USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 37
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I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: m. D. Childress f.
(Signature of Agent of Board of Health or other)
6/19/42
MEDICAL CERTIFICATE OF DEATH
(Monili)
L8 DATE OF
DEATH
JUNE
17
( Bay) )
1992 (Year)
19 1 HEREBY CERTIFY. 19 .. X0.
That I attended
deceased Kom
to
June 16
16, 1912
death Is said to
have occurred on the date stated above, at ..
2
Duration
Immediate case of death
Chronic Myocardehi
IMPORTANT 1480
Due to.
Due to.
Other conditions
(luclude pregnancy within 3 months of death)
Major findings :
Of operations
.....
IMPORTANT Physician
L'uderline The cause to which death shouldt be charged sta- listically.
20 was disease or Maury in any way related to occupation of deceased ? Il 90, specify 40000 Schwerer ('Signed)
M. D.
Date 6-18 Y2
21
winthrop
l'lace of Burial, Cremation or Removal.
June
20
(City or Town)
1942
22 NAME OF
FUNERAL DIRECTOR ...
Howard S Jurnaldo
ADDRESS
Received and filed.
JUN 2 2 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. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of decorATION is very important. See instructions and PARENTS
100m (d) -1-41-4667
Health Offices (Official Designation)// (Date of Issue of Permit)
anthrop
DATE OF BURIAL
Date of
Of autopsy.
What test confirmed, diagnosis ?
Cunscultation
May 1
1 last saf h
alive on ... .........
255
.A
1960 ....
1
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
( Specify whether)
(write the word)
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 aml 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. 16. 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, served 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 cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundreil and fourteen. the worl "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 Juls fourth, nineteen hundred and two, and the Mexi- can border service of nineteen humtred and sixteen and nineteen bundred 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 froin 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 healthgoris agent aforesaid or from the clerk of the town where the boily is huried. No such permit shall he issued until there shall bave 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 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 member of the hoard of health, or employed hy 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 carly 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 form for the removal of such body has been sooner obtained hercuuder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased aerved 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 counter-ign 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 nece+ sary information which can be obtained as to the deceased, or as to the manner or canse of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).
No umleriaker 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 hoard, from the clerk of the town where the body is to he buried or the funeral is to be hell, or from a person apointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114. Sec. 46. G. L., (Terceutenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died hy violence. If a iulical examiner has notice that there is within his county the hoily 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 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.
( ") 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- cian is ah-ent 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 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 .- Cause of death means the disease, or complication which causes death. not the mode of ilying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death, As related causes, name earlier morbiil 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 occupatiou was that of honie housework, write bousework. 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 uone.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH ity Hospital
To be filed for burial permit with Board of Health or its Agent.
Registered No.
110
{ { If death occurred in a hospital or institution, St. (give its NAME instead of street aud uutuber)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence.
No.
280 thirty
(Usual place of abode)
Length of stay : In hospital or Institution
( Before death)
( Sperift whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
temle
4 COLOR OR RACEJ
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCEO
(write the word)
single
(innl)
19
HEREBY CERTIFY,
5a If married, widowed, or divorced HUSBAND of
(Cive maiden name of wife in full)
(or) WIFE of
( Ihusband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here.
AGE
8 63 Years Months Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
at
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
13 NAME OF
FATHER
Ruland Contin
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Freland
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
1
17 fattura
Relation, If any
Informant .. ( Allress)
200 1
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : Som No Childrens
Siguature of Agett Board of Health or other) June 19/42 .
(Oficial Designation)
(Date of Issue of Permit)
18 DATE OF
DEATH
Jame 15 1942 (Year)
(Day)
That I attended deceased from
19
19 42
| last saw h ............... alive on.
Kif, 199 death is said to
have occurred on the date stated above, at 11. 05 Pm. Immediate cause of death. Lemin
Due to.
Pyelonephoto
...........
Que to.
Other conditions
(luclude preguancy within 3 months of death)
IMPORTANT
Major findings :
Of operations.
Oate of.
Of autopsy.
almen
What test confirmed diagnosis ?
Physician t'nderline 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.
(Signed)
(Address)
M. D.
19/2
21
l'lace of Burial, Cremation or Removal.
DATE OF BURIAL
2
0
(City or Towu)
.......
22 NAME OF
FUNERAL DIRECTOR ...........
ADDRESS
Received and filed.
JUN 22 1992
.19
(Registrar)
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recitai to that effect.
100m (d)-1-41-4667
1
(County) Winthrop
(City or Town)
No.
Elinfitto
Conlon
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
(If nonresident, give city or towu and State)
Hospital
years
months
11
days.
In this community> yrs. mos. days.
Duration IMPORTANT 24h
PARENTS
PLACE OF DEATH
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 aus member of the family of the deceased, furnish for registration a standard certifleate of death, stating to the best of his knowledge and behef the name of the deceased. his supposed age, the disease of which he died. defined as re- quired by seetion 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 ... Gcu. 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 I'nited States in any war in which it has been engaged, insert in the certificate a recital to that effeet, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen. the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a hunian 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 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 fromn 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 he returned and recorded, which shall be accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law. or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmien 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 rentoval 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 reinoval 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 aerved 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. ujum receipt of such statement and certificate, shall forthwith counter-ign it aud 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 aus other neces- sary information which can be obtained as to the drerased, or as to the manter or canse of the death, which the clerk or registrar may require .- Chap. 114. Sec. 43, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashea 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 sncb 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 apointed 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 ouly such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies aud 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 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.
( =) 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 phyai- 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 reaulting 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 reiated to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, naine earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statenient 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 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 inay be returned as at school or at boine. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestie 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
R-302
Auftolk
PLACE OF DEATH
(County)
Norton
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No ..
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Fannie
++ ++on
(If deceased is a married, widowed or divorced woman, give also maiden name.)
117 Shore Drive
St.
Winthrop
(If nonresident, give city or town and state)
(Specify whether)
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
fem
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
(write the word)
married
18 DATE OF
DEATH
June 19 1942
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Louis Vi.
witten
(Husband's name in full)
I last saw h ....
... alive on.
19 ........ ,
death is said
to have occurred on the date stated above, at .. 70/408 n. Duration
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
8
AGE
46 Years
.Months.
.. Days
If less than 1 day
Hours
.Minutes
tuberculrate of adrenala
Usual
9 Occupation:
at home
Industry
10 or Businessı
11 Social Security No ......
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Isaca Levincon
14 BIRTHPLACE OF
FATHER (City)
...
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 husband
Relation, if any
Informant
(Address)
A TRUE CORE Graneis
ATTESTI
(Registrar of city or town where death occurred)
DATE FILED 6/23/42
19
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?
20 Was disease or Injury in any way related to occupation of deceased ?
If so, specify
(Signed)
R ROOS
M. D.
(Address)
Boston
Date.
6/19% 42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL N't Lebanon # 30%
DATE OF BURIAL
(Cemetery)
June 21 1945
19
22 NAME OF
FUNERAL DIRECTOR
B Schloochen.
ADDRESS
Boston
Received and fled.
JUL 3 1942
19
(Registrar of City or Town where deceased resided)
-
vr
Due to
Due to
. . ..
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
PARENTS
50m-10-'39. No. 8427-f
after the close of the month in which the death occurred. (See Chap. 46, Sec. 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 W seww ww West tue octcasco resided in another city or town at the time
-
No ....... 330 Brookling Ava
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ....
....
years
19 | HEREBY CERTIFY.
Annil 27
19 .. 1.2., to.
That I attended deceased from
6/79/42
19.
....
50
Immediate cause of death ...
Addison's disease
about 1
....
€ Thay
(City or Town)
Of autopsy
R-301 A
Suffolk
(County)
Winthrop
(City or Town) 22 Elliot Street No.
The Commonturalth 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.
112
( ( If death occurred In a hospital or institution, St. { give its NAME Instead of street and number)
Nellie Fillmore Brown
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
22 Elliot SA
(Usual place of abode)
Length of stay: In hospital or Institution.
(Before death )
-
(Specify whether)
years
months
days.
In this community . 5
yrs.
- mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Varried
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Fred.
(Give maiden name of wife in full)
(Husband's name in fuil)
6 Age of husband or wife if alive 68
years
7 IF STILLBORN, enter that fact here.
8
AGE
75
Years
Months.
-
.Days
-
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
Own Home
11 Social Security No ..
memphis
12 BIRTHPLACE (City)
(State or country )
Tennessee
13 NAME OF
Cannot be learned
FATHER
14 BIRTHPLACE OF
Cannot be learned
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Fred E. Brown
Kelation, lifCany
Informant
( Address)
22 Elict St Tinthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued :
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