USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 64
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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 discase 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 scetion for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, icport 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 honte. 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
R-301 A
:
Suffolk (County)
Winthrop
(City or Town)
No. od Freemont Street
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,
[ {If death occurred In a hospital or institutinn, St. ¿ give its NAME instead of street aud uumber)
2 FULL NAME
Emily Elizabeth Taylor
(If deceased is a married, widowed or divorced woman, give also maiden name.) bo Freemont Street
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital nr Institution
(Before death)
( Specify whether)
years
months
days.
In this community '2 1 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
Femalel White
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN. enter that fact here.
8 AGE . : 15 Years 2 Months . - Days
If less than 1 day
Hours .
Minutes
Usual
9 Occupation :
Housework
Industry
10 or Business :
Own Home
11 Social Security No.
None
Bedford
12 BIRTHPLACE (City)
(State nr ennutry)
New Hampshire
13 NAME OF
FATHER
Henry Taylor
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Africa
15 MAIDEN NAME
OF MOTHER
Julia Ann Moore
16 BIRTHPLACE OF
MOTHER (City)
Salem
(State or country)
Mass
17 Julia Ann Taylor
Informant ( Address) 08 Freemont St Winthrop
I HEREBY CERTIFY that a satisfactorystandard certificate of death was filed with me BEFORE the burial or transit permit was Issued :
(Signature of Agent of Board of Health of other>
Health Officer 10/13/42
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
10
(Month )
(Day)
(Year)
19 I HEREBY CERTIFY,
Jan. ,
That I, attended deceased from
19.
42,
to October 18 1942
I last saw h .......!..... allve on.
October 9, 1992 death Is sald to
have occurred on the date stated above, at.
3:30
.. m.
Immedlate cause of death
of IntestINES.
Duration IMPORTANT
0
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?
l'indlerline 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)
Edward
(Address)
200 Washington
Date BCT-13-1942.
Everett
21
Wood Lawn Cemetery
....
l'lace of Burial, Cremation or Removal. DATE OF BURIAL ..
(City or Town)
October
ST
42
19.
...
22 NAME OF
FUNERAL DIRECTOR Howard SIunações
ADDRESS
Winthrop Mars
Received and filed
19
(Registrar)
100m (d)-1-41-4667
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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to insert a recital to that effect. PARENTS
1
PLACE OF DEATH
r
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
St.
( It nonresident, give city or town and State)
1942
MARRIED
WIDOWED
or DIVORCEDSingle
(Give maiden name of wife in full)
i
(Official Designation)
IMPORTANT Physician
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 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 niemher 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 by the physician or officer and the date of hia death ... Cen. Laws, Clap. 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 deceasedl, to the best of his knowledge and helief, served in the army. navy or marine corps of the I'nited States in aus 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 seetion, 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 aml the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetween 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, froin 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 dire grave For 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 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 certifieate 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 board 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 Imunan 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 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. 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 board of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to he 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 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) Attending physicians will certify to auch 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- 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 inelude not only death« eaused 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 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 discase, 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, 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 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 terma, aa housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A Suffolk County) Winthrop 1
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.
Registered No.
( If death occurred in a hospital or institution, give ita NAME Instead of street aud number)
vience Laurence Joseph Kincaid
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give atto maiden name.)
(a) Residence. No.
205 Somerset
Are
St.
Winthrop
(If nonresident, give efty or town and State)
Length of stay: In hospital or Institution
(Before death)
(Spfrify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
Married
or DIVORCED
Sa If married, widowed, or divorced Helen A. Hurpley HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive 1.3 .. / ... years
> IF STILLBORN. enter that fact here.
AGE 33 Years Months Days
If less than 1 day
Hours .......
Minutes
Usual
9 Occupation :
upholsterer
Industry
Upholstery
11 Social Security No. 012-12-4373
East Boston
12 BIRTHPLACE (City)
( Siale or country)
ruan.
13 NAME OF
FATHER
George E. Kincaid
14 BIRTHPLACE OF
Somerville
FATHER (City)
(State or country)
mass.
15 MAIDEN NAME
OF MOTHER
Mary S. Towers
16 BIRTHPLACE OF
MÓTHER (City)
Cambridge
(State or country)
recass.0
17 Www. Helew A. Kincaid
Relation If any
Informant ... ( Address) 205 Somerset Ave.
I HEREBY CERTIFY that a satisfactory standard certificata of death was filed with me BEFORE the burjat or fransit permit was Issued ? Mm. 8. Ctul dress
(Signature of Agent of Board nt Health or other)
Health Officer 10/15/42
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
13
1942
( Month)
(Day)
(Year)
19 1
HEREBY CERTIFY,
)
194/2.
Can 13
...
That I attended deceased from
I last saw himan allva on
Can-13, 19/ death Is said to
have occurred on the date stated above.
m.
Duration
Immediate cause of death.
agranulocytosis
lagranallastoria
Due to
Due to. Sangrenores ulcero
Other conditions,
( Include pregnancy within 6 months of death)
IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?
If so, spaolfy ..
(Signed)
M. D.
(Address) 4 Werhudba a Day 60/14 1942
21
Winthrop
DATE OF BURIAL
October
16
19 42
22 NAME OF
M. r. Kelly
FUNERAL DIRECTOR.
ADDRESS
11 Meridian ST. E. B.
Received and flad. 19
(Registrar)
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.
100M-E - 2-42.8855
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot.
PLACE OF DEATH
(City or Towny Winthrop Community Hospital. No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if sg specify WAR)
(Usual place of abode)
Hospital
years 1 months 7 days.
In this community
5 yrs.
mos.
dayı
MEDICAL CERTIFICATE OF DEATH
...
(Give maiden name of wife in fuff)
10 or Business :
.......
PARENTS
Major findIngs :
Of operations
Date of
Of autopsy.
What test confirmed diagnosis ?.
Winthro .... l'lace of Burial, Creniation or Removal
(City or Town)
19
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or regiatared hospital medical officer shall forthwith, after the death of a person whoin he has attended during his last Illness, at the request of an undertaker or other authorized person or of ans meniber of the family of the deceased, furnish for registration a standard certifcate 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 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, 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 helief, 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 saine. For neglect to comply with any provisinn of this section, such physician or officer shall forfeit ten dollars. For the purposes of this eec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the Chins relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deenied 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 bundred and seventeen. G. L. Chap. 46. Sec. 10.
No undartakar or other person shall hury 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 buman body and remove it from a town, from one cemetery to another, or from oue grave or tomb other than the receiving tonib to another In the same cemetery, until he has received a permit from the board of health or ita 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 all recorded, which shall be accompanied, in case of an original Interment, by a satisfactory certificate of tbe attending physician, if any, as required by law, or in lieu thereof a certifieste as hiereinafter 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 hy the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medl. cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, froin one town to another within the comnonwealth 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 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 forthwith countersigo 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 mabuer or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. L., (Tercentenary Editiou).
No undertaker or other person shall hury a human body or the ashes thereof which have been brought luto the conimonwealth until he haa re- ceived a permit so to do from the board of health or its agent amminted 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 front a |.ersun appointed to have the care of the cemetery or burial grouil in which ibe interment is made. .. . Chap. 114. Sec. 46. G. L., (Terceutenary Elition).
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 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 game; ...- General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only an those of persona to whom they have given bedside care during a last illuess from disease unrelated to any form of injury.
(2) Board of Health physiolans will certify to such destha only as those of persons who, though disabled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whove phyaf- cian is absent from home when the certificate of death is needed.
(3) Medioal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or la- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), theriual, or electrical agenta, all deaths following abortion, but also deaths from diseasa resulting from Injury er Infection related to occupation, the audden deatha of persons not disabled by recognized disease, and those of persons found dead.
Statemant of Cause of Death .- Cause of death means the disease, or complication which causes death. not the more 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.
Statemant of Ocoupatlon .- 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 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 he returned as at school or at home, For a woman whose only occupatiou was that of honte housework, write housework. For a person engaged in domestic service for wagen, however, designate the occupation by the appropriate terms, as housekeeper private fantily. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
(County) Winthrop
(City of Town) 93 Grovers Avenue
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.
Registered No.
S ( If death occurred in a hospital or Institution, St. [ give Ita NAME Instead of street and number)
2 FULL NAME.
( If decessed is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
93 Grovero Que
.......
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
years
months
days.
In this community / 2 yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACEJ
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
Cima
(Give maiden name of wife In full)
( Husband's name In full)
6 Age of husband or wife if alive 48 years
> IF STILLBORN. enter that fact here.
AGE 64 . Years 7 Months 27 Days
If less than 1 day
Hours
Minutes
Usual
6
Wholesale Flow Dealer
Industry
10 or Business :
Flow
12 BIRTHPLACE (City)
(Siate or country)
) Horseheads, M. y.
13 NAME OF
FATHER
Charles P. Case
14 BIRTHPLACE OF
FATHER (City)
(State or country)
M. 9
15 MAIDEN NAME
OF MOTHER
Annali Sykes
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
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