USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 76
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Of operations
Odino- Correm
Physician
Of autopsy.
Date of
4,00
Anderlino the cause to which death should be
What test confirmed diagnosis ?. S.
charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ? No If so, speolfy ..
....
R.
(Signed)
(Address) with
to GET [ 19]
19
11
1mln2 y// 200
Place of Burial, Cremation or Removal.
DATE OF BURIAL
10/7/43
(City or Town)
21
22 NAME OF
FUNERAL DIRECTOR
Johan St. peter
ADDRESS
135/ London It Lauf Boston
Received and Alad OCT 11 1943 19
( Registrar)
100M-6 · 2-42-8855
The Commonforalthe 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. 224
Registered No.
St.
S ( If death occurred in a hospital or Institution,
{ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased
U. S. War Veteran,
if so speolfy WAR)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
19
1 /2 your.
T
15
Ireland
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 s person whom he has attetuled during his last illness, at the request of an undertaker or other authorized person or of ans meniber of the family of the deceased, furnisb for registration a atandard 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 by section one. where same was contracted. the duration of his last illness, when last aeen alive by the physician or officer and the date of hia death ... Gen. Lawa, Chiap. 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 hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, aerved 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 inimediate 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 purposea, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety- eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. C. L. Chap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human body 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 ita agent appointed to lasue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it froin a town, from one cemetery to another, or from oue 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 ahall have been delivered to such board, sgent or clerk, as the case inay be, a satisfactory written atatenient 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, 01 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate caimot 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 aelectinen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If auch 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 haa been sooner obtained hereunder. If the death certificate contains a recital, as required
hy section ten of chapter forty-six, that the deceased served in the army, Davy 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 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 nece+ sary information which can be obtained as to the deceased, or as to the manner or canse of the death, which the clerk or registrar 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 board of health or its sgent 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. C. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died by violence. If s 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 hody liea aud take charge of the same; ... - General Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calls for the observance of the following rules of practice :
(1) Attending physiciana will certify to such deatha only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health phyalolans 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 phyaf- cian is absent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all deatha sup- posably due to Injury. These include not only deaths csused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following ahortion, hut also deaths from dlaeasa resulting from injury or infection related to oooupation, the sudden deaths of persons not disabled hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the dlaease. or complication which causes death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng death. As related causes, name earlier morbid conditions, if any. related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation ia very im- portant. so that the relative healthfulness of various pursuits can be known. Make aome eutry 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 gainfully employed may he returned as at school or at home. For a woman whose only occupatiou was that of home housework. write bousework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terma, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DELLE
Solemn High Mass.
M R-301
8 See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. 100m(b)-1-41-4693 T. D. WRITE PLAINLY, WITTE UNFAVING DLACE INE TITIS WATERMANENA ALVVASE. BTWY VODI VI ENTO PARENTS
PLACE OF DEATH No.
Suffolk (County )
(City er Town) 5 Charles.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
225
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number) PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran? .. If so, (specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
years months
days.
In this community X
yrs.
28
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
White
6 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)! married
5. If married, widowed, or divorced Well Thompson HUSBAND of. VEia.
(Givemaiden name of wife in full)
(or) WIFE of
(Husband's name in full)
8 Age of husband or wife if alive .years
7 IF STILLBORN. enter that fact here.
AGE
78 Years 6
.Months .. 6 Dayı
If less than 1 dey Hours
Minutes
Industry
Station agood manin Conchat
11 Social Security No ..... -
12 BIRTHPLACE (City) Ecet Pittaton
(State or country)
maine
13 NAME OF
FATHER
Daniel annon; Thoration.
14 BIRTHPLACE OF East bittetor FATHER (City) (State or country) moms.
· 18 MAIDEN NAME
OF MOTHER
Veste Pulsifer
16 BIRTHPLACE OF
MOTHER (City) ....
(State or country)
Ent Pellation
17 .-
Vera. 1osób. Tomaten
Relation, if any
wife
)
Informam 5 Chessa SE Nunchu mais
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the Burial or transit permit was issued: Hm . S. Chil dress D (Signature of Azept of Board of Health or other) 1 health Officer 10/4/43
(Official Designation) (Date of Issue of Pernfit)
18 DATE OF
DEATH
Out
(Month)
4
(Day)
1442
(Yeaf) -
19
I HEREBY CERTIFY.
19
19
I last saw h alive on
19
...... ,
death is said to
have occurred on the date stated above, at
5.30A
.m.
Immediate cause of death ....
Themmiluje
Due to Life a bit .
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis ?.
20
Was disease er injury in any way related to occupation of deceased ?.
If so, specifx
(Signed)
0 Fachowy
M. D.
... ... 19.3 ...
21
Havingto family
mexico mains
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
1943
FUNERAL DIRECTOR
22 NAME OF
Also. R. Gennem
ADDRESS
Received and filed
OCT - 1943
19
A TRUE COPY ATTEST:
(Registrar)
1
....
Winifred Cincon Thompson
(If deceased(je a married, widowed or divorced woman, give also maiden name.)
5 Charles LA
Winchut Mes
.......
(If nonresident. give city or town and State)
MEDICAL CERTIFICATE OF DEATH
That I attended deceased from
to
Duration Important
Important
PHYSICIAN
Underline the cause to which death should be charged sta- tlstically.
10 or Business:
79
-
St.
2 FULL NAME.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shali forthwith, after the death of a person whom he has attended during his last iliness, 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 fourteen, shail, 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, specifying the war, and shall aiso certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any pro- vision of this section, such physician or officer shail forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shail include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and Juiy fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shali 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 heaith, 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 shail exhume a human body and remove it from a town, from one cemetery to another. or from one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he has received a perinit from the board of heaith or its agent aforesaid or from the cierk of the town where the body is buried. No such permit shall be issued until there shail have been delivered to such board, agent or cierk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded. which shall be accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law. 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 in- sufficient, a physician who is a member of the board of health, or em- pioyed by it or by the selectmen for the purpose, shali upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shail 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 shaii 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 removai, unless a permit in the usual form for the re- movai 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 heaith, or its agent, upon receipt of auch statement and certificate, shail 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 shail thereafter furnish 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, Sec. 45, G. L., (Tercentenary Edition).
Medical examinere shall make examination upon the view of the dead bodies of only 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 shail forthwith go to the piace where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shaii 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 heaith or Its agent appointed to issue such permite, or if there is no such board, from the cierk 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 observance of the following rules of practice:
(1) Attending physicians wili certify to such deaths only as those of persons to whom they have given bedside care during a last iliness from disease unrelated to any form of injury.
(2) Board of Health physicians wili certify to such deaths only as those of persons who, though disabied by recognized disease unrelated 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 wiii investigate and certify to ail deaths supposably due to injury. These Include not only deaths caused directly or indirectiy by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but aiso 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 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 business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only 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
R-302
1
PLACE OF DEATH
(County) HAVERHILL (City or Town)
No.
10 Mt. Vernon
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
HAVERHILL (City or town making return)
226
Registered No.
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Flora B. Lewis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
(Usual place of abode)
244 Grand View av
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
....
years
months
days.
In this community
yrs.
mos.
20 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
18 DATE OF
DEATH
October
6
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, .Sept 19
That I attended deceased from
1944.3 ..
to ....
O.c.t ........
6
19 ... 43.
I last saw h ............ alive on
Q.c.t.5.
19.4.3 death is said to
have occurred on the date stated above, at
7.30 P.m.
Duration
6 Age of husband or wife if alive
6.5.
years
7 IF STILLBORN, enter that fact here.
8 73 Years 1 Months
22
.Days
If less than 1 day Hours. .Minutes
Usual
9 Occupation :
Music ..... teacher
Industry
10 or Business:
11 Social Security No ..
none.
12 BIRTHPLACE (City)
(State or country)
NH
Hampstead
13 NAME OF
FATHER
Osa D Nichols
14 BIRTHPLACE OF
FATHER (City)
Hampstead.
(State or country)
N H
15 MAIDEN NAME
OF MOTHER
Adeline C Bailey
16 BIRTHPLACE OF
MOTHER (City)
Salem.
(State or country)
NH
17 Joseph ... H Lewis
Relation, if any
Informant (Address) 244 Grand View ay Winthrop
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Oct
13
19 43
MEDICAL CERTIFICATE OF DEATH
19.43
Female
White
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
Immediate cause of death
Cerebral thrombosis
3 WK.
-
Due to
Arteriosclerosis
-
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of.
should be
charged sta- tistically.
What test confirmed diagnosis ?
20 Was disease or Injury in any way related to oooupation of deceased ?
If so, specify
(Signed) ES Bagnall
M. D.
(Address)
Groveland
Data 0 -8 19 43
21 PLACE OF BURIAL,
CREMATION OR REMOVALElmwood
Haverhill.
DATE OF BURIAL
october
9
(City or Town)
19 43
22 NAME OF
FUNERAL DIRECTOR
Earle W Graffam
Haverhill
ADDRESS
Reoelved and filed
NOV 9 1943
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
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.)
Underline the cause to which death
Of autopsy
PARENTS
AGE
(Specify whether)
........
(If U. S.
War Veteran,
specify WAR)
-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Towa) 216 Grovere No.
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 Agent.
Registered No. § ( If death occurred in a hospital or institution, ( give its NAME instead of street and nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME
annie miller
( If deceesed is a married, w@lowed or divorced women, give also maiden name.)
(a) Residence. No.
216 Grovere Que
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
yeara
months days.
In this community
2 yrs.
2
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
Female White
5 SINGLE
( ( write the word )
MARRIED
married
orVDIVORCED
Sa If married, widowed, or divorced
HUSBAND of
Julique meiden pm
( or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive yaars
IF STILLBORN. enter that fact here.
8 AGE 5.5 Years Months Days
If less than 1 dey Hours Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
at home
11 Social Security No. mone
12 BIRTHPLACE / City )
(Siate or country)
Russia
13 NAME OF
FATHER
Samuel Traub
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Rosalyn ( learned
apmal by
16 BIRTHPLACE OF MOTHER (City) ( State of country)
Russia
17 Julius miller
Informant (Address) 2/6 Justere Que Winthrop
22 NAME OF
FUNERAL DIRECTOR
ManuelaStanetoby
Reosivad and Aled
OCT 1 0 1943
19
........
( Registrar)
Duration IMPORTANT 7years
3 mas ....
6 mos IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
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