USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 80
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is very important. See instructions and extracts from the laws on back of certificate.
followmo partial
Date of 11/12/41
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, after the death of a person whom lie 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 tbe name of the deceased. his supposed age, the disease of which he died, defined as required by section one, wbere same was contracted, the duration of his last illness, when last seen alive by tbe physician or officer and the date of bis 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 which has not been buried, until be has received a permit froin the board of bealtb, or its agent appointed to issue such permits, or if there Is no such board, from tbe clerk of the town wbere the person died; and no undertaker or otber person shall exhume a human 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 bealth or its agent aforesaid or from the clerk of tbe town wbere tbe body is buried. No such permit shall be Issued until t bere shall have been delivered to sucb 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 tbereof a certificate as herelnafter provided. If there is no attending pbysiclan, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is In- sufficient, a physiclan 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, tbe medical examiner sball make such certificate. If such a permit for the removal of a buman body, not previously Interred, from one town to anotber within 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 within thirty-six hours after such removal, unless a permit In the usual form for tbe re- moval of such body has been sooner obtained bereunder. If the death certificate contains a recital, às required by section ten of chapter forty- six, that the deceased served In the army, navy or marine corps of tbe United States In any war In which It has been engaged, such recital shall appear upon tbe permit. The board of bealth, 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 tbe cause of deatb sball tbereafter furnisb for registration any otber necessary information which can be obtained as to the deceased, or as to tbe manner or cause of the death, wblch 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 bealth or its agent appointed to issue such permits, or If there is no such board. from the clerk of the town where the body le to be buried or the funeral is to be held, or from a person appointed to have tbe care of the cemetery or burlal ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition) .
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as tbose 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 deatbs 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 deatb 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 deatbs following abortion, but also deaths from disease resulting from injury or Infection related to occupation, tbe 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 the mode of dying, e. g., beart failure, aspbyxia, astbenia, 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 la very important, so that the relative healthfulness of various pursuits can be known. Make some entry In this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing deatb, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home bousework, 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
RM R-301
Suffolk
(County)
1
Winthrop
(City or Town)
PLACE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
Foma lo
or DIVORCED
White
5a If married, widowed, or divorced
(or) WIFE of
George Mcleod
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
AGE
78
Years
-
Months.
.......... Days
Usual
Housewife
9 Occupation:
11 Social Security No ..
None
12 BIRTHPLACE (City)
(State or country)
Ireland
14 BIRTHPLACE OF
FATHER (City)
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Treland
17
Informant.
Charlotte ML od
(Address)
4 Pleasant St
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
is very important. See instructions and extracts from the laws on back of certificate.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
(State or country)
Ireland
200m-10-'39. No. 8427-d
(write the word)
18 DATE OF
DEATH
november 27
(Month)
(Day)
1941 (Year)
19 | HEREBY CERTIFY. That I attended deceased from
November 10
1941, to Noventa 27, 194
I last saw h ........ alive on ... Novely 27, 1951, death is said Duration to have occurred on the date stated above, at 100 Immediate cause of death ... Cerebral Htemontage ..... ............
24/0
....
3 days -
Due to
arteriosclerosis
........
...
......
Other conditions none (Include pregnancy within 3 months of death)
Major findings :
Of operations
none
Date of
Of autopsy none
What test confirmed diagnosis ?
2.0 Was disease or Injury In any way related to occopation of deceased ? 200
If so, specify)
Chamos
M. D.
(Signed).
Jacob
(Address) 562 Hlinky Date
5 Kr 2341
21 Winthrop Place of Burial, Cremation or Removal Ticity of Town) DATE OF BURIAL VecIL oh FO male. 19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Winthroo
Received and filed
19
(Official Designation) (Date of Issue of Permit)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
23
Card2.
(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME Mary A. McArthur Mcleod
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(U U. S. 3War Veteran. specity WAR)
(a) Residence. No.
(Usual place of abode)
ength of stay: In hospital or institution
(Specify whether)
4 Pleasant &t
St.
(If nonresident, give city or town and state)
~ years
- months
I days.
In this community 32
yrs. - mos. - days.
PERSONAL AND STATISTICAL PARTICULARS
Widowed
HUSBAND of
(Give maiden name of wife in full)
6 Age of husband or wife if alive. .Years
If less than 1 day
.Hours ...
Minutos
Industry 10 or Business: Own Home
13 NAME OF
FATHER
John McArthur
15 MAIDEN NAME
OF MOTHER
Cannot be learned
Relation, if anyt CR
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)
11/28/41
A TRUE COPY ATTEST:
(Registrar)
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
.......
Due to
Hypostatic Premunia
MEDICAL CERTIFICATE OF DEATH
Hospital
No Vinthron Community
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- tration 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, 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 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 is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may bc, 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 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 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 violcnee, 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 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 a 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 obtaincd hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the ariny, 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 fur- 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, 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 common wealth 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 mar ... Chap. 114, Sec. 46, G. L., (Tercentenary Edition.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical 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 mcans 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 oceupation 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, 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
RM R-301 ||
1 No. PLACE OF DEATH 2 F 14H-1939-3 ( 2-388 ength 2 3 SEX BORO RESIO. 8 5g If HUSBA ARKA-OIST. (or) V. 6 Age OCCUPATION 9+54 7 IF ST 8 AGE NATIV. DEC. 01 Usu 9 Occ Indu 10 or 2 Il Soc CAUSE 1 057 12 BIRT (Sta CAUSE 2 13 14 X OPERATION (S - TYPE ACCID. PARENTS 16 FO. T. ACCID. 17 ATT .- AUTOP. Infora (Addre I HER CEM. filed v information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state € 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
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
239
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
BUREAU OF RECORDS DEPARTMENT OF HEALTH BOROUGH OF BRONX
Certificate of Death
Certificate No. 8339
1941 SEP 9 PM 12 04
·
Daniel
B.
SANBORN
Unknown, if any
1. NAME OF DECEASED (Print)
First Name
Middle Name
Last Name Social Security No.
PERSONAL PARTICULARS (May be filled in by Funeral Director)
MEDICAL CERTIFICATE OF DEATH (To be filled in by the Physician)
16. PLACE OF DEATH:
Massachusetts
2 USUAL RESIDENCE: (a) State ..
(c) Towa or City.
Winthrop
(b) Com
19
19 death is said
.. m.
Duration
17 DATE AND HOUR OF
(Month)
(Dey) (Year) | (Hour) }
3 SINGLE, MARRIED. WIDOWED, OR DIVORCED (write the word)
Married
4 YOUEX HUSBAND } of Ruth Alma Sanborn
& DATE OF BIRTH OF DECEDENT
(Month)
(Day)
October 21 . 898
6 AGE
If LESS than 1 day,
A2 YTI. mos.
days
hrs. or
mint
that I last saw h.im alive on ...... September 8 . 1941 .
and that the facts stated in items 16-20 are correct. Statement of cause of death is based on (amopry) (operation) (laboratory test) (clinical findings ) (Cross out terms that do not opply.)
DATE OF ONSET
8 BIRTHPLACE OF DECEDENT (State or country)
9 How long in U. S. (if of foreign birth)Life
10 IF DECEASED WAS VETERAN, NAME WAR
World War
11 NAME OF FATHER OF DECEDENT
Daniel B. Sanborn
Contributory causes and other conditions.
12 BIRTHPLACE OF FATHER
(State or country)
13 MAIDEN NAME
OF MOTHER OF DECEDENT
(maiden name_unknown)
Autopsy :
Operation : January .
Date of .... None
Date ofJanuary
(If none, so state)
(If none, so state)
Condition for Ventriculogram
which performed Left osteoplastic craniotomy.
15 SIGNATURE OF INFORMANT Information obtained from RELATIONSHIP records of deceased. TO DECEASED
CARLETON BALTS M.D. C & Medical Officer Address 130 W. Kingsbridge PåDate September 9,1941
M. D.
ate
19
ADDRESS
2 PLACE OF BURIAL Manchester, 4, 74. OR CREMATION
DATE OF BURIAL OR CREMATION SURE 9,1941 Suppe
Town)
19
DIRECTOR
ADDRESS
PERMIT NUMBER 1040
BUREAU OF RECORDS DEPARTMENT OF HEALTH
CITY OF NEW YORK
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
(Registrar)
1. 1)
or town and state) yrs. mos. days.
I
( Year)
ended deceased from
(a) NEW YORK CITY: (b) Borough. Bronx, New York
(c) Name of Hospital Veterane Administration or Institution. (If not in hospital or institution, give street ond number.)
(d) No. 364 Winthrop Street (If in rural area, give location) (e) Length of residence or stay in City
of New York immediately prior to death
non-resident
(d) Length of stay at place of death immediately prior to death 12/28/40 to 9/8/41
DEATH September 8 , 1941 7:304
19 Color or Race
20 Approximate Age
18 SEX Male White
42 years
(Year) 21. I HEREBY CERTIFY that I attended the deceased from December 28 1940 to September 8 1941;
NATIV. MOTMEN 01
A Trade, profession, or particular kind of work, as opinner, Teacher
sawyer, bookkeeper, etc.
B Industry or business in which
work was done, as allk mill, sawmill, bank, etc.
Grammar School
Principal cause of death Left frontal Neoplasm.
Unknown
PHYSICIAN
Underline the cause to which death
United States (Stata unknown)
Caroline Jane
14 BIRTHPLACE
OF MOTHER
New Hampshire
(Stale or country)
PARENTSOF DECEASED
should be charged sta- tistically.
Received and filed.
19
1042
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 15 200m-10-'39. No. 8427-d
.................
BORO-DEATH
INSTITUTION 440
00 7 OCCUPATION
Maseachisette
23 FUNERAL E. Devlin live.
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- tration 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, 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 thercfrom 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 elerk of the town where the person dicd ; 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 aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, 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 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 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 violence, 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 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 a 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 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 eountersign it and transmit it to the clerk of the town for registration. The person to whom the permit is zo given and the physician certifying the cause of death shall thereafter fur- 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, 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 permity, 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 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 last ill- ness froin disease unrelated to any form of injury.
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