USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 21
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St.
Registered No.
[ (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S.
War Veteran.
1
(a) Residence. No .....
(Usual place of abode)
3 SEX
Female
4 COLOR OR RACE
White
Ba If married, widowed, or divorced
HUSBAND of.
(or) WIFE of.
7 IF STILLBORN. enter that fact here.
8
84
.
Industry
11 Social Security No.
16 BIRTHPLACE OF
MOTHER (City).
WALES
Informant.
(Address)
99 winthropSt.
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
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
10 or Business :.
In Home
(Give maiden name of wife in full)
WARREN MOORE
(Husband's name in full)
MEDICAL CERTIFICATE OF DEATH
IMPORTANT
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
M. D.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shali 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 belief the name of the deceased, his supposed age, the disease of which he died, defined as required hy 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 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 recelv- Ing tomh to another in the same cemetery, until be has received a permit from the board of bealth or its agent aforesaid or from the clerk of the town where the body is buried. No such permlt shall be Issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, In case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as herelnafter provided. If there is no attending physician, or if, for sufficlent reasons, hls certificate cannot be obtained early enough for the purpose, or ls In- sufficient, a physician who is a member of the board of health, or em- ployed hy It or by the selectmen for the purpose, shall upon application make the certificate required of tbe 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 body, not previously interred, from one town to another within the commonwealth cannot be ohtalned 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, tbat 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 re- moval of such body has been sooner obtained hereunder. If the deatb 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 countersign It and transmit it to the clerk of the town for registration. The person to whom the permit is so given and tbe 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 deatb, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or otber 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 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 deaths only as tbose of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortlon, 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 dylng, 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 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 deatb, report the usual occupation prior to Illness. If the deceased had retired from business, 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FIRM R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physiolans to Insert a recital to that effect. extracts from the laws on back of certificate.
PLACE OF DEATH
/(County)
1
...
(City or Town) 15 Sueño Are
The Commontoralth 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.
56
§ ( If death occurred In a hospital or Institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
St.
(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
yrs.
mos. -
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
Firmadel Mente
5 SINGLE
( write the word)
MARRIED
WIDOWED
18 DATE OF
DEATH
March
15
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, That I attended deceased from
1939,
to.
March 15
1942
I last saw h ...?...... alive on
much Is, 19 42 death Is said to
have occurred on the date stated above, at.
1:45
P
.m.
6 Age of husband or wife If alive
years
Immediate cause of death
senifity
Duration IMPORTANT
7 IF STILLBORN, enter that fact here.
8 96 Years 4 Months. - .Days
If less than 1 day Hours ...... Minutes
Usual
at Home
9 Occupation :
Industry 10 or Business :
11 Social Security No.
Или В миланков
13 NAME OF
FATHER
chun Klen den mg
14 BIRTHPLACE OF
FATHER (City) (
(State or country)
Scotland (
PARENTS
15 MAIDEN NAME
OF MOTHER
Jeannette Scott
20 Was disease or injury in any way related to occupation of deceased ? WWW.
If so, specify ...
('Signed)
Hobroentill
M. D.
(Address) Jaume
Cambridge Cornici Place of Burial, Cremation or Removal
DATE OF BURIAL March 18
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Signature of Agent of Board & Health or other)
Heater Office 3/16/42
Received and filed : 1 8 1942
19
(Official Designation) (Date of Issue of Permit)
(Registrer) X
100m (d)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : Nu. D- Childrenx
Relation, if any
17 Informant. (Address) 1222/ Crescent St.
Cascada
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Douglas.
Glendening
Physician
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- tistically.
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
1942
5a If married, widowed, or divoroed
HUSBAND of
all Give maiden name of wife in full)
(or) WIFE of
restiden fame ?
(Ilusband's name in full)
AGE
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item or information
No.
G Bailey
(Was deceased a U. S. War Veteran, if so specify WAR)
(Usual place of abode)
Registered No.
MuchoDate 3-16 1942 Cambridge (City or Towny
12 BIRTHPLACE (City)
(State or country)
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 registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, bis supposed age, the disease of which he died. defined as re- quired by section one, where same was contracted. the duration of his last illness, when last seen alive by the physician or officer and the date of bis death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceiling 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, aerved in the army, navy or marine corps of the I'nited 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 canse 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 inchide 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 aud two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or ita 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 delivered to such board, agent or clerk, as the case may be, & 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 he obtained early enough for the purpose, or is insufficient, a physi- cian who is a meniber of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the 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, unlesa 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-aix, 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, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death. which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the 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 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).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his conuty the body of such a jerson, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persons to whom they have given bedside care during a last illneas from disease unrelated to any form of injury.
(2) Board of Health physiclans will certify to such deaths only aa those of persons who, though disahled by recognized disease 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 by traumatism (including reauiting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causea 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 im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou 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 terina. aa housekeeper-privato family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
CIM R-301 A
BOSTON NOTIFIED
Suffolk (County).
Winthrop, Mass. (City or Town) Station Hospital, Fort Banks, Mass. No.
" ( If death occurred in a hospital or Institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Baby Boy (Unnamed) STOUT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
-
682 Massachusetts Ave.
. St.
B.o.s.t.on ...... Mas.s.
(Usual place of abode)
(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
-
yrs.
-
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(ITusband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
Stillborn
8 AGE Years - Months - Days
If less than 1 day Hours Minutes
Usual 9 Occupation :
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City) .Winthrop. ... Massachusetts. ( State or country )
13 NAME OF
FATHER
Stewart G. Stout
14 BIRTHPLACE OF
FATHER (City)
Louisville, Kentucky
(State or country)
15 MAIDEN NAME
OF MOTHER
Margaret (None ) Hansen
16 BIRTHPLACE OF
Brooklyn, New York
MOTHER (City)
(State or country)
17 Mrs. Margaret Stout Mother any 682 Massachusetts Ave , Boston, Mass.
Informant .. ( Address)
100m (d)-1-41-4667
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 Spicer 3/16/42
(Official Designation) (Date of Issue of Permit) /
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March
15
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
March 15
42
March 15
42
19
to
..
19
I last saw
im
March 15
19.42
., death Is sald to
have occurred on the date stated above, at.
6:05
Immediate oause of death
Stillbirth
Prematurity
Duration IMPORTANT 65 mos.
-
Due toCause undetermined.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations.
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ? If so, specify Sidney Olano Ist 2xS (Signed)
(Address)
Fort Banks Mass.
Mar 15
42
Date
19
21
Woodlawn
Everett
Place of Burial, Cremation or Removal.
DATE OF BURIAL
March. 16
(City or Town)
19.4.2
22 NAME OF Murray+murray J. Vincent When
FUNERAL DIRECTOR ....
ADDRESS
257 Beach St Reeves
Received and filed MAR 1 8 1942 19
( Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
per birch cost.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT ACCURU. GYCry LICIN VI IIVILLIO.IV. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
extracts from the laws on back of certificate.
PLACE OF DEATH
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit 'with Board of Health or its Agent.
57
Registered No.
(Was deceased a
U. S. War Veteran,
If so specify WAR)
42
That I attended deoeased from
Date of.
Of autopsy.
None
What test confirmed diagnosis ?
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 haa attended during his last illuesa, 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 the name of the deceased. his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive 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 aa 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 ariny, 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 purposea 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 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 fromn 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 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 hercinafter 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 inake auch certificate. If such a permit for the removal of a human body, not previously interred. from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a perniit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
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