USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 20
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(3) Medical Examiners will investigate and certify to all deatha sup- posably due to injury. These include not nnly 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 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. Aa 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 .- l'recise statement of occupation is very im- portant, so that the relative healthifulness 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 illuesa, 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 bousekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FIRM R-301 A
1
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 7 musstle a. e
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death )
(Specify whether)
years
months days.
In this community
3 yrs. - mos. ~ days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE!
Female Colored
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Se'[Give maiden name of wife in full)
duma
(Minshand's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN. enter that fact here.
8 66 Years - Months AGE Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
10 or Business :
Industry
at Home
11 Social Security No.
martinaw
12 BIRTHPLACE (City)
( State or country)
n. C.
13 NAME OF
FATHER
Charles Vaughn
14 BIRTHPLACE OF
FATHER (City)
(State or country)
n.C
15 MAIDEN NAME
OF MOTHER
Mildred Lewellyn
16 BIRTHPLACE OF
MOTHER (City)
madison
(State or country)
3.C.
17 nuo nannie Wartung Relation, if any (Address) 7 minsth ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlat of transit permit was Issued : V. D. Childrens
(Signature of Agent of Board of Health or other) Healthe officer 3/13/42
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
March
12,
1442
( Month)
( Day)
( Year)
19 -
HEREBY CERTIFY,
That I attended deceased from
Dec 15.
1991.
to
Mar 12
1942
I last saw her
alive on.
Mar 12,, 19 42 death Is said to
nave occurred on the date stated above, at.
m.
Immediate cause of death Cardias Decompensation
artesin claire lus
Due to Curtaos eleroleilfaut Wirenel
Due to.
Other conditions
Cerebral aboplazas
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?
-
Duration IMPORTANT Nor 124
?
.
man 2 12 IMPORTANT
Physician
l'uderline The cause to ahich death should be charged sta. Istically.
20 Was disease or injury in any way related to oocupation of deceased ?. If so, specify ......................
(Signed)
(Address) 19 menarlane
M. D.
Date /201/2 1942
21 eur trian / farmorla
Place of Burial, Cremation or Removal.
Washing 10
(City or Town)
DATE OF BURIAL.
march 15
19542
22 NAME OF
FUNERAL DIRECTOR ...
: B. Johnson
ADDRESS
608
Received and filed MAR 1 8 1922
.19
(Registrar)
100m (d)-1-41-4667
Suffolk (County) Hinthat (City or Town)
PLACE OF DEATH No. 7 myrtle are mattie b. Jumby
The Commonforalth ot 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.
53
Registered No.
(( If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so, specify WAR)
St.
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effeot. should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state 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. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information PARENTS
ears
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 atteraled during his last illness. at the request of an wialertaker or other authorized per-on or of any member of the family of the decrased, furnish for registration a starulard certificate of ilrath, stating to the best of his knowledge atul belief the name of the drceased. his supposed age, the discase of which he ched, defined as re- quired 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.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall. if the deceased, to the best of his knowledge and belief, 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 aal the secondary or immediate cause of death as nearly as he cau 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 all the Philippine msurrection, which shall, for said purposes. he deemed to have taken place between February fourtecuth, eighteen hurulred and ninety-eight aud luly 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 hunan body in a town, or remove therefrom a human body which has not been buried, until he has received a permit froin the board of health, or its agent appointed to issue such perinits, or if there is no such board, froin the clerk of the town where the person died; and no undertaker or otlier 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 huried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall be accompanied. in case of an original intermeut, by a satisfactory certificate of the attending physician, if any, as required by law. of in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate caunot he obtained early euouglt for the purpose, or is insufficient, a physi- cian who is a member of the hoard of health, or employed by it or hy the selecttien 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 auch certificate. If such a permit for the removal of a linman body, not previously interred, frota one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual forin 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 hren engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall forthwith counter-ign it and transmit it to the clerk of the town fur registration. The person to whom the permit is so given aml 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 malmier or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition ).
No unalertaker or other person shall bury a Innan hody 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 heldl. or from a persou appointed to have the care of the cemetery or burial ground in which the iuterment is made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only snch persons as are supposed to have died by violence. If a inclical examiner has notice that there is within his couldy 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 obaervance 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 physi- ciau 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 of 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 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 .- Canse 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 discase causing death. As related causes, naine 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 im- portant, so that the relative healthifulness 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 discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had uo occupatiou whatever write lione.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A |
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 100m-2-'40-D-729-a
PLACE OF DEATH
Suffolk
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.
51
S (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME.
Benjamin D Robinson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
56 Park Ave
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
-
(Specify whether)
years
months days.
In this community
1 8yrs. ~ mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
Robinson
(Give maiden name of wife in full)
(or) WIFE of .. (Husband's name in full)
.. years
If less than 1 day Hours Minutes
11 Social Security No.
382 -09-3902
Ireland
13 NAME OF
FATHER
Joseph Robinson
14 BIRTHPLACE OF FATHER (City) .... (State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Martha McGill
16 BIRTHPLACE OF MOTHER (City) (State or country) rreland
17 Relation, if any
Mrs. Amelia Robinson( Wife
Informant (Address) 6 Park Ivo., Winthrop,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Childrena
(Signature of Agent of Board of (Health or other)
Health oficer 3/16/42
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
March
13
1942
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
That I attended deceased from March 10, 1942, to.
I last saw h IM alive on.
.......... , 19 ...... , death is said to
have occurred on the date stated above, at.
Immediate cause of death
Duration IMPORTANT
Due to. 1
Due to.
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations
.Date of
Of autopsy ..
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?. A
If so, specify.
1
M. D.
(Signed)
(Address) ..
.Date ........................ 19.
21 winthrop
Winthrop
Place of Burial, Cremation or Removal. March
(City or Town)
DATE OF BURIAL.
16
19 82
22 NAME OF
FUNERAL DIRECTOR
147
Winthrop St. Winthrop
Richard He White
ADDRESS
Received and filed
.............. 19
(Registrar)
(County) 1 Winthrop (City or Town) 56 park Ave No. (Usual place of abode) 3 SEX Male 4 COLOR OR RACE White Sa If married, widowed. or digorsedr HUSBAND of 6 Age of husband or wife if alive 19 7 IF STILLBORN. enter that fact here. 8 5 7 1 12, Usual 9 Occupation :.... Carpenter .. ...... Industry Job 10 or Business : 12 BIRTHPLACE (City) (State or country) information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state AGE Years Months Days 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
Registered No.
(If U. S. War Veteran,
Thronosdo
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 attendcd during his last iliness. 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 belicf the name of the deccased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted. the duration of hislastillness, when iast scen alive by the physician or officer and the datc of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shali hury or otherwise dispose of a human body in a town, or remove therefrom a human body 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 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 receiv- ing tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the 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, hy a satisfactory certificate of the attending physician, if any, as required hy iaw. or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is in- sufficient, a physician who Is a member of the board of health, or em- ploycd hy It or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human 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 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, 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 rectal shall appear upon the permit. The hoard of health, or its agent, upon receipt of such statement and certificate, shali forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L .. (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashcs thereof which have been hrought 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 cierk of the town where the body is to he huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial 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 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 indirectiy 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, asthenla, etc. As principal cause name the disease causing death. As related causes, name earlier morbld conditions, if any, related to the principal cause and any Important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation Is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry In this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to Illness. If the deceased had retired from husiness, report the usual occupation prior to retirement. Children not galnfully 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
FRM R-301 A
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 100m-2-'40-D-729-a
PLACE OF DEATH
Suffolk (County ) Unichrap (City or Town) 99 Winthrop, St No .....
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.
55
2 FULL NAME
Martha (JANE(PORTER) MOORE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
99 Eliniprix
St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community 23
yrs.
-
mos. -
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Windows
18 DATE OF
DEATH
March
14
1942
(Month)
(Day)
(Year)
That I attended deceased from
19/ 1 HEREBY CERTIFYHace 1.4 .1942
15
19 45 to.
I last saw her alive
("/Har
13, 1942, death is said to
have occurred on the date stated above, at.
3. P. m.m.
Immediate cause of death
Cerebral / demoranghe
Due to.
Due to.
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 ?. 220
If so. specify
(Signed)
Whoop man Date Mar 14, 1942
(Address)
21.
leekser
Bridgeport Ohio
Place of Burial. Cremation or Removal.
(City or Town)
1942
DATE OF BURIAL.
March
17
22 NAME OF
FUNERAL DIRECTOR.
Howard S. Reynolds
ADDRESS.
180 Winthrop St. Winthrop
Received and filed MAR 1 8 1942
.19
agent
man./14/42
(Offirta) Designation)
(Date of Issue of Permit)
(Registrar)
Duration IMPORTANT
6 Age of husband or wife if alive. years
.. Years.
Montha.
18
.. Days
If less than 1 day
.Hours
Minutes
Usual
9 Occupation :.
Housewife
12 BIRTHPLACE (City) GRidge PORT (State or country)
Ohio
13 NAME OF
FATHER
William PORTER
14 BIRTHPLACE OF FATHER (City) ..... (State or country) Penn-
15 MAIDEN NAME
OF MOTHER
KATHERINE.
(State or country) England
17 MaudE P. MOORE (daughter)
Relation, if any
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)
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