USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 25
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SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
(County)
Winthrop
(City or Town)
No. Fisher Rest Home
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, St. give its NAME instead of street aud number)
2 FULL NAME
Edith F Wendell
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
10 Sturgis St
(Usual place of abode)
Hospital
years
3 months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Married
Female
White
5a If married, widowed, or divorced
HUSBAND 'of
{Give meiden name of wife in full) .
(or) WIFE of
( Husband's name in fuli)
6 Age of husband or wife if elive 70 years
> IF STILLBORN. enter that fect here.
8
AGE
83 Years 2
Months
21 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupetion :
Housewife
Industry
Own Home
10 or Business :
11 Social Security No.
None
Bath
12 BIRTHPLACE (City)
( State or country)
Maine
13 NAME OF
FATHER
Cyrus E Parker
14 BIRTHPLACE OF
Unable to Obtain
FATHER (Clty)
(State or country)
15 MAIDEN NAME
OF MOTHER
Anna Cross
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
Mrs Henry Barneg RDaughter
17 Informent ( Address) 12 Baldwin Pl. New Haven Conn
I HEREBY CERTIFY that a satisfactory standard certificata of death was filed with ma BEFORE the burla/or transit permit was Issued ? Www. D. Children -
(Signature of Agent of Board of Healththe other )
He atthe officer 3/30/43
... (Omcial Designation) (Date of Issue of Permit)/
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March
28,
1943
( Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
Thet I attended deceased from
Jung. 15.
1942, 40
March 28
19 43
I last saw h ...
er alive on
March 27, 1943, death is said to
have oocurred on the date stated above, at.
2,15 a.m.
Immediate cause of death
Cerebral Hemorragia
Sudden
3 years
...
10 years
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Mejor findIngs :
Of operations
Date .of
Of autopsy
What test oonfirmed dlegnosis ?.
Clinical Signs
20 Was disease or injury in any wey related to oooupation of deceased ?........
If so, spaolfy
('Signed)
M. D.
(Address)
Date Mar 24 1943
21
Woodlawn
Piace of Burial, Cremation or Removal.
March
30
(City or Town)
43
DATE OF BURIAL.
19
22 NAME OF
FUNERAL DIRECTOR .:
Howard JEmotels
ADDRESS
Reoalved and Aled.
1543
19.
( Registrar)
100M-G - 2-42-8855
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, Section 10, requires physicians to insert a recital to that effect. PARENTS
1
PLACE OF DEATH
-
PHYSICIAN - IMPORTANT
U. S. Wer Veteren,
if so spoolfy WAR)
St.
(If nonresident, give city or town and State)
20
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
Due to
Hypertension
Arterio Sclerosis
Duration
IMPORTANT Physician
Underline the cause to which death should ba charged sta- tistically.
Everett
........
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physloian or registered hospital medloal officer shall forthwith, after the death of s person whoin 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 ataudsrd certificate of death. ststing to the best of his knowledge and belief the name of the deceased, bis supposed age, the disease of which he died. defined as re- quired by section one. wleere 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, 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 deceased, to the best of his knowledge and belief, 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 same. For neglect to comply with any provision of this section, such physlcisn or officer shall forfeit ten dollars. For the purposes of this aec- 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 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. Chsp. 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 s permit from the board of health, or its agent appointed to lasue 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 fromn 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 delivered to such board, sgent 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. o1 in lieu thereof a certificate as liereinafter provided. If there is no attending physician, or if, for sufficient ressous, his certificate camot 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 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, from one town to another within the comunouwealth cannot be obtained esrly enough for the purpose, the certificate of desth made as above provided and in the possession ot the undertaker desiring to make such removal sliall 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 hody has been sooner ohtalued hereunder. If the death certificate contains a recital, aa 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 ststenient 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 canse of the death, which the clerk or registrar unay 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 hoard of health or its agent appminted 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 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 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 & 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 phyalcians will certify to such deatha only as those of persons to whom they have given hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health phyalolans will certify to such deaths 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 ia absent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatiam (including resulting septicemia). and by the actlon of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from dlacasa resulting from injury or Infection related to occupation, the sudden deatha of persons not disablad hy 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 fallure, asphyxia, asthenia, etc. Aa principal cause name the disease caualug death. As related causes, name earlier morbid conditions, If any, related to the principal cause and any important complicstion of the principal cause.
Statement of Oooupatlon .- 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 hsd 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 occupatiou was that of honie 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)
The Commontoralih 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, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or-divorced woman, give alo 25 Wordsile que. Huech St
(a) Residence. No.
(Usual place of abode)
(If nonresident, give clty or town and State)
Length of stay: In hospital or Institution
(Before death)
years
months days.
In this community
3 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
X SEX
4 COLOR OR RACEJ
I hite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
18 DATE OF
DEATH
March
30
1943
( Month)
(Day)
(Year)
Sa If married, widowed, or divorced
HUSBAND of
...
(or) WIFE of
My soive maiden none of fate in file
( Husbend gl neme In full)
6 Age of husband or wife if alive
years
> IF STILLBORN. enter that fact here.
8 AGE 70 Years Months . Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Thome
Industry
10 or Business :
11 Social Security No.
'2 BIRTHPLACE ( City)
(State or country)
man
13 NAME OF
FATHER
14 BIRTHPLACE OF FATHER (Clty) (State or country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Joseph & Brown Relation, If any
Informant ( Address) 25/ /tharde de Hecho
I HEREBY CERTIFY that a satisfactory standard certificate of deeth wes filled with ma BEFORE the burial or transit permit was Issued ? W M. D. Childrensp
(Signature of Agent of Board (of Health or other)
VLe altre Milicer 4/1/43
(Omcial Designation) ( Date of Issue of Permit)
19 | HEREBY CERTIFY,
That I attended deceased from
April 15.
March 29
19
43
I last saw h ......!........ alive on.
ANMAREA - 1943, death Is said
have occurred on the date stated above, at.
11
9.
Immedlate oause of death. Cerebral Hemorrhage
IMPORTANT
3 years .......
Due to.
Due to.
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findings:
Of operations
Date of
Of eutopsy
What test confirmed dlegnosis ?..
Clinical Signs
Underline the cause to which deuth should be charged sta- listically.
20 Was disease or injury in any way related to occupation of deceased ? 200 If so, specify
....
21
Harmo
Plece of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
19:443
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Recalvad and fled 19
APR.
1 .... 1943
(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-4 - 2-42-8855
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physicians to insert a recital to that effect.
1
PLACE OF DEATH
Weretwoh ......
(City or Toupp 125 & till que Hanters No.
mrs. Paulie Rest (Bowditch
2 FULL NAME
race Brauni
maiden name.)
(Waa deocesed a U. S. War Veteran, if so specify WAR)
(Specify whether)
-
(Signed)
Winthrop, mass
M. D.
Date March311913
PARENTS
Duration
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medioal officer shali forthwith, after the death of a person whoin he has attended during his last illness, at the request of an undertaker or other authorizeil person or of any meniber of the family of the deceased, furnish for registration a standard certificate of desth, ststing 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 Que. where same wss contracted. the duration of his last Iliness, when last 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 belief, served in the army, navy or marine corps of the l'uited States in any war in which it has been engaged, insert in the certificate a recitsi to that effect, speci- fying the war, sud shall also certify in such certificate both the primary and the secondary or iinmeiliste csuse of death as nearly as he can state the ssine. For neglect to comply with any provision of this section, such physician or officer shsil forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one buwired and fourteen, the word "war" shall inchule the Chins 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 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 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 thau the receiving tomb 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 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 board of hesith. or employed by it or by the selectinen for the purpose, shsli upon application niske the certificate re- quired of the attending physician. If death is csused by violence, the medi- 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 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 served 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 statenient 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 manier of 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 hunisn body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a perinit so to do frum the hoard 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 be buried or the funeral is to he held, or front a person appointed to have the care of the cemetery or burial gronml in which the interment is 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 by violence. If a medicsi examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the hoily 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 fast iffuesa from disease unrelated to any form of injury.
(2) Board of Health physlofans will certify to such deaths only as those of persons who, though disshled 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 is needed.
(3) Medioai Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not onis deaths csused directly of in- directly by traumatism (including resulting septicemia), and by the action of cheniical (drugs or poisons), thermal, or electrical agenta, aml deaths following abortion, but also deaths from disease resulting from injury or infeotlon 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 meana the disease, or complication which causes death. not the moile of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng 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 Oooupatlon .- Precise statement of occupation la 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 iliness. 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 home. For a woman whose only occupatiou waa that of honie 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-303-A
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for extracts from the laws relative to the return of certificates of death. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to insert a recital to that effeot
PLACE OF DEATH
Suffice (County)
(City or Town) 251 Court Road
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
St. § ( If death occurred in a hospital or institutlon, { give its NAME instead of street and number)
2 FULL NAME.
(If deceased ie a married, widowed or (divorced woman, give also maiden name.)
(a) Residenoe. No.
2
51 Crest Rd Niettuch
(Usual place of abode)
Length of stay: In hospital or Institution ...
(Before death)
(Specify whether)
years
months
daye.
(If nonresident, give city or town and State)
In this community 0 yre.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE Muito
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED ced
5a If married, widowed, or divoroed HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
(Husband'e name in full)
6 Age of husband or wife If allve 50 years
7 IF STILLBORN, enter that faot here.
8 AGE ... 50 .Years
Months. - Days
If less than 1 day Hours Minutes
Usual 9 Ocoupation :
Houseunk
Industry 10 or Business :
11 Scolal Security No ...
East Portare
12 BIRTHPLACE (City)
(State or country)
masa
PARENTS
15 MAIDEN NAME OF MOTHER SER Mannie D. Richarda
16 BIRTHPLACE OF MOTHER (City) (State or country)
Petit Givere
17
n
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : WilliamD. Childress (Signature of Agent of Board of llealth or other)
agent april 1/1943
(Official Designation) (Date of Issue of l'ermit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
march - 30-1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, st De fully.) acute cardiac failure
Hypertensive Heart Ducase
20 Aooldent, sulolde, or homlolde (specify) Date of ooourrenoe ... 19
Where did Injury ocour ?
(City or town and State)
Did Injury gcour In or about home, on farm, in Industrial place, or In publio
place ? (Specify type of place) Manner of Found dead in his cellar
Injury
Nature of
Floor
Injury
While at work ?. Was there an autopsy ?.
21 Was disease or Injury In any way related to occupation of deceased?
If so, specify.
Hun Suckles
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