USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 11
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FORM R-301
Suffolk
(County)
1
Winthrop
(City or Town)
PLACE OF DEATH
(a) Residence. No ...
(Usual place of abode)
3 SEX
Female
a
AGE
77
Usual
10 or Business:
Il Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
PARENTS
Informant
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
is very important. See instructions and extracts from the laws on back of certificate.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
Own home
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
5a If married, widowed, or divorcod
HUSBAND of
(Givegikke T& gifs in full)
sing
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive Years
7 IF STILLBORN, enter that fact here.
Years Months. Days
If less than 1 day
.. Hours.
.Minutes
9 Occupation:
Housewife
(State or country)
Sweeden
15 MAIDEN NAME
OF MOTHER
Margaret
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweeden
17 Frank Arnoldson BrotHer
(Address)
11 Marion Rd. Belmont Mass,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with mo BEFORE the burial or transit permit was issued: Www. D. Children
Signature of Any of code of Health or other)
Meabile Officer
3/10/43
(Officiat Designation) (Date of Issue of Fermit) /
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
(write the word)
DEATH
February 7, 19/3.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, That I attended deceased from
Jan, 1/
19./.3, to ............ h ........ 7 ...
......
.19.
13
I last saw h ............ alive on
Feb. 7.
19 .... 2., death is said
to have occurred on the date stated above, at 10: 10m. PM Duration
Immediate cause of death Pulmonary er bolism 2%
nr's.
Due to
Coronary disease
yrs
Due to
Chronicmyocarditis
&
arteriosclerosis.
v.A.a.r.s.
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
.no
Date of.
Of autopsy
.......... no.
What test confirmed diagnosis ?.... l.i.n.i.c.c.l.
20 Was disease or injury la any way related to occopatioo of deceased ?
no
If so, specify ..
(Signed) .......
Richard
M. D.
(Address) ..
1148 Which
21
Winthrop
Place of Burial, Cremation or Ropy burar
DATE OF BURIAL
IS
43
FUNERAL DIRECTOR
22 NAME OF
Howard S Chumoldo
ADDRESS
winthrop mais.
Received and filed. 19
....
A TRUE COPY ATTEST:
(Registrar)
MARGIN RESERVED FOR BINDING
200m-10-'39. No. 8427-d
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
No Winthrop Community Hospital
5
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Anna M Rossing
(If deceased is a married, widowed or divorced woman, give also maiden name.)
80 Shirley Street
St.
ength of stay : In hospital or institution
(Specify whether)
Hospital
years
months
24 days.
In this community 25yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Sweeden
13 NAME OF
FATHER
Andris Arnoldson
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
195 3
Date.3.8
Registered No.
28
(I U. S. War Veteran. specity WAR)
(If nonresident, give city or town and state)
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 regis- tration 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, 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 buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit 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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 thercof 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 physician who is a member of the board of health, or employed by it or by the sclectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner 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 a 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-slx, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish 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 .- 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 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 funcral 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.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance 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 ill- ness from disease unrelated to any form of injury.
(2) Board of Ilealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related 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 traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or clectrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, 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 discase causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can 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 busi- ness, 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 housekecper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
PLACE OF DEATH
suffolk
(County)
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. 29
Registered No.
$ { If death occurred In a hospital or Institution, St. { give its NAME instead of street aud number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veleran,
if so. specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
( Specify whether)
years
months
1 days.
In this community
25yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Yeb.
8
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
January 10
30
to
That I attended deceased from
19.
Feb 8
19X3
i last saw him
alive on
Jetway 8, 1943
death is said to
have occurred on the date stated above, at
1:15 A:
m.
Immediate cause of death ..
acute Coronary Thrombosis
Due to.
arquia Pectoris
Due
Hypostatic Pneumonia
24 hours ......
Other conditions.
none
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operations
none
Physician
t'uderline 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, specify
(Signed)awb Chans m. D.
(es) 562 Hurley OF
Date 2/10/429
M. D.
21
Winthrop
Kinhnon
l'lace of Burial, Cremation or Removal.
(City or Towu)
DATE OF BURIAL
Teb. 10, 1943
19
22 NAME OF
Buchard & White
ADDRESS
147
Winthrop.it ....
Winthrop ..... Msaa.
Received and filed
1
(Registrar)
100m (d) -1-41-4667
1
Winthrop
(City or Town)
Winthrop Mospital
No.
2 FULL NAME
Lewis W Franklin
14
Orlando Ave
(a) Residence. No.
(Usual place of abode)
3 SEX
4 COLOR OR RACE|
White
Male
Tarbox
(or) WIFE of
63
7 IF STILLBORN. enter that fact here.
8
77
AGE
Years
3
Months
29 Days
Usual
9 Occupation :
Merchant
Industry
Wool
10 or Business :
11 Social Security No.
none
Notisk
13 NAME OF
FATHER
Joseph Franklin
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Brown
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Argentins
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 OCCUPATION is very important. See instructions and
should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
N. D .- WRITE PLAINET, WITH UNTADINO PLACA INA-THIS IS A PERMANENT RECORD. Every item of information
(State or country)
New Hampshire
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
Sa If married, widoved; or divorced
HUSBAND of
(Give maiden name of wife in full)
( flitshand's name in full)
6 Age of husband or wife if alive years
if less than 1 day
Hours
......
Minutes
12 BIRTHPLACE (('ity) (State or country) Lass.
17 Mrs. Belle Franziin Relation, if any
Informant
( Addres«)
"+"Orlando tve. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlad or Hepfit permit was issued : Wie. S. Guldress
(Signature of Agent pf Board & Hlewith or other) Health Officer 2/10/47
(Official Designation) ( Date of Issue of Pormit) /
Duration
......
...... 15 years
Date of.
Of autopsy
none
What test confirmed diagnosis? Clinical * lab
FUNERAL DIRECTOR:
19
Winthrop
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
Ap sioian or registered hospital medical officer shall forthwith, after thedeath 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 re- quired 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.
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 canse of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove thercfrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case inay 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, o1 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 hoard 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 lruman body, not previously interred, from one towi to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, 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 nmarine 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 tbe 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 hury a human hody or the ashea thereof which have been hrought 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 front 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 hody 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 deatha 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 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 deatha 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 diaease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the 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 gaiufully employed may be returned as at school or at home. For a woman 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, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
PLACE OF DEATH
Suffolk 319.43
ASVERE NOTIFIED
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.
30
{ (If death occurred in a hospital or institution, St. give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
(a) Residence. No.
82 Garfield Ave ...
(Usual place of abode)
St.
Revere
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
( Before death)
(Specify whether)
years
months
1
days.
In this communityif@s.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEParried
Male White
5a If married, widowed, or divoroed
HUSBAND of
.. Mary ..... Dinneen
(Give maiden name of wife in full)
(or) WIFE of
(Ilushand's name in full)
6 Age of husband or wife if alive
47
years
7 IF STILLBORN, enter that fact here.
8 AGE ... 4.7 .. Years - Months. Days
If less than 1 day
Hours .........
.Minutes
Usual
9 Occupation :
Clerk
Industry
Rail .... Road
11 Social Security No.
Revere
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
James Doherty
14 BIRTHPLACE OF
FATHER (City)
Boston.
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Mary E.Collins
16 BIRTHPLACE OF
MOTHER (City)
B.o.s.t.o.n
(State or country)
Mass
17 Mary Doherty
(Address) 82 Garfield Ave. Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transil permit was Issued: Wane. S. Childressx (Signature of Agent of Board of Health or other) .... Health Officer 2/10/43
(Official Designation) (Date of Issue of Vermit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
9
1943
(Month)
(Day)
(Year)
That I attended deceased from
19 I HEREBY CERTIFY,
February 8.
19
1943
February 8, 1943
to ..
I last saw h
... alive on
Fel 8, 1943
death Is sald to
have occurred on the date stated above, at
1730A
m.
Immediate cause of death
Duration ·· IMPORTANT
Cerebral Hennesligga
2-8-43
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 ?
20 Was disease or injury in any way related to oooupation of deceased ?. If so, specify
(Signed)
taroto Muurgracz
(Address)
21
Holy Cross
Malden
any
Place of burial, Cremation or Removal.
(City or Town)
DATE OF BURIAFeb. 12,1943
19
22 NAME OF
FUNERAL DIRECTOR.
Michal & Parcella
ADDRESS
10 No. Benett St., Boston
Received and filed.
19
(Registrar)
IMPORTANT
Physician Underline the cause to which death should be charged sta- listically.
M. D. 1943
10Um (d)-1-41-4667
1 3 SEX PARENTS If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a reoital to that effeot. extracts from the laws on back of certificate. should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and 10 or Business :
Winthro»
(City or Town)
No. Winthrop ... Community Hosp.
2 FULL NAME
James Edward Doherty
(If deceased is a married, widowed or divorced woman, give also maiden name.)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan 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 atandard 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 ... Gen. Laws, Chap. 46, Scc. 9.
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