .
22 NAME OF
FUNERAL DIRECTOR
Howard SPunsles
ADDRESS Anitrong Man
Received and filed. ...... NOV 2 1 1941 19
(Registrar)
Major findings:
Of operations
none
Date of
Of autopsy.
none
.....
What test confirmed diagnosis? Cliccaly
Labination
Licute Pulmonary
Due to. Edema
Other conditions More (Include pregnancy within 3 months of death)
17
Marion Coffin
(.
Wife
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Marrie
years
months
days.
Registered No.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
-
(Specify whether)
4 COLOR OR RACE
White
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 wbom he has attended during his last illness, at the request of an undertaker or otber authorized person or of any meinber 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, his supposed age, the disease of which he died, 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 has received a permit from the board of health, or its agent appointed to issue such perinits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhuine 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 tbe 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 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 such removal; provided, that such body sball 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 hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, tbat tbe 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 tbe 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 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 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 deatbs 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 deatb, not tbe mode of dying, e. g., beart 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 cbanged on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired froin business, report tbe 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 wbo had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION.
M R-301 A
1 No. 3 SEX (or) WIFE of 8 63 9 Occupation : 17 Informant ( Address) If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that effect. PARENTS 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 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain Industry 10 or Business :
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 142 Pauline
St.
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.
Registered No.
219
" (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Agnes I. Fitzpatrick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
142 Pauline St.
(Usual place of abode)
Length of stay : In hospital or Institution
( Before deatlı)
(Specify whether)
none
years
months
days.
In this community 30
yrs. -
mos.
- dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
(Month)
(Day)
1941 (Year)
19 | HEREBY CERTIFY.
200 13.
19 41
to
That I attended deceased from
1 last saw h
alive on hin
17
1941
death Is sald to
have occurred on the date stated above, at
4P
m.
Duration IMPORTANT
1941
Due to. arteriosclerosis
1930
Due to.
Chronic Lesbareta
....
19.30
Other conditions.
leb & ceface à cunhal
( Include pregnancy within 3 months of death) que - ho relate to death
Major findings :
Of operations
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to ocoupation of deceased ?. If so, specify
(Signed)
J. Lande gutili
M. D.
....
(Address)
Ten:
Winthrop
(City or Town)
DATE OF BURIAL
19
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE/the burjalcor transit permit was issued : Man. D. Children &
(Signature of Agent of Board of Llerith or other) Health Officer 11/19/41
... {Official Designation) (Date of Issue of Permit) ,
(Registrar)
100m (d)-1-41-4667
4 COLOR OR RACE!
5 SINGLE
(write the word)
18 DATE OF
DEATH
nov.
17
MARRIED
WIDOWED
or DIVORCEDivorced
Female White
Frenee J. Fitzpatrick
HUSBAND of
(Give maiden name of wife in full)
(Ifusband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
AGE
Years.
Months ............
.. Days
If less than 1 day Hours Minutes
Usual
At Home
None
LI Social Security No. NOne
12 BIRTHPLACE (City)
( State or country )
Mass.
13 NAME OF
FATHER
Jeremiah Reardon
14 BIRTHPLACE OF
FATHER (City)
Cannot be learned
(State or country)
15 MAIDEN NAME
OF MOTHER
Ann Carey
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cannot be learned
Mrs. John J. Herbertelation.dhpny 142 Pauline St. , Winthrop
21
Winthrop
Place of Burial, Cremation or Removal.
Nov.
1941
Date. of.
.........
Of, autopsy
skru mile
What test confirmed diagnosis? pensavo
L 2 Date 111-18 19 44
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Boston
Received and filed.
NOV 2 1 1941
19
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) None
St.
(If nonresident, give city or town and State)
75
Immediate cause of death.
Cerebral Hemorrhage
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan 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 atandard 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 aud the date of hia death ... Gen. Laws, Chap. 46, Scc. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by aection forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, aerved 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 snd fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- csn border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a 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 tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforcsaid 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 thercof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained carly enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the connnonwealth cannot be obtained carly 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 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 manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a peraon 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 ahall make examination upon the view of the dead bodiea of only such persons aa 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 disabled by recognized disease unrelated to any form of injury, have died without recent medical sttendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medioal 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 deathis from disease resulting from injury or infection related to ocoupation, 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 cauae 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 Occupation .- l'recise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully cmploved 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
Dr. G. Lynde Gately
M R-301 A
- PLACE OF DEATH
(County) Winthrop
No. 53 (City OF The Thornton SK.
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or Its Agent.
220
Registered No.
{ (If death occurred in a hospital or institution,
give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of ahode)
Length of stay: In hospital or institution
(Before death)
( Specify whether)
years
months days.
In this community
12 Jrs. - mos.
-
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACEI
White
5 SINPLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced HUSBAND of
Give maide name of life in full)
( Husband name in full)
6 Age of husband or wife if alive 44
7 IF STILLBORN, enter that fact here.
8 AGE 43 .Years Months. Days
If less than 1 day
Hours
Minutes
Housework
Own home
11 Social Security No ..
Boston
mass
13 NAME OF
FATHER
Jeremiah Danaly
14 BIRTHPLACE OF
FATHER
((City)
Kerry,
(State or country)
15 MAIDEN NAME
OF MOTHER
Margaret Howard
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Relation if ar
55 the
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Não . Children 2 (Signature of Agent of Board of Health of other) Heath officer 11/18/41
(Official Designation) ( (Date of Issue of Permit)
18 DATE OF
DEATH
(Month)
(Day)
1941 (Year)
19
WHEREBY CERTIFY,
That I attended deceased from
19.
to
19
41
I Just saw him
alive on
www.17, 194, death is said to
have occurred on the date stated above, at
5 A
m.
Duration
years Immediate cause of death.
IMPORTANT
Due to.
metistinis in luogo 1/4 cp
Due to.
17 yrs
Other conditions
(Include pregnancy within 3 months of death)
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