USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 79
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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
301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
43
Sea View Ave
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 ite Agent.
252
Registered No.
[ { If death occurred in a hospital or institution, give ita NAME instead of street and nuniber) St.
PHYSICIAN - IMPORTANT
2 FULL NAME
THOMAS MANNINE ARCHDEACON
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
43
SEA VIEW AVE
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
...
years
months
days.
In this commuats
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
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
IF STILLBORN. enter that fact here.
8
AGE 23.
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occuoation :
TimeKeeper
Industry
10 or Business :
Fort
Devine N
11 Social Security No.
023 -- 12 -- 4826
winthrop
12 BIRTHPLACE (City)
( State or country)
Mass
13 NAME OF
FATHER
John J. Archdeacon
14 BIRTHPLACE OF
FATHER (Clty)
Boston
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Florence Manning
16 BIRTHPLACE OF
East Boston
MOTHER (City)
(State or country)
Mass
17 Informantlorence ... Manning ( Address) 43 Sea View Ave
Archde& pmon if any MOLH
I HEREBY CERTIFY that a sausfactory standard certificata of death was filed/with ma BEFORE the burlet or transit permit was Issued: MILL. Children
(Signature of light of Board of Wealth or other) Thealth sprick 10/23/43
(Official Designation) ( Date of Trave of Permail))
18 DATE OF
DEATH
22
1943
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
10/21
That I attended deceased from
19
43
to
10/22/1943
i last saw h
is alive on
10/221, 1973, death is said to
have occurred on the date stated above, at ...
le : 50 P.m.
Duration
IMPORTANT
Immediate cause of death. Jul. Tuberculosis
Dua to
7
Due to.
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
Major findIngs :
Of operations
Physician
Underiino the cause to which death should ba charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?.
If so, speoly Phcada Libe may
...... M. D.
(Signed) ..
(Address) 26 WaveWay Live Data :0/221943
21 Holy Cross Malden
Place of Burial, Cremation or Removal.
DATE OF BURIAL
(City ,or Town)
Oct . 25
1943
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Ohmy My Malet
Winthrop
Reosivad and Aled
19 ....
( Registrar) X
extracts trom the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
100M-G · 2·42-8855
Date of
Of autopsy
What test confirmed diagnosis?
X-rayo. etc
.........
MEDICAL CERTIFICATE OF DEATH
(Specify whether)
St.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No.
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 linesa, at the request of an undertaker or other authorized person or of any meniber of the family of the deceased, furnisb 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 by section one. where same was contracteel. the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 16, 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 ariny. navy or marine corps of the I'nited States in aus 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 can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred 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 hetween February fourteenth, eighteen hundred and ninety-eight and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundred aud sixteen and nineteen bundred 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 ita agent appointed to issue such permits, or if there is no such board. from tbe 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 cenietery to another, or from one grave or tomb other thau 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 shall be issued until there aball have been delivered to such board, agent or clerk. as the case may be, a satisfactory written statement 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 certifieste as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health. or employed by it or by the selectinen 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 ahaii make such certificate. If such a permit for the removal of a humnsu body. not previously interred, froin one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of desth made as above provided and in the possession of the undertaker desiring to make such removal shsil 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 recitai. aa 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 furnish for registration any other necet 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 .- Cbap. 114. Sec. 45. G. L., (Tercentenary Editlou).
No undertaker or other person shall bury a human body or the ashea thereof which have been brought Into the coninionwealth 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 intermeut is made. .. . Chap. 114. Sec. 16. G. L., (Tercentenary Editiou).
Medical examiners 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 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 lawa caiis for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only aa those of persons to whom they have given bedside care during a iast illness from disease unrelated to any form of injury.
(2) Board of Health phyalolana wili certify to such deaths only aa those of persons who, though disahled by recogulzed disease unrelated to any form of injury. have died without receut medical attendance or whose pbyaf- cian is ahsent from home when the certificate of death is needed.
(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 recuiting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from diacasa resulting from Injury or Infection related to occupation, the audden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causea death. not the mode of dying. e. g., heart failure, asphyxia, astbenia, etc. Aa 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 ia very im- portaut, so that the relative bealthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the disease causing death, report the usual occupation prior to illness. If the deceased bad retired from businesa, report the usual occupation prior to retirement. Children not gainfuily employed may be returned aa at school or at hoine. For a woman whose only occupation was that of honie housework. write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa bousekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301
PLACE OF DEATH
Suffolk
(County) Winthrop Ma (City or Town) 28 Thornton Park No ...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
St.
Effie Rand Plumer Rand
If deceased is a married, widowed or divorced woman, give also maiden name.)
28 Thorsten Park Wielkawon Pass
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
years
months
days.
-In this community 2 2 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
widened or Hvordan
(Give malden name of wife in full)
Fred Caldwell Pluma
(Husband's name In full)
67
years
6 Ago of husband or wife if alive ..
7 IF STILLBORN, anter that fact hore.
8
66
Years
7
.Months ....
Days
If less than I day
Hours .....
Minutes
0 Occupation :
at- home
Industry
10 or Business :..
Howscarpe
12 BIRTHPLACE (City).
(State or country)
newburg hat
mais
13 NAME DE
FATHER
ER James albert Rand
14 BIRTHPLACE OF
FATHER (City) ...
newburyport
18 MAIDEN NAME
OF MOTHER
Lydia Worcester Litch
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
nova Scotia
17
Fred .. Plumer (Araban)
Informant.(
(Address) 23 Thornton Park Withegg
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health/or other)
seattle officer 10/23/43 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
(Month)
(Day)
194)
(Year)
19 I HEREBY CERTIFY.
19 ...
.... , to.
That I attended deceased from
I last saw h .......
... alive
19
death is said to
have occurred on the date stated above, at.
2.200 m.
Immediate cause of death ..
Duration Important
Due to.
Due to
Important
Other conditions.
(Include pregnancy within 3 months of death)
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
-
20 Was disease ar injury in any way related to occupation ol deceased? ......
If so, specify
(Signed)
(Address) Y
Cnn n Date 10/22/07
M. D,
21
oak Hill ( unit newburyport mass.
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
Dc- 2411
19.5-3
22 NAME OF
Chas. R. Benensó
FUNERAL DIRECTOR
ADDRES
wirthich muss.
Received and filed. 19
A TRUE COPY ATTEST:
(Registrar)
8 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH.
Manuel
.........
Registered No ..... [ (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)
(Af nonresident, give city or town and State)
1 2 FULL NAME. 3 8EX Jewell. Sa If merrie HUSBAND of (or) WIFE of AGE Ueual II Social Security No. PARENTS If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert, a recital to that effect. 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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- (State or country) 100ml(2)-1-41-4695
Litchfield
Relation, if any
Of autopsy
What test confirmed diagnosis !.
Major findings: Of operations
Date of
19
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, after the death of a person wbom he bas 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, furnisb for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, bis supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive by the physiclan or officer and the date of bis death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnisbing a certificate of death as required by the preceding section or by section forty-five of chapter one bundred and fourteen, shall, If the deceased, to the best of his knowledge and helief, served in the army, navy or marine corps of the United States in any war in wbich It has been engaged, insert in the certificate a recital to that effect, specifying 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 same. For neglect to comply with any pro- vision of this section, sucb physician or officer shall 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" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between Fehruary fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder service of nineteen bundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not heen buried, until he has received a permit 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 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 receiv- ing tomb to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the hody is huried. No such permit shall he issued until there shall have been delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to he returned and recorded, which shall be accompanied, in case of an original interment, hy 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 hoard of health, or em- ployed hy it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously interred, from one town to another within the commonwealth cannot he 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 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 re- moval of such hody has been sooner ohtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-
six, tbat the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recltal shall appear upon the permit. The board of heaith, 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 tbe physician certifying the cause of death shall thereafter furnish for registration any other necessary Information which can he ohtained as to the deceased, or as to tbe manner or cause of the deatb, which the clerk or registrar may require .- Chop. 114, Sec. 45, G. 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 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.
No undertaker or other person shall hury 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 hoard of health or its agent appointed to issue such permita, or if there is no such hoard, from the clerk of the town where the body is to he buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or hurial 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 tbe observance of the following rules of practice:
(1) Attending physicians will certify to such deatbs only as those of persons to whom they bave given bedside care during a last Illness 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 disahled hy 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 will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of deatb 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 conditions, if any, related to the principal cause and any important complication of tbe principal cause.
Statement of Occupation .- Precise statement of occupation la 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 hy 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-301 A
1552 Suffolk
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. 204
Registered No.
St. 5 ( It death occurred in a hospital or institution, ( give its NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
Baby Boy Doherty 2 FULL NAME ..
( If deceased is a /married, widowed og divorced woman, give also 161 Johnson ave
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
yeara
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEĮ
Male White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
finale
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in futt)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if elive
years
> IF STILLBORN. enter that fact hera. Stillborn
8 AGE Years Months Days
If less than 1 day Hours . Minutas
Usual
9 Occupation :
none
Industry 10 or Business :
Move
11 Social Security No. MOVE
'2 BIRTHPLACE (City
( State of country)
Winthrop Mass
13 NAME OF
FATHER
James G. Doherty
14 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country)
mass
15 MAIDEN NAME
OF MOTHER
Catturine E. Sullivan
16 BIRTHPLACE OF
MOTHER (City) *.
( State or country)
East Boston
17 Informant ( Address)/
James & Doherty Jahre If any
I HEREBY CERTIFY that a satisfactory standard oartificata of death was filed with me BEFORE the dual or trangt permit was Issued ?
(Signature of Agent of Board of Hfaith or other) Heste Spreche 10/25/43
(Omcial Designation) ( Date of Issue of Permit)
18 DATE OF
DEATH
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