USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 7
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Hospital
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
months
2 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
( Month)
29 1943
(Day)'
(Year)
That I attended deceased from
19 I HEREBY CERTIFY ,
november 22 1942
Summary 29
1943
1 last saw ham.
en
.alive on ...
January 29,643
death Is said to
have occurred on tha date stated above, at.
Immediate cause
death,
acute Myelogencons
Leukemia
4 mos
Due to.
Due to.
Other conditions.
Enlayed Hayrand
(Inelude pregnancy within & months of death)
Major findings :
Of operations
Sitestural obstruction
due to adhesion Date of July 25/194
Of autopsy
none
What test confirmed diagnosis ?..
.................... 2 years IMPORTANT
Physician t'nderline Alie cause to which death
charged sta- tistically.
20 was disease or injury in any way related to ocoupation of deceasedk2 ...
If so, specify.A ..
(Signed) Jacob Olan 1.80
.....
M.
P
(Address) 562 Munley Ti
Date Jau 3/
1043
21
Winthrop
Winthrop
l'lace of Burial, Cremation or Removal.
(City_or Town)
1
43
19.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the butlal of transi! permit was Issued : Www. D. Childress
(Signature of Kgout of Board of flealtR or other)
Ve allti
officer
2/1/43
(Official Designation) (Date of Issue of Permis)"
100m (d)-1-41-4067
4 COLOR OR RACEI 5 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCED
Married
Sa If married, widowed, or divorced
HUSBAND of
(Give mideberb Dodson
(or) WIFE of
( 11nsband's name in full)
6 Age of husband or wife if alive
49
years
7 IF STILLBORN. enter that fact here.
8
487,
5
Months
Days
4
If less than 1 day
Hours
Minutes
Usual
Housewife
Industry
Own Home
11 Social Security No.
None
Revere
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
J Neils Miller
FATHER (City)
(State or country)
Denmark
15 MAIDEN NAME
OF MOTHER
Anna Nelson
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Denmark
17 Albert Dodson
Informant. ( Aldre<4) 17" Bartlett Parkway winthrop
RHus band
DATE OF BURIAL
February
22 NAME OF
FUNERAL DIRECTOR Toward S Gerolds
ADDRESS
Want It That
Received and filed. .19
1
(Registrar)
No. 3 SEX AGE 9 Occupation : 10 or Business : PARENTS If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physiolans to insert a recital to that effect. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK -- THIS IS A PERMANENT RECORD. Every item of information 14 BIRTHPLACE OF
PLACE OF DEATH
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
...
St.
(If nonresident, give city or town and State)
16
5:157:
m.
Duration IMPORTANT
....
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 deaili 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 registration a standard certificate of death, stating 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 hy 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 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 cau 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, 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 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 exlume a human hody 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 sante 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 he 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. o1 in lieu thereof a certificate as liereinafter 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 medi- cal examiner 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 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 livalth, or its agent. upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other acces- sary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition ).
No undertaker or other person shall hury a human hody or the ashes thereof which have been brought into the conrmonwealth until he has re- ceived a permit so to do from 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 be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Clap. 114. Soc. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination npon 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 hody 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 physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from discase unrelated to any form of injury.
( 2) Board of Health physicians will certify to such deaths only as thoae 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 needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only death‹ caused directly or in- directly by traumatism (including reaulting 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 .- 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 conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- 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 on account of the discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gaiufully employed inay 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 uone.
SPACE FOR ADDITIONAL INFORMATION
-
M R-301 A
PLACE OF DEATH
Suffolk (County) Winthrop
2.9.43
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 Ägent.
Registered No.
( ( If death occurred in a hospital or institution, ¿ give its NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
mary J. Quigley
( If deceased is a married, widowed or divorced woman, give miso maiden name.)
(a) Residence. No.
280 Mesh Eagle St
St.
East Balon
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Refore desth)
( Specify whether)
yeara
months
3
days.
In this community / yrs.
mos.
daya.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female Mute
5 SINGLES
( write the word)
MARRIED
WIDOWED
or DIVORCED2 Med
Sa If married, widowed, or divorced
HUSBAND of
(or) WIFE of
-Give maiden name of wife in full)
( Husband's name in full)
6 Age of husband or wife if alive
55 years
9 IF STILLBORN. enter that fact here.
AGE
8
72
Years
Months
-
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Houserack
Industry
Olun Home
11 Social Security No.
12 BIRTHPLACE (City)
( Stale or country)
East Boston
masa
13 NAME OF
FATHER
Carneilus Lynch
14 BIRTHPLACE DF
FATHER (City)
(State or country)
chiland
15 MAIDEN NAME
OF MOTHER
ME Hancora Leather
16 BIRTHPLACE DF
MOTHER (City)
(State or country)
Chiland
17 Informant ( Address )
I Quiles
Relation, If any
. I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : William & Childress (Signature of Agent of Board of Ileaith or other) augent 1/31/43
(Omciai Designation) Mate of fQue of Permit)
18 DATE DF
DEATH
Jan
29 1943
( Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
face. 15
43
19.
to ..
That I attended deceased from au. 29
last saw h
alive on ..
Jan. 29 1943
.. , death is said to
have occurred on the date stated above, at
m.
Duration
Immediate cause
acuta Pulmonar actuar
Due to
Cardiac Fallera
2 days
5 ways
Other conditions.
( Include pregnancy whhin 3 months of death)
IMPORTANT
Major findIngs:
Df operations
Physician
Underline the cause to which death should charged sta- tisticallyf
20 Was disease or injury in any way related to ocoupation of degeased ?.
If so, specify
(Signed) Jens. H. Schmacht ..... ... , M. D.
(Address) 19 Questo Sv Ens Date 1/30, 19963
21
Place of Barial, Crepustion or Removal.
DATE OF BURIAL
1943
(City or Town)
22 NAME DF
FUNERAL DIRECTOR
Judeneck & manach
ADDRESS
East Boston
Received and Aled
19
( Registrar)
100M-6 -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 should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to insert a recital to that effect. PARENTS
1
... (City, or Town) Manchaop Community Hospitals. No.
2 FULL NAME
(Was deceased a
U. S. War Veteran,
if so specify WAR)
home
(Usual place of abode)
Habestal
MEDICAL CERTIFICATE OF DEATH
IMPORTAN 1 day
Due to
Streptococcus foryngites
Date of
Of autopsy
...
What test confirmed diagnosis?
aux phonynales
10 or Business :
4 COLOR OR RACEJ
BORTON NOTIFIED
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized per-on or of any meniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and behet the name of the deceased, bis supposed age, the disease of which he died. defined as re- quired 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 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 decessed, 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- fylug the war. and shall also certify in such certificate both the primary and the secondary or inmediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deenicd to have taken place hetwcen February fourteenth, eigliteen 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. 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 ita 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 ahall exhume a human body and remove it froin 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 aforexaid or from the clerk of the town where the body is buried. No such permit ahall be issued until there shall have been delivered to such board, agent or clerk, as the case thay be, a satisfactory written atatenient containing the facta required by law to be returned ankl 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 ilereinafter 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 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 renioval shall constitute a permit for such removai; 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 aerved 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 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 veces sary information which can be obtained as to the deceased. or as to the manner of cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a 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 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 from a person appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Cbap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons ss 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 aud 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 wili certify to such deatha only an those of persons to whom they have given bedside care during a iast iliness from disease unrelated to any form of injury.
(2) Board of Health physiolans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death is needed.
(8) Medloal Examiners will investigate and certify to all dcatha sup- posably due to injury. These include not only deaths caused directly or in- directiy by traumatism (including resulting septicemia), and by the action of chemical (druga or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from diseasa 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 .- Cause of deathi meana 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 conditiona, If any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation ia 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 yeara 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 had retired from business, report the usuai occupation prior to retirement. Children not gainfully employed may be returned aa at school or at home. For a woman whose only occupation waa that of honie housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
Cambridge notified 2-9-43
1
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town) Station Hospital, Fort Banks, Mass. No.
The Commontoralth ot 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.
18
( (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
HERBERT ALONZO WADSWORTH
(If deceased is a married, widowed or divorced
woman, give also maiden name.)
(a) Residence. No.
983 Memorial Drive
xx ... Cambridge ....
Mass.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
( Before death)
(Specify whether)
years
months
21days.
In this community
yrs.
O
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCEO Married
Sa If married, widowed, or;
Afitgingtre Norman
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 Unknown
7 IF STILLBORN. enter that fact here.
8
AGE .
55
Years
1
Months.
.22 Days
If less than 1 day Hours ........... ....... Minutes
Usual
9 Occupation :
officer
Industry
U. S. Army
10 or Business :
11 Social Security No.
None
12 BIRTHPLACE (City)
Lewiston, Idaho
(State or country)
13 NAME OF
FATHER
John Ribble Wadsworth
14 BIRTHPLACE OF
FATHER (City)
(Unknown)
-
(State or country)
Indiana
15 MAIOEN NAME
OF MOTHER
Mary Herbert
16 BIRTHPLACE OF
MOTHER (City)
(Unknown) -
(State or country)
Indiana
17 U. S. Army
Informant.
(Address)
.......... ( Relatlon, if any
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : Www. D- Childefter.
(Signature of Adept of Board of llbalth or other)
The alta Office 2/1/43
( Officlal Designation ) ( Date of Issue of PermitY
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
OEATH
January
29.
1943
(Month)
(Day)
(Year)
19 1 HEREBY CERTIFY,
That I attended deceased from
January 8,
19 43, to January 29,
1943
1 last saw
him
.alive on
January 29 19 43, death Is said to
have occurred on the date stated above, at.
6:30
a.
Immediate cause of death.
Congestive heart
Duration IMPORTANT
10 days
Due to.
Mitral insufficiency and
arteriosclerosis.
Due to.
Other conditions
Broncho pneumonia(Fried-
(Include preguancy within 3 months of death) Lander.
Cardiac hypertrophy. Anemia, simple
Major findings :
Of operations.
None
Date of
Of autopsy.
None
What test confirmed diagnosis?
IMPORTANT Physician
l'uderline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to ocoupation of deceased ?.......
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