Town of Winthrop : Record of Deaths 1943, Part 58

Author: Winthrop (Mass.)
Publication date: 1943
Publisher:
Number of Pages: 594

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 58

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SPACE FOR ADDITIONAL INFORMATION

R-301 |

CAUSE OF DEATH in plain terins, 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.

200m-10-'39. No. 8427-d

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with mo BEFORE the barial or transit pormit was issued:

Www. D. Childress.8.

(Signature of Agent, of Board of Health or other) Dealta (Dificial Designation) (Date of Issue of Permit)

8/13/43

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

aug 12 -1943

(Month)}

(Day)

(Year)

19 I HEREBY CERTIFY. That I attended deceased from

19 ..

.... , to ....

.....

...

19 ..

I last saw h ............ alive on.

19 ........ ,

death is said

to have occurred on the date stated above, at 7:15 pm.

Duration

Immediate cause of death Stillborn 8/2 minutes

Due to

Other conditions

(Include pregnancy within 3 months of death)

Major findings :

Of operations

Of autopsy

What test confirmed diagnosis ?.

20 Was disease or lojury la aoy way related to occupation of deceased ?

(Signed)

305 Have & EBoth aug 12.

.. Date .....

21 Holy Gross malden

Place of Burial, Cremation or Removal.

DATE OF B

August

Kelly

(City or Town)

ADDRESS

11 Mendiala 5%, 50

Received and filed

A TRUE COPY ATTEST:

(Registrar)

PLACE OF DEATH

BOSTON NOTIFIED 9/9/ 43 Supfick

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD

CERTIFICATE OF DEATH

Registered No ..

It It audrey Rd Winthrop Communityen) Hospital No.

.St. ( give its NAME instead m street and number)

2 FULL NAME

Baby Boy Short

(If deceased is a married, widowed or divorced woman, give also maiden name.)

16 St andrews Rd

St.

(a) Residence.

No.

(Usual place of abode)

Length of stay: In hospital or institution

(Specify whether)

years

months

days.

In this community -

yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX Male

4 COLOR OR RACE | 5 SINGLE

white

(write the word)

MARRIED

WIDOWED

or DIVORCED

Single

5a If marrfed, widowed, or divorced HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 Age of husband or wife if alive.

years

7 IF STILLBORN, enter that fact here. stillborn

8 - AGE. Years.

Months Days

If less than 1 day Hours .. Minutes

Usual

9 Occupation:

Industry

10 or Business:

11 Social Security No.

Winthrop

12 BIRTHPLACE (City)

(State or country)

13 NAME OF

FATHER

Lynar W. Short

PARENTS

4 BIRTHPI

FATHER (City)

11924 ceville

(State or country)

wisconsin

15 MAIDEN NAME

OF MOTHER

Catherine A. Ryan

16 BIRTHPLACE OF

MOTHER (City)

East Boston

(State or country)

ruas

17 Mrs un Hart Relation, if any

aunt

Informant

(Address)

14 St. Andrews Td. E.B.

PHYSICIAN

Date of ..

.....

Underline the cause to which death should be charged sta- tistically.

If so, specify.

Charles meloni

M. D.

19 ..

-1943

22 NAME OF

FUNERAL DIRECTOR

(City or town making return)

(County) & By Winthrop

(City or Toyn)

(If U. S.

War Veteran.

specify WAR)

.....

2/0.

(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 hy the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.

No underlaker or other person shall hury or otherwise dispose of & human hody in a town, or remove therefrom a human body which has not been huried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhumc a human hody and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may he, a satisfac- tory 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 hy 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 hy it or hy 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- incr shall make such certificatc. 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 hody 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 heen sooner obtaincd 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 hoard 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, Sce. 45, G. L., (Tercentenary Edition.)

No undertaker or other person shall hury a hunian 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 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 thesc laws calls for the ohserv- ance of the following rules of practice :

(1) Altending 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 dicd 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 lo injury. These include not only deaths caused directly or indirectly hy trawnatism (including resulting septice- inia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut 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 fallure, 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 causc.

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 husi- ness, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For & 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 housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.

SPACE FOR ADDITIONAL INFORMATION

1 A Auffolk

PLACE OF DEATH

(County) Winthrop (City or Town) 4) Cliff are No.

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.

Registared No. S ( If death occurred in a hospital or institution, ( give its NAME instead of street and nunsber)

PHYSICIAN - IMPORTANT

(Was deceased a

U. S. War Veteran,

if so spaolfy WAR)

(a) Residenca. No.

(Usual place of abode)

Length of stay: In hospital or Institution.

(Before death)

( Specify whether)

years

months

days.

In this community

yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

Male

4 COLOR OR RACE

White

5 SINGLE

MARRIED

WIDOWEO

or DIVORCEO

(write the word)

married

5a If married, widowed, or divorced HUSBAND of

(or) WIFE of

( Husband's name in full)

6 Age of husband or wife if aliva

yaars

> IF STILLBORN. enter that fact hera.

AGE

Years

Months

Days

If less than 1 day

Hours.

Minutas

Usual

9 Occupation :

Wire Chief.

Industry

10 or Business :

New England: Jet Set-Co.

11 Social Security No.

021-09-8466

12 BIRTHPLACE (City)

(State or country)

New York.

13 NAME OF

FATHER

FrenW myalls

PARENTS

15 MAIDEN NAME

OF MOTHER

Lara Pastoral

16 BIRTHPLACE OF Livermore Falls MOTHER (City) Liveson (State or country) Mame!

17 (Address) 47 Led Vave Windwith Straw Hiss!

I HEREBY CERTIFY, that a satisfactory standard oartifioste of death was fled with me BEFORE the burial or transit permit was Issued ?

(Signature of Agent of Board of Health other)

Idealthe Melidir 8/16/43

(Official Designation) ( Date of Issue of Permit)

18 OATE OF

DEATH

august

14 1943

Month)

(Day)

(Year)

19 | HEREBY CERTIFY,

august 13

,43

august 14

19.

That I attendad deosased from

I last saw h

.alive on

august 14, 194 death Is said to

hava oocurred on tha data statad abova,

at 12:30 p!

Immedlate cause of daath.

Cerebral Hemontage

Oua to.

arteriosclerosis

Due to.

Other

none

( Include pregnancy within 3 months of death)

IMPORTANT

Major findIngs:

Of operations

none

Data of

Of autopsy.

noul

What test confirmed Clinical

20 Was disease or injury in ony way rajatad to oooupation of deogesed ?...

(Signad) Jacoby Giant

... 4

M. D., (Address)362, turkey VY

Date

.....

Date of Burial, Crensation or Removal, DATE OF BURIAL.

1973

22 NAME OF

FUNERAL DIRECTOR

ADORESS

242 Washing Inlove Likea

Raoaived and fled If 8.3 1943

( Registrar)

St.

2 FULL NAME.

Harold @ Ingalls

( If deceased is a married.

47 Clics Love

widowed or divorced woman, give also maiden name.)

St.

(If nonresident, give city or town and State)

Freuen Kisteen (Give maiden name of wite in full)

Duration

2-3 more.

Physician Underlina the cause to which death should ba charged sta- tistically.

100M-6 - 2-42-8855

14 BIRTHPLACE OF

FATHER (Clty)

(State or country)

maine

Perú

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 regls- 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 dicd, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody 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 tomh 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 he, a satisfac- tory 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 physician who is a member of the board of health, or employed hy it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy 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 hody 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 hoard 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, Sco. 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 untll he has received a permit so to do from the hoard 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, Scc. 46, G. L., (Tercontenary Edition. )

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the ohscrv- 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) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by trawnatism (including resulting septice- inia), 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 morhid con- ditions, if any, related to the principal cause and any important complication of the principal causc.

Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursults 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 husi- ness, report the usual occupation prior to retirement. Children not gainfully employed may he 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 housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.

SPACE FOR ADDITIONAL INFORMATION

1 A

Andfolk

(County) Winthroks (City or Town) 4/ Cliff Que No.

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, give its NAME instead of street and number)

PHYSICIAN - IMPORTANT

(Wes deceased

U. S. Wer Veteren,

if so specify WAR)

St.

(If nonresident, give city or town and State)

Length of stay: In nosoltal or Institution

(Before death)

(Specify whether)

yeera

months

days.

In this community

yrs.

mos.

dayı.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

Male

4 COLOR OR RACEJ

White

5 SINGLE

(write the word)

married

MARRIED

WIDOWED

or DIVORCED

Sa If married, widowed, or divorced trendem Risteen

HUSBAND of

(Give meiden name of wife in full)

(or) WIFE of

( Husband's name in full)

6 Age of husband or wife if alive

years

" IF STILLBORN. enter that fact here.

AGE

Years

Months

Days

If less than 1 day

Hours

.Minutes

Usual

9 Occupetion :

Chief.

Industry

10 or Business :

New England: Jet Set-Con

11 Social Security No.

021-09-8466

12 BIRTHPLACE (City)

( Siate or country)

new york.

13 NAME OF

FATHER

FrenW myalls

PARENTS

15 MAIDEN NAME

OF MOTHER

Lira Basford

16 BIRTHPLACE OF-7

MOTHER

Livermore Hallo

(State or country)

name.

17 And Flowwith Myallex 320h. y any. (Address) STE

I HEREBY CERTIFY, that a satisfactory standard certificate of death wes fled with me BEFORE the burial or transit permit was Issued :

(Signature of Agent of Board of Health other)

Idealthe Appear 8/16/43

(Official Designation) ( Date of Issue of Permit)

18 DATE OF

DEATH

august

14 1943

(Month )

(Day)

(Year)

19 | HEREBY CERTIFY,

august 13

,43

august 14

That I attended deceased from

19.

i last saw h

.alive on

august 14, 1940 death Is said to

have occurred on the date stated above,

at 12:30 p!

.m.

Immedlate cause of death.

Cerebral Hemontage

Due to.

arteriosclerosis

Due to

Other conditions.

none

( Include pregnancy within 3 months of death)

IMPORTANT

Physician

Underline the cause to which death should be charged ste- tistically.

20 Was disease or injury in any way rejeted to oooupation of deogesed .... If so, specify ........... (Sig Jacob,tranne 10,000 M. D. (Address)362, Turkey CY

Date Gy 14945.

......

Date of Burial, Cremation or Removal DATE OF BURIAL

Felicity der aprescole .

.. 2 ... 19. 43

22 NAME OF

FUNERAL DIRECTOR.

ADDRESS

242 Washing Salone Likea.

Received and Aled. 6 83 1943

( Registrar)

100M-G - 2-42-8855

PLACE OF DEATH

2 FULL NAME.

Harold @ Ingalls

( If deceased is a married,

(a) Residence. No.

47 Will Love

widowed or divorced woman, give also maiden name.)

(Usual place of abode)

Duration

2 -3 more.

Major findings :

Of operations

none

Dete of

Of eutopsy.

noul

What test confirmed diegnosis? clinical

14 BIRTHPLACE OF

FATHER (City)

(State or country)

maine

peru

St.

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 anthorized per-oo or of ans meoiber 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 by section one, where same was contracted. the duration of his last ilInesa, 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 furoishing a certificate of death aa 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, apeci- 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 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 aod of sections forty-five, forty-six and forty seven of said chapter one bundred and fourteen, the word "war" shall inchide the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, 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 sixtcen and nineteen bundred and seventeen. G. L. Chap. 46, Sec. 10.

No undertaker or other person shall bury or otherwise dispose of a buman 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 isaue such permita, 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 huinan 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 haa received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there aball bave been delivered to such board, agent or clerk, as the case inay be, a satisfactory written atatenient containing the facta 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 ia no attending physician, or if, for sufficient reasons, hia 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 medi- cal examiner shall make sucb certificate. If aucb 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 renioval ahall 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, uoless a permit in the usual form for the removal of such body has been aooner obtained hereunder. If the death certificate containa a recital, as required

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Town of Winthrop : Record of Deaths 1943, Part 58

Author: Winthrop (Mass.) Publication date: 1943 Publisher: Number of Pages: 594

Author: Winthrop (Mass.)
Publication date: 1943
Publisher:
Number of Pages: 594