USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 70
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8
AGE
Years
Months.
Days
Usual
9 Occupation:
Industry
10 or Business:
Il Social Security No.
12 BIRTHPLACE (City)
13 NAME OF
FATHER
warren Campbell
14 BIRTHPLACE OF
Revere
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Emma Kinsella
PARENTS
17
Warren Campbell
(Address) 283 Court Rd, Winthrop
50m-10-'39. No. 8427-f
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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
(State or country)
Mass.
(State or country)
Cambridge, Mass.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
East Boston
Relation, if any .Father
A TRUE COPY.
Frederick st. Birker
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
October 13, 1942
19
1
St.
Registered No.
1293
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
months
days.
In this community
yrs.
....
years
(write the word)
Single
(Give maiden name of wife in full)
19
., to.
19.
Date of ..
Underline the cause to which death should be charged sta- tistically.
R-302
Suffolk
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 ..
8362
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Florence M Poor
(If deceased is a married, widowed or divorced woman, give also maiden name.)
115 Circuit Rd
St.
Winthrop
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE| 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
(write the word)
years
If less than 1 day
Hours.
.Minutes
(State or country)
Mass
14 BIRTHPLACE OF
FATHER (City)
Robbiston
Harriet Wyman
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
Relation, if a
A TRUE COPY.
ATTESTS
(Registrar of city or town where death occurred)
DATE FILED
Oct 14
19
42
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Oct
11
1942
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
Oct.10
19
That I attended deceased from
2 Oct, 11
I last saw b
.... r.alive on
Oct 11
42
19.
death is said
to have occurred on the date stated above, at
7:02 P
.m.
Immediate cause of death ..
Hypertensive heart disease
Cerebo vascular hemorrhage
Due to
with nemiolegia
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease er Injary lo any way related to occupation of deceased ?
If so, specify.
(Signed)
J S Hodgson
M. D.
(Address) Boston Mass
Date 10/1/1942
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Woodlawn Cem
Malden
DATE OF BURIAL
Oct 1.
19.4.2
22 NAME OF
FUNERAL DIRECTOR
C R Bennison
ADDRESS
Winthrop Mass
Received and filled. 19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
(County)
Roston
(City or Town)
No .Mass .... General ... Hospital
St.
(II U. S.
War Veteran.
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
years
months
days.
3 SEX
F
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE.
Months2.7 .... Days
66 Years1 1
Usual
9 Occupation:
At home
Industry
10 or Business:
11 Social Security No ...
12 BIRTHPLACE (City)
Chelsea
13 NAME OF
FATHER
Joseph L Poor
15 MAIDEN NAME
OF MOTHER
Calis
PARENTS
17
Informant.
A B Poor
(Address)
Winthrop Mass
50m-10-'39. No. 8427-f
copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
(State or country)
Mass
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
(Give maiden name of wife in full)
(Husband's name in full)
Duration
Underline the cause to which death should be charged sta- tistically.
(Cemetery)
(City or Town)
R-301 A
1
PLACE OF DEATH
suffolk (County)
Winthrop
(City or Town) Winthrop Comunity Hospital No.
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 218
Registered No. [ {If death occurred in a hospital nr Institution, St. ( give its NAME instead of street aud number)
2 FULL NAME
Merbert T. Ward
(If deceased is a married, widowed or divorced woman, give also maiden nanie.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
145 Washington Ave.,
St.
(If nonresident, give city or towu and State)
Length of stay : In hospital or Institution
( Before death)
(Specify schoolhar)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACEI
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
Sa If married, widowed, os digohey ward
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
62
years
7 IF STILLBORN. enter that fact here.
8
AGE
68
Years
8
Months
6
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Salesman
Industry
10 or Business:
Wholesale Drug
11 Social Security No ..
024-01-4659
12 BIRTHPLACE (City)
( State or country)
England
13 NAME OF
FATHER
John Ward
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
not known
16 BIRTHPLACE OF
MOTHER (City)
Ingland
(State or country)
17 Clara Storey Ward
Relatipi, if any
Informant ( Address) 140 Washin ton Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Nau. S. ChildrenRx
...
(Signature of Agent of Board of Health or other)
Healthe 11/5/42
7 (Official Designation) (Date of Issue of Permity /
18 DATE DF
DEATH
Nov. 3, 1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended
ceased from
October 3/ 1942
to
november 3, 1942
I last saw
h ..
alive on
nos
2
42
death Is sald to
have occurred on the date stated above, at.
12:10 A:
m.
Immediate cause of death ...
Cerchial Hemorrhage
Due to.
arteriosclerosis
Due
Clisonia Interstitial replicadas
1 year
IMPORTANT
Physician
L'inlerline the cause to which death shouhl be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased 2 60.
If so, specify
(Signed) Laere
M. D.
(Address) 562 Studey Vite
Date 11/4/419.
21
Winthrop
I'lace of Burial, Cremation or Removal.
DATE OF BURIAL
Nov. 8, 1942
19
22 NAME OF
Richard 16 gr heute
FUNERAL DIRECTOR
ADDRESS
147 Winthrop St., winthro
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, Seotlon 10, requires physicians to Insert a recital to that effect. PARENTS
Duration POURTANT
... Izean
Other conditions,
(Include pregnancy within 3 months of death)
Major findings :
Of operations ..
Date of.
Of autopsy
none
What test confirmed diagnosis ?
climeal x lab.
(City or Town)
(Usual place of abode)
Ha 1. In years
months
day's.
In this community
yrs.
mos.
days.
30
White
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 drath, stating to the best of his knowledge and behef the name of the decrase. his supposed ago, the disease of which he died. defined as re- quired hy section one, where same was contracted. the duration of his last illness, when last aeen 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 belief, servid 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 secomlary 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 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 niurty-eight and July fourth, nineteen hundred and 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 perinit 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 boily 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, hy a satisfactory certificate of the attending physician, if any, as required by law. 01 in lieu thereof a certificate as liereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cammot he obtained early enough for the purpose, or is insufficient, a physi- cian who ia a member of the hoard of health, or employed hy it or by the aelectmen 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 linnan body, not previously interred, from one town to another within the commonwealth cannot be obtained carly enough for the purpose, the certificate of death nade as above provided aml 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 reinoval, unless a permit in the usual forin for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States In any war in which it has been engagedl. 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 transimit 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 canse 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 hody or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the huard of health or its agent appointed to issne 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 he 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, Scc. 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, thengh disabled hy 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 on in- directly by traumatism (including reaulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aml deatha following abortion, hut also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death. not the mode of dying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease cansing death. As related causes, naine earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative 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 home. For a wonian whose only occupation was that of honre 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
M R-303A
Sulfolk (County)
Uhr Commnumraith of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S
To be filed for burial permit with Board of Health or its Agents,
Registered No ..
ยง (If death occurred In a hospital or institution, ..................... . St. { give its NAME instead of street and number)
george lu. Rogers
....... (If deceased Is a married, widowed or divorced woman, give also maiden name-)
(If U. S. War Veteran, specify WAR)
Cherish
23
(If nonresident, give city or town and state)
(Usual place of abode)
Pust Home
years
7
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
it.
8 SINGLE
MARRIED
WIDOWED
or DIVORCED1:1e
5a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name In full)
6 Age of husband or wife if alive
.years
7 IF STILLBORN, enter that fact here.
7
14
6
AGE
Years ..........
Months .......
Days
If less than 1 day
Hours ..
.. Minutes
Usual
9 Occupation :..
Grocer
Industry
10 or Business :...
Groo rtv
11 Social Security No .....
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Nicholsa Pagal
14 BIRTHPLACE OF
FATHER (City) .........
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Intint Brown
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
17
Relation, if any
Michcel Brooks
(si ton
Informant .........
(Address)
-Cross St
inthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was ffled with me-BEFORE the burial or transit permit was issued: Man.D. Children (Signature of Agent of Board of Health or other)
Health Office
11/6/42
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Wvember -5 - 1942
(Month)
(Day)
(Year)
19 I 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.) Carcinoma felt kidney helt
Testicle xof Braind
Cormann Mersin
20 Accident, suicide, or homicide (specify)
Date of occurrence.
19
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 ...
Found dead me hasted firm
Nature of
Injury ..
Koor
While at work ?.
Was there an autopsy? 1/0
21 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Munk Trickley
(Signed)
M. D.
(Address)
Batten
Monte-5-
.. 19.4.2
22. Calvary Boston
Place of Burial, Cremation or Removal, DATE OF BURIAL.
Vov 7: 15151
19
23 NAME OF
FUNERAL DIRECTOR
John TO Males
ADDRESS
Received and filed
19
(Registrar)
25m-2-'40-D-729-b
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
1
Mutterop (City or Town) PLACE OF DEATH No 125 cliff are
. CERTIFICATE OF DEATH
2 FULL NAME ...........
(a) Residence. No Hotel arginine 4 Bulfinch P& Boston
Length of stay: In hospital or institution. (Specify whether)
(write the word)
PARENTS
(City or Town)
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. his supposed age, the disease of which he dled, defined as required hy 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.
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 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 body and remove it from a town. from one cemetery to another, or from one grave or tomb other than the receiv- Ing tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body Is buried. No such permit shall be Issued until there shall have been dellvered 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 physician who Is a member of the board of health, or em- ployed by It or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human 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, 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 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 recltal 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 19 80 given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary Information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chop. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall hury 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 huried 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.
. . 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 full 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 calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled 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 abortion, but also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled hy recognized disease, 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, the mode of its production together with the circumstances when 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." "Asphyxiation hy suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internal injury sustained under circumstances unknown."
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