USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 61
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.... PLACE OF DEATH No
Sulfuric (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S
CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
82
Registered No.
S (If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME film ce. Hewitt
(If deceased is a married, widowed or divorced woman, give also maiden name.)
70 Prospective Winstweb
St.
(If nonresident. give city or town and state)
Hospital
-
years
- months
/0 days.
In this community 20
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of.
......
(Give maiden name of wife in full)
mary ann Brown
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive ..
..... years
7 IF STILLBORN, enter that fact here.
AGE.
8
86 Years
-
.Months .............. Days
If less than 1 day
Hours .....
.Minutes
Usual
9 Occupation :.
Retired
10 or Business :....
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Unknown Hewitt
14 BIRTHPLACE OF
FATHER (City) .......
(State or country)
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
17 Laurence Heivitt
Relation, if any
Informant
(Address) 70 Prospect are Windup
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: WM. D. Childrento (Signature of Agent of Board of Health or other)
Healite Officer
10/2/42
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Oct-
1-
1942
(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.) interio clerotic Heart Disease
Fractured Rt. Huneries Burner Colles Fracture Left
accidental
20 Accident, suicide, or homicide (specify)
Date of occurrence ......
Jeft-15
19.55.3.
Where did
Injury occur?
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place?
(Specify type of place)
Manner of
Injury .....
Tell accidentally on tai at
Injury ......
Nature of
Mouttrop
on
Jebt-15-1942
While at work?
Was there an autopsy ?.
no
21 Was disease or injury in any way related to occupation of deceased? 1
If so, specify ..
Jak Trickle
(Signed) ...
M. D.
(Address)
pat-1-
19 ... 52
22 Holy Cross malden
Place of Burial, Crewiation or Removal.
(City or Town)
DATE OF BURIAL
October
3
19.51
23 NAME OF
FUNERAL DIRECTOR
Q.C. Kirly
ADDRESS ..
17 Bennington at EBoston
Received and filed .19
(Registrar)
7
............
Industry
Cabinet maker
PARENTS
25m-2-'40-D-729-b
1
(City or Town) Northrop Community Hospital
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(If U. S.
War Veteran,
specify WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail forthwitb, 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 by section one, wbere same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a buman 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 receiv- Ing 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 wbere the body is buried. No such permit sbail 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 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 pbysician who is a member of the board of bealtb, or em- ployed by it or by tbe selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shali make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to anotber 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 form for the re- moval of sucb 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 tbe United States in any war in which it has been engaged, such recital sball appear upon tbe permit. The board of bealtb, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit It to tbe clerk of the town for registration. The person to whom the permit Is so given and the physician certifying the cause of death shail thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to tbe 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 buman body or tbe asbes thereof which have been brought into the commonwealth until be 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 tbe care of the cemetery or burlai ground in which the interment la made. . . . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners sball 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 county 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.
. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other wise a description as fuil as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calis for the observance of the following rules of practice:
(1) Attending physiclans 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 wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatisın (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 dlsease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, tbe mode of its production togetber with the circumstances wben these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Aspbyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skuil with asso- ciated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
A R-301 A ..
.
PLACE OF DEATH
Suffolk (County) Winthis (City or Town) 19. Coral Que.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or Its Agent.
Registered No.
.83
St.
¡ (If death occurred in a hospital or institution, ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
Samuel Bloomfield
(If deceased is a married, widowed or divorced woman, give also maiden 19- toral Rue.
(a) Residence. No. (Usual place of abode)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
months days.
In this community 2 yrs.
-
mos.
dayı
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE DF
DEATH
October
3
(Month)
(Day)
1942
(Year)
Lg I HEREBY CERTIFY,
That I attended deceased from
January 18, 1942
to
October 3, 1942
last saw h.
alive on
October 3 19 42 death Is said to
have occurred on the date stated above, at
3:30 A:
.m.
Immediate cause 9
acute Coronary Thrombosis
Due to.
auguia Pectoris
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
operations.
none
Date of
Df autopsy
none
What test confirmed diagnosis ? clinical x lab.
20 Was disease or injury in any way related to occupation of deceased? To If so, specify.
(Signed Jacob
abramo
(Address) 06 2 hurley St Date. ER,
act 3
M. D.
1942.
21 Fude
Relation, if any Place of Burial, Cremation or Removal
DATE OF BURIAL
acobl
4.
(City of Town)
44
19
42
I HEREBY CERTIFY that a satisfactory standard certificate of death tras filed with me BEFORE the burial or transit permit was issued : Vmix Clubdress.
(Signature of Agent of Board of flealth or other) Realthe Office 10/3/42
(Date of Issue of Permits
( Registrar)
Duration IMPORTANT 4 hours
9 mos
12 BIRTHPLACE (City)
(State or country )
13 NAME OF
FATHER
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME DF MOTHER
Sophie - Carotte
16 BIRTHPLACE OF MOTHER (City) ( State or country)
Previa
17 Informant Despace ( Address)
00
ra
teame
100m (d) -1-41-4667
4 COLOR OR RACE|
white
5 SINGLE
MARTIED
WIDOWED
or DIVORCED
( write the word)
lamed
Mille
5a If married, widowed, cor divorced HUSBAND of
€
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive 52 years
7 IF STILLBORN, enter that fact here.
Years
Months
Days
If less than 1 day Hours .Minutes
11 Social Security No.
1 No. 3 SEX Mole (or) WIFE of 8 5% AGE Usual 9 Occupation : PARENTS If deceased was a U. S. War Veteran, G. L. Chap. 46. Seotion 10, requires physiolans to insert a reoltal to that effeot. extracts from the laws on back of certificate. 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 EXACTLT. PHYSICIANS should state CAUSE OF DEATH in plain Industry 10 or Business :
2 FULL NAME
(Was deceased a U. S. War Veteran, f. so specify-WAR)
dame. ) V
St.
(If nonresident, give city or town and State)
tto
(Official Designation"
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
22 NAME DF FUNERAL ADDRESS 10-6000
Received and filed
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medloal officer shall forthwith, after the death of a person whoin he has attended during his last illuess, 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 deatlı, 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 by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Scc. 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 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, be deemneil 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 sgent 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 boily and remove it from a town, froin one cemetery to another, or from oue 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, 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 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 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 caunot 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 hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war In which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall fortliwith 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 furulsh for registration any other neces- sary information which can be obtained as to the deceased, or as to the mauner 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 sliall 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 board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Editlon).
Medical examiners shall mahe examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner lias notice that there is within his county 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 observance of the following rules of practice :
(1) Altending 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 physiclans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physl- 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 incluile 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 deathg 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 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 .- l'ICise sialement 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 disease 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 no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1 R-301 A
1 No. 3 SEX Female (or) WIFE of PARENTS 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. should be carefully supplied. AGE should be stated EXACTET. miDICIAND should state CAUSE Of DEATH in plain Industry 10 or Business : terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town) 170 Cliff
Avenue
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.
Registered No. f( If death occurred in a hospital or institution, St. ¿ give its NAMIE instead of street and number)
2 FULL NAME
Mrs. Florence Mary Burnett
(If deceased fs a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
170 Cliff Avenue
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
( Before death)
years
months
days.
In this community
3 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
6
1942
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
august 15 2042
October 6
1947
I last saw he alive on
October 6. 1942
death Is sald to
have occurred on the date stated above, at
FP:
.m.
Immediate oause of death.
Carcinoma of uterus
Due to
Cerebral Hemontage
4 days
Other conditions .....
une
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Carcinoma of items
Mass. Sensuel Hosp Date De Sept. 26/42
Of autopsy
none
What test confirmed diagnosis ?.
clinical + lab
Physician l'uderline 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, speoify.
(Signed)
.....
1662 Henley
(Address)
Date 10/6/4/19
21 Fond Street Cemetery , Braintree Place of Burial, Cremation or Removal. October
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTORMortimer M. Peck
ADDRESS
Braintree, Massachusetts
19
(Registrar )
100m (d)-1-41-4667
...
(Official Designation) ....
5 SINGLE
(write the, word)
MARRIED Married'
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(fInsband's name in full)
6 Age of husband or wife if alive 52
years
7 IF STILLBORN. enter that fact here.
8
AGE 52 Years
0
Months
0 Day's
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
House Wife
Il Social Security No.
12 BIRTHPLACE (City)
Braintree
(State or conntry)
Massachusetts
13 NAME OF
FATHER
Otto W. Peterson
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Denmark
15 MAIDEN NAME
OF MOTHER
Cora Bailey
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
Witasgett
17 Clifford C. Walker Relation, if any
Informant. (Address) 170 Cliff Av. WinthropSon in law
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the butial or transit permit was Issued : Childrenig
(Signature of Agent of Board of Health or other) Health Officer 10/ 7/42
(Date of Issue of Permit)
Duration
IMPORTANT Lzear ........
Due to.
IMPORTANT
M. D.
8
(City or Town)
42
Received and filed.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
(Specify whether)
4 COLOR OR RACE|
White
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