USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 30
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Statement of Oooupatlon .- Precise statement of occupation ia very im- portant. so that the relative bealthfulness 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 illuese. If the deceased bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at horne. For a woman wbose only occupatiou was that of home bousework. write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as bousekeeper-private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
if deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to insert a recital to that effeot
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Malden
(State or country) Mass
15 MAIDEN NAME
OF MOTHER Elizabeth Rourke
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
maso
17 Informant Lizabeth McDonald ( tilitroode) 25 Moore St
(Multiple 4h any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with,me BEFORE the burial or tramit permit was Issued : Www. D. Guldress x (Signature of Agent of Board of liearth of oflicr) Health Officer 4/12/43 (Official Designation) (Date of Issue of l'ermf)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
(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 mury was involved, state fully.) asphyxiation Positurial
POSITIONA
20 Accident, suloide, or homloide. (specify).
accidental
Date of ocourrenoe ..
april-10-
1943
Where did
Han thinh
injury ocour?
(Gity or town and State)
Did injury ooour in or about home, on farm, in industrial place, or in publio
piace?
(Specify type of place)
Injury
Manner of
Found dead in his vul
Nature of
Injury
While at work ?.
Was there an autopsy?
21 Was disease or injury in any way related to oooupation of deceased ?
If so, speolfy.
Huit Freckles
M. D.
(Signed)
(Address)
Bartin
apull-10-1943
22
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
19
23 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed ..
19
(Registrar)
-
1
PLACE OF DEATH No.
Swick (County) Arztxxx Winthrop
The Commonmoralth 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.
83
St. { (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME.
James G. M& Dwald
(If deceased is a married, widowed or divorced woman, give also maiden name.)
25 Moore St. Northrop
St.
(a) Residenoe. No.
(Usual place of abode)
Length of stay: in hospital or institution ....
(Before death)
(Specify whether)
years
months
days.
in this community
yrs.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(llusband's name in full)
6 Age of husband or wife If allve .
years
7 IF STILLBORN, enter that faot here.
8 AGE Years Month&I.I. Days
if less than 1 day
Hours ......
.Minutes
Usual
9 Ocoupation :
Industry
10 or Business :
11 Social Security No ..
Winthrop
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHEJames G. McDonald
50m (g)-1-41-4667
SHUMIN DIGIC CAUSE AND MANNER Ur VEAIn In plain rerms,
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.
M
=
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR).
(If nonresident, give city or town and State)
1943
Male white
(City or Town) 25 Kwore ST. Winthrop
R-303-A
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal officer shall forthwith, after the death of a person whom he bas atteruled 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 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.
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 comfdy 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 l'hilippine insurrection, which shall, for said purposes, be 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 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 lutman body and remove it froin a town, from one cemetery to another, or front one grave or tomb other than the receiving tomb to another in the same cemetery, until be has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the hody is buried. No such permit shall be issued until there sball have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall be accompanied, in case of an original interment. by a satisfactory certificate of the attending physician, If any, as required by law, or in lieu thereof a 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 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 medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously interred, front one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session 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 re- moval, unless a perinit 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 statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceaard, or as to the mamier or cause of the death, which the clerk or registrar thay re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the boily is to be buried or the funeral is to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Medical examiners shall make examination upon the view of the dead bodies of only auch 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.
. Ile shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manuer of death .- General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifiea 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 calla 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 illnesa from disease utirelated to any forin 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 neededl.
(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 trauntatism (including resulting septicemia), 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 by 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 atid of its consequences; and (2) under manner, the mode of its production together with the circuinstances when these are known. For example: "Con- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steant railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "l'facture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumahle nature; and (2) under manner, indicate the circuin- stances leading to medico-legal inquiry. For example: "Hemorrhage spon- taneous of the brain (basal ganglia) ( found dead in bed)." "ileart disease, presumably coronary sclerosis. (Sudden death. )"
DESCRIPTION (for unknown person) .
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
IM R-302
Worcester (County)
Grafton
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Grafton (City or town making return)
56
81
(C'ity or Town)
No.
Grafton State Hospital
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Anna D. Knudson
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
179 Pauline St
St.
Winthrop,
Mas.s ..
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution Hospital -
(Before death)
years
months
16days.
In this community
yrs.
· mos.
16 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
(Month)
(Day)
(Year)
5a If married, widowed, or divoroed
HUSBAND of
Ben jamimidkruds on 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.
8 AGE Years 75 Months. .Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housekeeper
Industry
10 or Business :
Own house
11 Social Security No ..
None
12 BIRTHPLACE (City)
Can ... not ..... be .... learned
(State or country)
Norway
13 NAME OF
FATHER
Seman Gulbrandsen
14 BIRTHPLACE OF
FATHER (City)
Can not be learned
(State or country)
Can not be learned
15 MAIDEN NAME
OF MOTHER
Tolina Tretburg
16 BIRTHPLACE OF
MOTHER (City)
Can not be learned
(State or country)
Can not be learned
(Signed)
(Address)
North Grafton
Date
4/12/9 43
21 PLACE OF BURIAL,
Winthrop, Winthrop
DATE OF BURIAL
22 NAME OF
Howard S. Reynolds
FUNERAL DIRECTOR
ADDRESS
Winthrop, Mass.
Reoelved and filed
MAY 3 1943
19
(Registrar of City or Town where deceased resided)
1
March 26
REEBY
CERTIFY,
43
19.
April 11,
143
Thạt
attended deceased from
I last saw h ... @I ...... alive on
April .... 11 ..... , 19.43 death Is sald to
have occurred on the date stated above, at 9:45 P .m.
Duration
Immediate cause of death.
Cardiorenal arteriosclerosis many
years
Due to.
Due to.
Other conditions.
Bronchopneumonia
3 days Physician
-
Major findings :
Of operations
None
Date of
Underline the cause to which death should be charged sta-
tistically.
What test
confirmed dlagnosis
20 Was disease or injury In any way related to oooupation of deceased ?... No ..
If so, speolfy
Soli Morris
M. D.
CREMATION OR REMOVAL
April 14, 1943
19
(City or Town)
17 Informant. Grafton S. H. recordselation, if any (Address) North Grafton, Mass
A TRUE COPY.
ATTEST:
(Registrar of city town when April 12, 1943th occurred)
19
DATE FILED
my previous" toutu "winch occurred in your city or town in case the deceased
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
50m (c)-1-41-4667
PLACE OF DEATH
1
Registered No.
1
(If U. S.
War Veteran,
specify WAR)
No
(Specify whether)
18 DATE OF
DEATH
April 11 1943
(Include pregnancy within 3 months of death)
PARENTS
Of autopsy
Clin & Lab
?
M R-303-A
PLACE OF DEATH
-- . (County)
1
No.
(City or Towd) text Banks Hospital Joseph T. Camino
St. { ( If death occurred in a hospital or institutlon, give its NAME instead of street and number)
2 FULL NAME
(If/deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No. 3 Paris Place E, Boston Les
(Usual place of abode)
Hospital
Length of stay: In hospital or Institution ..
(Before death)
(Specify whether)
years
months
( days.
In this community
yTs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX male
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) single
Sa If married, widowed, or divoroed HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve
years
7 IF STILLBORN, enter that faot here.
8 AGE 40, Years .Months. 3 ... Days
If less than 1 day Hours .. .Minutes
Usual 9 Occupation :
Soldier
10 or Business :
Industry
United States army
11 Soolal Security No ..... non 9
12 BIRTHPLACE (City) (State or country) n.Y.
13 NAME OF
FATHER
Eugene Cimino
14 BIRTHPLACE OF FATHER (City) (State or country)
Clt taly
15 MAIDEN NAME
OF MOTHER
Nicolena Pellegrino
16 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
17 Helen Bartolomeo
Informant ....
( Arlilipua) 8/ manis SIEB Rester
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with me BEFORE the burial of transit permit was Issued: Www. D. Clubdress
(Signature of Agent of Board of Health or other) Ife atthe office 4/14/43
(Official Designation) (Date of Issue of 'Permit)
V V
18 DATE OF
DEATH
april-12 -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 jfvolved, state fully.) Fractured Lacurated Brain
Traumatic Intracranial Hemorrhay
20 Aocident, suloide, or homlolde (specify)
Date of ooourrenoo
am-11-
1943
Where did
Besten
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or in publio place ? < street
(Specify) typs
Manner of
Said to have fallen in street
Injury aureus staffle with a man at
Nature of
5 MORE-11-1943
Injury
While at work?
Was there an autopsy ?..
yes
21 Was disease or Injury In any way related to oooupation of deceased ?.
If so, speolfy.
'M. D.
(Signed)
( Address)
Ostra
apa-12-2043
22 Holy Lexoss 1 Maldex
Place of Burial, Cremation or Removal. .
(City or Town)
Relation, if any
DATE OF BURIAL
april
15
1943
23 NAME OF
FUNERAL DIRECTOR.
OR Theder + magrath
ADDRESS
East Blottir
Received and filed
19
(Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effeot
extracts from the laws relative to the return of certificates of death.
50m (g)-1-41-4667
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
.. .............. . SI CHUAN MANNER OF DEATH in plain terms,
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, If so specify WARS r
Global ....
(If nonresident, give city or town and State)
Injury ooour ?
new york texty
PARENTS
1
BONTÓK NOTIZIE 5/10/13
-...
The Commonwealth 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. 85
(Give maiden name of wife in full)
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 umlertaker 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 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 ... Geu. Laws, Chap. 16, Sec. 9.
A physician or officer furnishing a certificate of death as required hy the preceding section or by section forty-five of chapter one humired 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 immciliate 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 include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, auil the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, 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 froin 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 bave been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall. be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a 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 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 medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to make such removal shall constitute a permit for such removal; proviled, that such body shall be returned to the town from which it was removed within thirty-six hours after suel re- moval, 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 reeript of such statement aml certificate, shall forthwith countersign it aint transmit it to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the decedard, or as to the manner or canse of the death, which the clerk or registrar may re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
Medical examiners shall make examination upon the view of the dead bodies of ouly 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. 3S, Sec. 6.
... lle shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manuer of death .- General Laws, Chap. 38, Sec. 7.
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