USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 19
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(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 electrical 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 disease 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 housekceper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FORM R-301 1
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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No. 50
5
(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
Crissa Isabel[Wilson) .Wait
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 39 Waldemar Avenue
St.
(Usual place of abode)
ength of stay: In hospital or institution
(Specify whether)
years
months
2
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE !
White
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced HUSBAND of (or) WIFE of Gilbert Henry waitull) (Husband's name in full)
6 Age of husband or wife if alive.
.years
7 IF STILLBORN, enter that fact here.
ÅGE.
Years
16 Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation:
At home
Industry 10 or Business:
11 Social Security No.
South Boston
12 BIRTHPLACE (City)
(State or country)
Massachusetts
13 NAME OF
FATHER
James L. Wilson
PARENTS
(State or country)
15 MAIDEN NAME
OF MOTHER
Christianna E. Hayden
16 BIRTHPLACE OF
MOTHER (City)
Quincy
(State or country)
Massachusetts
17 Harriet W. Holt daughter (Addis$39 Waldemar Ave. Winthrop Mass
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Um- Dlebuldices
(Signature
180
LA Kot Board of Health or other) 3/11/43
(Official Designation) (Date of Issue of Dernyt)
MEDICAL CERTIFICATE OF DEATH
5 SINGI.E
18 DATE OF
(write the word)
DEATH
March
9
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
mar. 7
19.43
to.
I last saw h. CY alive on.
march 8, 1943, death is said
to have occurred on the date stated above, at ...
10.02 AM
Duration
Immediate cause of death ..
Intestinal Obstruction
et
... 2 days ...
Due to
Peritonitis
Due to
..
Gente ruptured Appendicitis
2 days
Other conditions .
none
...
(Include pregnancy within 3 months of death)
Major findings :
Of operations
.......
TATESTRAL OBSTRUCTION
ruptured Dependiato Date of Mars, 94
Of autopsy
What test confirmed diagnosis operation
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease ur Injury In any way related to occupation of deceased ?
If no. specify I. D. Jmin m. D.
(Signed)
M. D.
(Address) Umathur man Date Mar 9 1943
21
Mt. Hope Cemetery Milton
Place of Bu
MaTURI2. 1943
Town)
DATE OF BURIAL
19
22 NAME OF
Charles R. Bennisob
ADDRESS
Winthrop Mass
Received and filed. 19
A TRUE COPY ATTEST:
(Registrar)
-
MARGIN RESERVED FOR BINDING
200m-10-'39. No. 8427-d
1
No .. Winthrop Community Hospital
) cu u. s.
War Veteran.
specity WAR)
(If nonresident, give sitx or town and state)
1Yar
194/3
8 80 3 Months
14 BIRTHPLACE OF
FATHER (City)
...
Vermont
2 days
FUNERAL DIRECTOR
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, See. 9.
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 elerk of the town where the body is buried. No sueh 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 certifieate 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 physician who is a member of the board of health, or employed by it or by the selectmen 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 eertificate. 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-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 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 eertifying 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 hrought 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 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.)
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 Health 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) Medieal 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 electrical 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., beart failure, asphyxia, asthenia, etc. As principal cause name tbe disease 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 bousework, write housework. For a person engaged in domestic serviee for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
Suffolk
(County)
12
Vinthron
(City or Town)
No. 75 Theleside Are
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.
51
S ( If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Ellen Louise ( Mellen ) Barry
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Reeldence. No.
76 Ingleside Ave
St.
(If nonresident, give city or town and State)
Length of stay: In hosoltal or Institution.
(Before death)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deosased from
5
9
19 43
to
I last saw hallve on.
10. 19 LE, death is cald to
have occurred on the date stated above, at.
.. m.
6 Age of husband or wife if alive years
> IF STILLBORN. enter that fact here.
8
69
AGE
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occuoatlon :
Housewife
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
Charlestown
(Siale or country)
Massachusetts
Other conditions
( Include pregnancy within 3 months of death)
Major findinge:
Of operations
Date of
Of eutopsy
What test confirmed diagnosis?
IMPORTANT Physician Underline the cause to which death should ba charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?.. If so, specify.
(Signed)
(Address)
200.11
Date ........... 1.1 ... 1.1.19 ........
21
Place of Burial, Crenistion or Removal.
(City or Town)
DATE OF BURIAL ..
arch 13, 1913.
19
.....
22 NAME OF
FUNERAL DIRECTOR ..
John F. Oraley
ADDRESS
Signature of Akent of Board of Health or other) Health Officer
3/12/43
Raoelvad and Alad
1
An
19
(Oficial Designation) (Date of Issue of Permit)
( Registrar)
nonw. Every item of information
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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoltal to that effect. extracts from the laws on back of certificate.
100M. G - 2- 42-8855
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Jane O'Donnell
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Treland
17
June 2.
Holland
Relation, If any,
Informant
( Address)
AVe" 71TE ron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the ballet or transit permit was Issued : Nau. S. Childress
years
months
days.
In this community 20
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE|
Thite
5 SINGLE
( write the word)
MARRIED Tidowed
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
TO? (Give maiden name of wife in full)
Www.a.
( Husband's name in fuff)
20
0
Immedlate oause of death.
Duration IMPORTANT
.... 24 pour
Due to
Industry
Own Home
Due to.
13 NAME OF
FATHER
Michael Mellen
coronar
Invonhor1
10
1143
...
PLACE OF DEATH
PHYSICIAN - IMPORTANT
(Was deoeseed a
U. S. War Veteran,
if so epeoify WAR)
(Usual place of abode)
1
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 whoin he has attended during his last illnesa, 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, lis supposed age, the disease of which he died. defined as re- quired by section one. where same was contracted. the duration of his last Illneas, when laat seen alive by the physician or officer and the date of hia 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 lieliet, 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 immeiliate cause of death as nearly as he can state the saine. 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 humulred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety-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. Clrap. 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 haa received a permit from the board of health, or its agent appointed to lsaue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a human body and remove it from a town, from one cenietery 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 boily is buried. No such permit shall be Issued until there shall have been delivered to sucb board, agent or clerk, as the case inay be, a satisfactory written atatement 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, aa required by law, o1 in lieu thereof a certificate as liereinafter provided. If there is no attending physician, or if, for sufficient reasona, hia certificate cannot be obtained early enough for the purpose, or is insufficient, a physl- cian who ia a member of the board of health, or employed by 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 medl- cal examiner ahall make such certificate. If such a permit for the removal of a human body, not previously interred, froin oue town to another withrin the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the posaesaion ot 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, unlesa 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 heen engaged. sucb 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 nece+ sary information which can be obtained as to the deceased, or as to the manner of 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 hunian body or the ashea thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the hoard of health or its agent appointed to Issue such pertita, or if there is no such hoard, from the clerk of the town where the body is to be 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 ibe Internient ia made. . . . Chap. 114. Sec. 46. G. L., (Tercentenary Editiou).
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 hss notice that there is within his county the body of such a persou, he shall forthwith go to the place where the hody lies aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calla for the obaervance 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 physlolans will certify to such deatha only aa those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death ia needed.
(3) Medloal Examiners will investigate and certify to all deatha sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (Including resulting septicemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following abortion, but also deatha from diseasa resulting from Injury or Infeotlon related to oooupatlon, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualug death. As related causes, name earlier morbid conditiona, if any, related to the principal cause and any Important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation la very 1m- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the discase causing death, report the usual occupation prior to Illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at huine. For a woman whose only occupatiou was that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private fanrily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physiolans 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
PLACE OF DEATH
Suffolk (County) Winthrop
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.
S ( It death occurred in a hospital or institution, St. f give its NAME instead of street aud number)
2 FULL NAME
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No.
10 fout
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
female !
4 COLOR OR RACE|
which
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
undowned
Sa If married, widowed, or divorced
HUSBAND of
...
(or) WIFE of
See(Give maiden name
0
( Husband's name In full)
6 Age of husband or wife if alive
yaars
9 IF STILLBORN. enter that fact here.
8
9:0 Years
1
Months
4 Days
AGE
If less than 1 day
.... Hours ............ Minutes
Usual
9 Occupation :
House wife
Industry
10 or Business :
Idone
11 Social Security No.
12 BIRTHPLACE (City)
(Siate or country)
13 NAME OF FATHER abel Butterworth
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
England
PARENTS
15 MAIDEN NAMĀ OF MOTHER Martha alexander
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17 albert Woodward Informant ( Address) 10 pourthe Windlong horton
Relation, If any Place of Burial, Cremetion-of Rrmoral. DATE OF BURIAL Mar . 16,
(City or Town)
19.5}
......
I HEREBY CERTIFY that a satisfactory standard oartifiosta of death was filed with ma BEFORE the burial or transit parmit was Issued :
William D. Children
(Signature of Agent of Board of Health or other)
Health Officer man, 14/43
(Omclal Designate) (Date of Issue st Permit)
( Registrar)
VV
-
1
No.
(City or Town 10 Locust annie B. Wooder
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