USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 76
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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 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 calis for the observance of the following rules of practice:
(1) Attending physlclans 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 wili certify to such deaths only as those of persons who. though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid 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 clianged on account of the disease causing death, report the usual occupation prior to IlIness. 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-301 A :
(County)
1
Winthrop
(City or Town)
3 SEX
4 COLOR OR RACE
Male
White
7 IF STILLBORN, enter that fact here.
8
82
11
AGE
Years.
Months
10 or Business:
II Social Security No.
N.o.n.e
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Maine
17
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
100m-10-'39. No. 8427-c
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
Mrs. A. B. Bradbury
Relation, if any wie
Informant ... (Address) '16 Lewis Ave., 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. Children (Signature of Agent of Board of Health or other) Health officer (Official Designation) (Date of Issue of Permit) 11/22/4
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Nov .
20
1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
11/17
.....
19.4 ... , to.
11/20
194
I last saw h .. Mag ... alive cn
11/20
19.6. .. , death is said
to have occurred on the date stated above, at. ............ m.
Immediate cause of death ..
maemia
Duration IMPORTANT 3 days
Due to
Due to. Prostitu
Other conditions
(Include pregnancy within 3 months of destin
Major findings : Of operations
PHYSICIAN Underline the cause to which death Date of. should be charged sta- What test confirmed diagnosis ?. tistically.
20 Y'as disease or Injury lu auy way related to occupation of deceased? ..... If so, specify
(Signed).
Haura
. M. D.
(Address) 200 RPe
Date
11/21
19 ....
21 Winthrop Winthrop
Place of Burial, Cremation or Remeval.
DATE OF BURIAL
19
Nov. 20
194fCity or Town)
22 NAME OF
FUNERAL DIRECTORY
Buchauto White
ADDRESS
147 Winthrop St., Winthrop
Received and filed
To be filed for burial permit with Board of Health or its Agent.
228
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR).
(a) Residence. No ....
(Usual place of abode)
Length of stay : In hospital or institution ..
-
-years
- months
7
days.
In this community
yrs. - mos. - days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married. wilgreier Fingersmith
Bic:
HUSBAND of
...
anice (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
70
.Years
Usual
9 Occupation:
Manager
Industry
Forest Supplies
12 BIRTHPLACE (City)
Buckfield
(State or country)
Näinë
13 NAME OF
FATHER
Charles D. Bradbury
15 MAIDEN NAME
OF MOTHER
Malina Chase
PLACE OF DEATH
suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop Comunity Hospital No
St. 3
2 FULL NAME Charles D. Bradbury
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 Lewis Ave., Winthrop
...........
St.
(If nonresident, give city or town and state)
If less than I day
Days
Hours
Minutes
Of autopsy
)
(Registrar)
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 regis- tratlon a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, hls supposed age, the disease of which he died, defined as required by section one, where game 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 tomh 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 aforesaid or from the clerk of the town where the body ls buried. No such permit shall he issued until there shall have been de- livered to such hoard, agent or clerk, as the case may be, a satisfac- tory 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 physiclan, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient. a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death Is caused by vlolence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another wltbln 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 dewiring 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 removal of such body has been sooner obtained hereunder. If the death certificate contalns 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 for- nish 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, Seo. 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 le 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, Soc. 46, G. L., (Tercontenary 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 deaths only as those of persons to whom they have given bedside care during a fast 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 who, though disabled hy recognized dlsease un- related to any form of Injury, have died without recent znedleal attendance or whose physician is absent from home when the certificate of death Is needed.
(3) Medical Examiners wlil investigate and certify to all deaths avypoaubly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septice- mia), and by the actlon 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 occapa- tion, the sudden deaths of porsons 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 deatii. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any Important complication of the principal eause.
Statement of Occupation. . Precise statement of occupation Is very important, ro that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person azed 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 Il!ness. 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, 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
A R-301 A DEC 9 1341
Suffolk
(County)
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.
229
[ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Charles ... H.Paisley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
20 Calhoun Ave.
St.
Everett
(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 50
yrs.
mos.
7
6 hrs.
PERSONAL AND STATISTICAL PARTICULARS
1
Winthrop
(City or Town)
29 Bates Ave
No.
(Usual place of abode)
3 SEX
Male
4 COLOR OR RACE!
White
(or) WIFE of
60
7 IF STILLBORN, enter that fact here.
8
AGE 60
Years
9
Months ..
10 Days
Usual
9 Dccupation :
Salesman
10 or Business :
11 Social Security No.
019-16-3371
12 BIRTHPLACE (City)
St.John.
14 BIRTHPLACE OF
(State or country)
PARENTS
(State or country)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoital to that effeot.
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. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
Industry
Wholesale Liquor
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
Seren Ar
Foster.
(Give maiden name of wife in full)
(Ilusband's name in full)
6 Age of husband or wife if alive years
If less than 1 day
Hours
Minutes
(State or country )
New Brunswick
13 NAME OF
FATHER
John M.Paisley
FATHER (City)
St.John, N.B.
15 MAIDEN NAME
OF MOTHER
Georgiana Trumbull,
16 BIRTHPLACE OF
MDTHER (City)
St .John .N. B.
17 Mrs.Sarah A.Paisley, Relation, if any
Informant.
(Address)
30 Calhoun Ave Everett Wass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : William D. Childress
(Signature of Agent of Board of Health or other)
agent NOV. 23/41
.... (Dfficial (Designation) (Date of Issue of Permit)
18 DATE DF
DEATH
November 20,1941.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
to.
may
1941
nor ro
That I attended deceased from
last saw h Care
.allve on
hor 15
, 1961.
death Is sald to
have occurred on the date stated above, at
7:10 P
m.
Immediate cause of death Pulmonary Hemorrhage.
Due to.
Carcinoma y Luna
Due to.
Dther conditions.
(Include pregnancy within 3 months of death)
Major findings : Of operations.
Date of
What test confirmed diagnosis ?
Duration
IMPORTANT
6 mo
IMPORTANT Physician Underline the cause to which death should be charged sta- Ustically.
20 Was disease of injury in any way related to occupation of deceased ? 20 If so, specify ..
(Sig
ichard. Fr. morris
M. D.
Date: 20-21 1944
21
Glenwood Everett iss.
Place of Burial, Cremation or Removal.
(City or Town)
DATE DF BURIAL ..
November 23, 1941
19
22 NAME DF
FUNERAL DIRECTOR .Henderson Co., W.n, grout
ADDRESS
517 Broadway; Everett, hass.
Received and filed
19
(Registrar)
)
100m (d)-1-41-4667
PLACE OF DEATH
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
MEDICAL CERTIFICATE OF DEATH
wy Nd &
01
Of autopsy
4 Play
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan or registered hospital medloal officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and helief the name of the deceased. his supposed age, the disease of which he died, defined aa re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive hy the physiciau or officer and the date of hia death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa required hy the preceding section or hy section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the hest of his knowledge and helief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, 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. 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 hody which has not been buried, until he has received a permit from the hoard of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or 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 aforesaid or from the clerk of the town where the hody is buried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human hody. not previously interred, from one town to another within the commonwealth cannot be obtained carly enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody 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 removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
hy aection ten of chapter forty-six, that the deceased acrved in the army, navy or marine corps of the United States in any war in which it haa been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement aud 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 he 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 hury a human hody or the ashes thereof which have been brought into the commonwealth until he haa re- ceived a permit so to do froin 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 hody is to be huried 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 hodies of only such persons as are supposed to have died by violence. If a medical examiner lias 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 ohservance of the following rules of practice : :
(1) Attending physicians will certify to such deatha only as those of persona 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 discase unrelated to any form of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly hy traumatism (including resulting aepticemia), 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 hy 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., licart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name carlier utorbid conditions, if any, related to the principal cause and any important complication of the principal causc.
Statement of Occupation .- I'melse aldiement of occupation ia very im- portant, so that the relative healthfulness of varions pursuits can he 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 hy the appropriate terms, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
....... .............................................................
1
M R.303A
Sellick (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
230
§ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
210
(If deceased is a married, widowed or divorced woman, give also maiden name.) 35 Willow are Aethiop
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Single
5a If married, widowed, or divorced HUSBAND of ...
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
8 66 Years ...... Months ......... .. Days
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