USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 88
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IMPORTANT
PHYSICIAN
Major findings:
Of operations.
Of autopsy.
What test confirmed diagnosis ?.
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 ....
Eduardo J. Franiger
(Signed)
(Address).
200 Wonlenentm/tv2 Date Jan. 1 1942
21 ....
Woodlawn
Evere.t.t.
Place of Burial, Cremation or Removal.
Jan.
2
(City or Town)
41
DATE OF BURIAL
.19
22 NAME OF
Howard Sahunolds
FUNERAL DIRECTOR ...
ADDRESS
mens.
Received and filed
JAN 3 1942
.. 19 .. ....
(Registrar)
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
1
100m-2-'40-D-729-a
M. D
.Date of
Duration
IMPORTANT
1941
20
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiclan or registered hospital medical officer shall forthwith, after the death of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized person or of any meinber 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 hury or otherwise dispose of a human hody in a town, or remove therefrom a huinan hody which has not been huried, 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 hoard, 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 anotlier, 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 hoard of health or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall he issued until there shall have heen delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall he accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required hy 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 by the selectinen 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 hody, 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 hody shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usuai form for the re- moval of such hody has been sooner ohtained 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 heen engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, sliall 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 he ohtained 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 tbereof which bave heen brought into the commonwealth until he has received a permit so to do from the hoard 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 buried or the funeral is to he 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 hedside 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 hy 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 supposahly 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 deatlıs from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahied 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., 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 cbanged on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husiness, 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-302
Essex
The Commontocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
262
(If death occurred in a hospital or institution,
St.
give its NAME instead of etreet and number)
Calvin White
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
speolfy WAR)
(a) Residenoe. No.
104 Highland
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
years
months
2
daye.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
5a If married, widowed, or divorced
HUSBAND of
Cannot ..... be .... learned
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
74
AGE
Years.
Months.
Days
If less than 1 day
Hours ....
Minutes
Usual
9 Occupation :
Ret. travelling salesman
Industry 10 or Business :
Il Social Security Ncannot ..... be ..... learned
12 BIRTHPLACE (City)
(State or country)
Kansas
13 NAME OF
FATHER
Cannot be learned
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Cannotbe learned
(State or country)
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City) Cannot be learned
(State or country)
17 M.K.McPhillips
Relation, if any
Informant.
(Address)
DSH
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
1/12/42
19
18 DATE OF
DEATH
Dec. 10, 1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
D.e.c ...
.8,, 19 ... 41,
to.
Dec.
10,
...
19 ... 41.
Į last saw h ..
im
alive on.
Bec. 10.19
death Is sald to
have occurred on the date stated above, at 9 P. .m.
Duration
years| Immediate cause of death.
Generalized arteriosclerosis 10yrs Arteriosclerotic heart dis royrs Congestive heart failure. Due to Terminal Bronchopneumonia
.... days
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings:
Of operations
Date of.
should be
charged sta-
tietically.
Of autopsy
clinical
What test confirmed dlagnosis?
20 Was disease or injury in any way related to oooupation of deceased ?.
(Signed)
(Address)
DSH
Date.
1/9/12
M. D.
winthrop
19
CREMATION OR REMOVAL
12/13/41
(City or Town)
DATE OF BURIAL
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
winthrop
ADDRESS
Reoelved and filed JAN 1 3 1942 19
(Registrar of City or Town where deceased reeided)
50m (e)-1-41-4667
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY WITH-LINE
PLACE OF DEATH
(County)
Danvers
1
(City or Town)
No.
Danvers State Hospital
5
(If U. S.
(Usual place of abode)
(Specify whether)
Registered No.
Underline the cause to which death
If so, specify.
Abrahan Gardner
21 PLACE OF BURIAL,
Winthrop
M R-302
1
PLACE OF DEATH
"i (County) BOSKINS
(City or Town)
No. 78 Glendale
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
263
(City or town making return)
Registered No.
10.620
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Agnes
Pedersen
(If deceased is a married. widowed or divorced woman, give also maiden name.)
53 Lewis Ave
St.
Winthrop Mass
(If nonresident, give city or town and state)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
De.c .... 21 .... 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
v.i.e.wed ........ body., 19.
to 12/21/41
19
I last saw h ............ alive on
19 ........ , death is said
to have occurred on the date stated above, at.
7/30Pm.
6 Age of husband or wife if alive. Years
7 IF STILLBORN, enter that fact here.
8 ÅGE. 63 Years 4 Months 16 Days
If less than 1 day Hours. Minutes
Usual 9 Occupation:
Industry
10 or Business:
at home
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Norway.
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis?
20 Was disease or Injury In any way related to occupation of deceased ? If so, specify.
(Signed)
P
E ASheridan
Boston
M. D.
(Address)
Woodlawn Everett
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
H E Reynolds
ADDRESS.
Winthrop
Received and filed JAN 1 5 1942
19
(Registrar of City or Town where deceased resided)
+
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
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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50m-10-'39. No. 8427-f
17
Informant.
Ralph .... Pedersen
(
Relation, if any son .......
(Address)
A TRUE COPY .-
ATTEST:
(Registrar of city or town where death.occurred)
DATE FILED
12 26/41 -
0- 19
(write the word)
widowed
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Gustay ... P .... Pedersen
(Husband's name in
Immediate cause of death.
chronic myocarditis
2 yrs
Due to
arteriosclerosis
Due to
13 NAME OF
FATHER
Hoseas Kristiansen
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Norway
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country) Norway
Date.
12/21% 41
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
(Ce
Dec 24 1941
19
(City or Town)
Date of
Underline the cause to which death should be charged sta- tistically.
PARENTS
3 SEX
female
4 COLOR OR RACE| 5 SINGLE
white
MARRIED
WIDOWED
cr DIVORCED
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
Duration
M R-305
Suffolk
PLACE OF DEATH
(County) Roston
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Boston
(City or town making returer
Registered No.
107.99
1 (If death occurred in a hospital or institution, en route to E B Relief Sta St. ( give its NAME instead of street and number)
2 FULL NAME
William
Stone
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
29 ..... Crystal .... Cove ... A.v ....... St.
Winthrop
(If nonresident, give city or town and state)
months
days.
In this community
yrs.
mos.
days.
PERSONAL, AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
OF 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
8 64 YOGrs 4 Months. 3 Days
If less than 1 day
Hours.
Minutes
Usual 9 Occupation:
stat fireman
Industry
10 or Business:
Comm.Mass M. D C
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Boston Mass
13 NAME OF
FATHER
Charles O Stone
14 BIRTHPLACE OF
FATHER (City)
Sweden
(State or country)
15 MAIDEN NAME
OF MOTHER
Mathilda Ehrenholm
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
17 Mrs Mary MacKay
Relation, if any
Informant
(Address)
1
sister .... )
A TRUE COPY.
ATTEST:
DATE FILED
12/31/41
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec 24 1941
(Month)
(Day) (Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) crush .... of chest; compound .... fractures of both legs and right arm
20 Accident, suicide, or homicide (spekjesumably
Date of occurrence ..
Dec 24 19accidental
Where did
Injury occur?
?Boston
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in
public place?
street
Manner of
said to have Beenlacon jured by
Injury
Nature of
n auto at E Boston Dec 24/41
Injury
While at work ?.
no
Was there an autopsy ?.
no
21 Was disease or Injury In any way related to occupation of deceased ? no
If so, specify
(Signed)
W J Brickley
(Address)
Boston
Date
12/27/41
22.
Winthrop
Winthrop Mass
Place of Burial, Cremat on or Removal.
Dec 29 f941
wn)
DATE OF BURIAL
19
23 NAME OF
FUNERAL DIRECTOR
R W White
ADDRESS
Winthrop
Received and tilod. 13
JAN 1.5 1942
(Registrar of City or Town where deceased resided)
25m-10-'39. No. 8427-g
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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
(City or Town)
No.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Specify whether)
years
7 IF STILLBORN, enter that fact here.
AGE
PARENTS
. M. D.
1
M R-305
PLACE OF DEATH
Essex (County)
1
Dan vers
(City or Town) Danvers State Hospital
The Commonfuealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers (City or town making return)
Registered No.
255
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Fred D. Hayward
(Ii deceased is a married, widowed or divorced woman, give also maiden name.)
125 Cliff Ave.
St.
Winthrop
(If nonresident, give city or town and state)
months
1 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
WIDOWED
or DIVORCEDVidowed
widowed, or diverssances Haigh
(Give maiden name of wife in full)
(Husband's name in full)
Years
If less than I day
Hours
Minutes
Usual
Retired hotel manager
13 NAME OF
FATHER
George N. Hayward
.N.H .....
Viana Barrett
.H.
Relation, if any
(Address)
JOSH
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
1/16/42
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec. 27, 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows : (If an injury was involved, state ful Cancer of prostate" and" chronic myocarditis and chronic adherent pericarditis
20 Accident, suicide, or homicide (specify)
Date of occurrence. 19
Whero did Injury occur?
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place?
(Specify type of place)
Manner of Injury
Nature of Injury
While at work ?
Was there an autopsy ?
yes
21 Was disease or injury in any way related to occupation of deceased ? If so, specify.
(Signed)
J. W. P. Murphy
M. D.
(Address)
Peabody
Date
12/27 41
22 .. Winthrop Winthrop.
Place of Burial, Cremation or Removal.
DATE OF BURIAL
12/29/41
19
(City or Town)
23 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop
Racoived and filed 19
F.E.B. 7
1942
(Registrar of City or Town where deceased resided)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
........
years
SE 3
No.
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
male
white
Sa If married,
HUSBAND of
(or) WIFE of.
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
76
AGE
Years
Months.
Days
9 Occupation:
Industry
10 or Business:
12 BIRTHPLACE (City)
Gilson,
14 BIRTHPLACE OF
Gilson,
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
IS BIRTHPLACE OF
Gilson,
PARENTS
MOTHER (City)
(State or country)
17
of death should be transmitted on Forin R-305 to the clerk of the city or town in which the deceased resided as soon as possible
25m-10-'39. No. 8427-g
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
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
(State or country)
IT.H.
II Social Security No.
Cannot be learned
Informant.
Mary .... , McPhillips
M R-302
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
266
(City or town making return)
Registered No
1091-3-
(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
304 Shirley
.......................
St.
Winthrop
(If nonresident, give city or town and state)
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Dec 31 1941
(Month)
(Day)
(Year) patient
19 | HEREBY CERTIFY.
12/10/41
to.
19.
12/31/41
19
I last saw h ...
.. alive
19.
death is said
to have occurred on the date stated above, at.
21/418
Duration
Immediate cause of death ..
cerebral ... hemorrhage
wks
Due to
broncho pneumonia
...
dys
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?
20 Was disease or Injury in any way related to occupation of deceased ?
If so, specify
M W O'Connell
(Signed)
(Address)
B.os.t.on
Date
1/1 19 42
.
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Pride of Jacob W Rox
(Cemetery)
(City or Town)
DATE OF BURIAL
Jan 1 1942
19
22 NAME OF
FUNERAL DIRECTOR
H .... Levine
ADDRESS
Brookline
Received and filed. JAN 1 5 1942
19
(Registrar of City or Town where deceased resided)
2 FULL NAME
Sarah
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution
3 SEX
4 COLOR OR RACE| 5 SINGLE
female
white
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE
54 Years
Months.
Days
Usual
9 Occupation:
Industry
10 or Business:
II Social Security No ...
12 BIRTHPLACE (City)
Russia
(State or country)
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
PARENTS
(State or country)
Informant.
(Address)
50m-10-'39. No. 8427-f
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
after the close of the month in which the death occurred. (See Chap. 46, Scc. 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
(State or country)
Russia
(Give maiden name of wife in full)
(or) WIFE of
Israel ..... Sternberg
(Husband's name in full)
years
52
If less than 1 day Hours. .Minutes
at home
13 NAME OF
FATHER
Joseph Levey
Rose Leah -
Russia
17 Abraham Levey Relation, if any
.. ( .... bro
A TRUE COPY.
ATTEST:
(Registrar of city, or town where death occurred)
DATE FILED
1/3/42
19
1
-
No. Boston ... City ..... Hospital
Levey
(If U. S.
War Veteran,
specify WAR)
.... years
(write the word)
divorced
That I, attended deceased from
Due lo
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
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