USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 6
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(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 traumatism (including resulting aepticemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following ahortion, but also deatha from diseass resulting from injury or Infeotlon related to occupation, the sudden deaths of persona not disabled by recognized dlaease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the diaease, or complication which causea death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name tbe diaease caualug death. As related causes, name earlier morbid conditiona, if any, related to the principat cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Im- portant, so that the relative healthfulnesa of various pursuits can be known. Make some entry in thia aection for every person aged 10 yeara or over. If the occupation had been given up or changed ou account of the dixcase causing death, report the usual occupation prior to illness. If the deceased bad 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 home housework. write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as housekeeper-private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 S
1
Suffolk /(County) 2. 9:4.3
The Commonwealth 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 Agente
Registered No.
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
2 FULL NAME
Female Purcell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No 106 Endicott avenue
(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
4 COLOR OR RACE,
5 SINGLE
(write the word)
Single
MARRIED
WIDOWED
or DIVORCED
5a If married, 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
Uoual
9 Occupation :. Industry 10 or Business:
II Social Security No .....
12 BIRTHPLACE (City)
Drinthrop
(State or country)
mans.
13 NAME OF
FATHER
Mark Purcell
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Revere
(State or country)
mass.
15 MAIDEN NAME
OF MOTHER
anna nielsen
18 BIRTHPLACE OF
MOTHER (City) ....
East Boston
(State or country)
mass.
17 mack Purcell
Relation, if any (Father)
Informant .. (Address) 106 Endicott ave.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with my BEFORE the burial of trapdit permit was issued:
Childress x
Signature of Agony of Board of Health or other)
Health Officer 1/29/43 (Official Designation) (Date of Issue of Permits Z
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
You.
25-1943
(Month)
(Day)
(Year)
19 I HEREBY CERTIF
19 ......
10/1
Far 25
19.
I last saw her alive on
19
death is said to
have occurred on the date stated above, at ....
m.
Duration IMPORTANT
Due to
Chimie Zephritis in wocher
Due to
albumina.
.....
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify Sempre . It Schianta
(Signed).
(Address) 19 Guests SV. EB Date 1/28
19.
¥3
21 S. Michaela Boston Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL ..............
196 .. 3
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS
& 17 Bennington St.
Received and filed. 19
(Registrar)
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
No.
(City or Town) PLACE OF DEATH IKinch DEVERE NOTIFIED
Winthrop Community Hospital St.
(If U. S. War Veteran. specify WAR).
.St
Severe
(If nonresident, give city or town and state)
That I attended deceased from
Immediate cause offeathers Acrates tortues
Major findings: Of operations.
Date of ....
-
Of autopsy.
What test confirmed diagnosis ?.
1OM - A- 1.42 - 8511
Corrected Copies sent - 10/29/43 FORM R-301 ||
Julfall (County)
REVERE NOTIFIED max 2- 9:43
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
15
Registered No. .....
(If death occurred in a hospital or institution,
,give its NAME instead of street and number)
2 FULL NAME
Batue Perotti;
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No 185Prospectaux
(Usual place of abode)
ength of stay : In hospital or institution
years
months
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX 4 COLOR OR RACE Female white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
7
Sa If married, widowed, or divorced
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. .years
7 IF STILLBORN, enter that fact here.
3
AGE
Yoarg.
Months.
Days
If less than 1 day
18Hours Minutes
11 Social Security No.
12 BIRTHPLACE (City)
OTinchaço
maux
(State or country)
13 NAME OF
FATHER
Peter Paratici
14 BIRTHPLACE OF
FATHER (City)
Revere
(State or country) mais
15 MAIDEN NAME
OF MOTHER
Fedeta Valla.
16 BIRTHPLACE OF
MOTHER (City)
IGrave
(State or country)
(mars
17 Jeter Ceratti
Relation, if any
Facher
(Address) 105 Pro ppeal Dorf
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the byrjak or translt permit was issued: Nu. D- Children Signature of Agent of Board of HealthZor other)
Health Office 1/29/43 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jan
29 1943
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
27
29
19.
to .............
19 3
...
A last saw b. alive on
027
19 ....... , death is said
10
to have occurred on the date stated above, at
..... 2, ... m.
Duration
Immediate cause of death ..
Tenture Cute
Due to
55 mn )
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis?
20 Was disease or Isjory In any way related to occopation of deceased ?
If so, specify ..
KA
M. D.
(Address).
21
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
19 ..
Y
FUNERAL DIRECTOR
22 NAME OF
livella
ADDRESS
Received and filed 19
A TRUE COPY ATTEST:
(Registrar)
MARGIN RESERVED FOR BINDING
1 PLACE OF DEATH HUSBAND of (or) WIFE of. Usual 9 Occupation: Inlormant. is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Industry 10 or Business:
per: bucure information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 200m-10-'39. No. 8427-d
(City or Town)
Now .....
Jau U. s. War Veteran.
specity WAR)
St.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
(Signed)
238 Mismach Lod
Date1/27
19/13
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 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 elerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu 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 certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-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 certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be
obtained as to the deccased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the 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) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatisin (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 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 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 housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
ESuffolk
(County)
Winthrop
The Commonforalth 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. 16
Registered No.
f ( If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17 Bartlett Parkway
(a) Residence. No.
(Usual place of abode)
Hospital
years
months
2 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
White
4 COLOR OR RACEI
5 SINGLE
( write the wurd)
MARRIED
WIDOWED
or DIVORCED
Married
Sa If married, widowed, or divorced
HUSBAND of
(Give mideberb: Dodson
(or) WIFE of
(Ihusband's name in full)
years
7 IF STILLBORN. enter that fact here.
AGE ..
8
487
Years
5
Months
4
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Housewife
Industry
Own Home
10 or Business :
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
Revere
Mass
13 NAME OF
FATHER
J Neils Miller
14 BIRTHPLACE OF
FATHER (City)
(State nr country)
Denmark
15 MAIDEN NAME
OF MOTHER
Anna Nelson
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
Denmark
17 Albert Dodson
ReHusband
Informant ( Address) 17 Bartlett Parkway Winthrop)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buffal of transil permit was Issued: Nuu. S. Childressx
(Signature of Agent of Board of Ilealth or other)
Ileallti 2/1/43
(Official Designation) (Date of Issue of Dermit)
18 DATE OF
DEATH
January
( MonthI)
29 1943
(Day)
(Year)
19 | HEREBY CERTIAX.
That I attended deceased from
november 22 1942
Summary 29
1943
1 last saw h.
en
.alive on ...
January 29,6/3
death Is sald to
have occurred on the date stated above, at.
5: 1570.
m.
Duration IMPORTANT
Immediate cause
acute Myelogeneous
Leukemia
4 mos
Due to.
Due to.
Other conditions.
Enlayed Murad
(Include pregnancy within
months of death)
Major findings :
Of operations
detestinal obstruction
due to adhesion Dat
of July 25/194
Of autopsy
none
which death should be charged sta. listically.
20 was disease or injury in any way related to ocoupation of deceased & .... If so, specify .......
.
M. D.
( Address) 362 Hurley To
Date Jau 3/
1943
21
Winthrop
arginthrop
l'lace of Burial, Cremation or Removal.
February
1
,43
19.
22 NAME OF
FUNERAL DIRECTOR
Howard S reynolds
ADDRESS
want It That
Received and filed 19
(Registrar)
100m (d)-1-41-4067
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
1
PLACE OF DEATH
(City or Town)
Winthrop Community Hospital
No.
Christina Marie Dodson
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
(If nonresident, give city or town and State)
16
Length of stay: In hospital or Institution
( Before death)
( Specify schother)
PARENTS
What test confirmed diagnosis ?.
............ 2 years IMPORTANT
Physician t'underline
(City_or Town)
DATE OF BURIAL
6 Age of husband or wife if alive
49
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 bis death .. . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buricd, 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 hoard, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hercinafter 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 certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-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 certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be
obtained as to the deccased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the 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 deathis only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Ilealth physicians will certify to such deatbs only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deatbs from disease resulting from injury or infection related to occupa- tion, the sudden deathis 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 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 housckecper-privatc family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
ESuffolk 1
(County)
Winthrop
(City or Town)
Winthrop Community Hospital
The Commonforalth 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. 16
Registered No.
{ { If death occurred in a hospital or Institution, St. (give its NAME instead of street and number)
2 FULL NAME
Christina Marie Dodson
(If deceased is a married, widowed or divorced woman, give also maiden nanie.)
(a) Residence. No.
17 Bartlett Parkway
(Usual place of abode)
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