USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 80
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Oct 22
(Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attendad deceased from
353 1943
to
19
/ last saw h
alive on
19
......
daath is sald to
hava occurred on tha date stated above, at.
7:45 p.m.
Duration IMPORTANT
Immediate cause of death
Stelton
Due to.
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findIngs :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
IMPORTANT Physician Underline the cause to which death should ba charged sta- tisticelly.
20 Was disease or inify in any way relatad to oooupation of deceasad ?.
If so, specify ...
('Signad )
(Address)
Data. 10/2019 17
21
Holy Cross C
l'iace of Burial, Creniation or Removal.
malden
(gity or Town)
DATE OF BURIAL ...
Och 25
19.53
22 NAME DF
FUNERAL DIRECTOR ....
Charles 78. Treana
ADDRESS
Earl Boston
19
Reoaivad and Alad.
DC1 29 1943
( Registrar)
100M-G - 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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Sootlon 10, requires physicians to insert a recital to that effect.
1
PLACE OF DEATH
( CHunta ) Withrok ......
No. ......
(City on Town)/ Winthrop Community peaspita
maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
1943
PARENTS
. M. D.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail forthwith, after the death of a person whoin he has attemuled during his last illness, at the request of an undertsker or other authorizeil person or of any member of the fanrily of the deceased, furnish for registration a atandard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disesse of which he died. defined as re- quired by section one. wliere ssme wss contracieil. the duration of his last illness, when last seen alive by the physician or officer aud the date of hia death . .. Gen. L.sws, Chap. 46, 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 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- fying the war, and shall also certify in such certificate hoth the primary and the secondary or immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia 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 horder service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chlap. 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 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 bosrd, from the clerk of the town where the person died; and no undertsker or other person shall exhume a huinan body and remove it froin a town, from one cenietery to another, or from one grave or tomh other thau the receiving tonih to another in the same cemetery, until he has received a permit from the hosrd of health or its agent aforessid or from the clerk of the town where the hoily is huried. No such permit shsil he issued uutil there ahall have been delivered to such hoard, agent or clerk, as the case inay be, a satisfactory written statement containing the facts required by law to he returned ail recorded, which shall be accompanied, in case of an original internient, 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 physi- cian who is a member of the hosrd of health, or employed by it or hy the aelectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death is caused hy violence. the medi- cal examiner chall 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 esrly enough for the purpose, the certificate of desth made as above provided and in the possession ot 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 removsl, unlesa a permit in the ususl form for the removal of such body has heen sooner obtained hereunder. If the desth 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 heen engaged. such recital shall appear upon the permit. The hoard 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 nece+ sary infurnimiion which can he obtained as to the deceased, or as to the manuer 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 hunisn hody or the ashes thereof which have been brought Into the conimionwealth until he has re- cenved a permit so to do from the hoard of health or its agent appointed to issue ruch 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 iu which the interment is made. ... Chap. 114. Sec. 46. G. L., (Tercentenary Editiou).
MedicsI examiners shall make examination upon the view of the dead hodies of only such persons ss are supposed to have died hy 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 lica aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawe calle 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 last illness from disease unrelated to any form of injury.
(2) Board of Health physiolana will certify to such deaths only ae 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.
(3) Medical 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 septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, all deaths following ahortion, hut also deaths from diseasa resulting from injury or Infeotlon related to occupation, the sudden deathe of persons not disabled hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death, not the moile of dying, e. g., heart failure, asphyxia, asthenia, 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- 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 heen given up or changed ou account of the discase causing death, report the usual occupation prior to illness. If the deceased hsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned aa at school or at hoine. For a woman whose only occupation was thst of honre housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
104 Highland ave No Ella m Earle
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No .....
255
f (If death occurred in a hospital or Institution, St. { 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
5
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widood
Ba If married, widowed, or divorced
HUSBAND of ...
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. .years
If less than 1 day
Hours
Minutes
Danvers
man.
13 NAME OF
FATHER
Daniel Fogy
(State or country) mans.
18 MAIDEN NAME
OF MOTHER
Ella unknown
(State or country)
man
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:
Itm & Childress
(Signature aver d'eau of Health or other)
10/28/43
... (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
25
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY
That I attended deceased from
1943, to Coaf25
1943
I last saw han alive on
Oct 26, 1993, death is said to
have occurred on the date stated above, at 9:40 $
m.
Immediate cause of death.
Cranio Decompensate
Due to.
Oh, Hypertension trasterotal
Due to.
Other conditions.
Semília
(Include pregnancy within 3 months of death)
Major findings: Of operations.
Of autopsy
What test confirmed diagnosis ?.
Chacal
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?Le .. .
If so. specify
(Signed jack & Iacute0)
M. D.
act 27 10 43
(Address) (48 Mewhy Date
21. .
Ceder Grove Em
Place of Burial, Crematlun or Removal. (City or Town)
DATE OF BURIAL
oct
28,1943 18.
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
110 wanternst
Received and filed
OCT 29 1943
..
19
A TRUE COPY ATTEST:
(Registrai)
1
2 FULL NAME.
3 SEY
4 COLOR OR RACE
White
Female
(or) WIFE of.
7 IF STILLBORN, enter that fact here.
8
5.85
ÅGE ...
Years
Months .............
.Days
Usual
Housecafe
8 Occupation :
10 or Business :....
11 Boclel Security No .....
-
12 BIRTHPLACE (City).
(State or country)
14 BIRTHPLACE OF
FATHER (City).
Danvers
16 BIRTHPLACE OF
PARENTS
MOTHER (City).
0 anos
17
Michal Aring
Informent
(Address)
mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF
100m(h:)-1-41-4695
I. D."WRITE PLAINLI, WISST ONPAVING DLAVA INN ATWW WATLAMIANUNS AL
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.
Industry
at Home
(If deceased Is a married, widowed or divorced woman, give also maiden name.)
104 Highland ave
St
(If nonresident, give city or town and State)
20 Earle
Duration Important 2 ans
Important
Date of ..
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwith, after the death of a person whom he has attended during his last lilness, 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 bellef the name of the deceased, his supposed age, tbe disease of which he died, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen allve hy 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 sectlon forty-five of chapter one bundred and fourteen, shall, 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 also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can etate the same. For neglect to comply with any pro- vision of this section, such 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, be deemed to have taken place between February 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 hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not heen huried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing tomh 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 body is buried. No such permit shall he issued until there shall have been delivered to such board, 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 he 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 he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the hoard of health, or em- ployed by It or hy the selectmen for the purpose. shall upon application make the certificate required of the attending physician. If death is caused by 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 body shall he 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 heen 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, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The hoard of health, or Its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit It to the clerk of the town for registration. The person to whom the permit 1s 80 given and the 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 the manner or cause of the death, 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 bodies of only such persons as are supposed to bave died by violence. If a medical examiner has notice that there is within bis county the body of such a person, he shall forthwith go to the place where the body iles and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human hody or the asbes thereof which have been hrougbt Into the commonwealth until he has received a permit so to do from the board of health or Its agent appointed to lssue 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 observance of the following rules of practice:
(1) Attending physicians will certify to sucb deaths only as those of persons to whom they have given hedside 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 disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahly due to injury. These Include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the actlon 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 disabled hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid conditions, if any, related to the principal cause and any Important complication of tbe principal cause.
Statement of Occupation .- Precise statement of occupation is very important, 80 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 heen 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 he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation 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
i
R-301 A
PLACE OF DEATH
Suffolk (County)
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registared No.
( It death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
(WPHYSICIAN - IMPORTANT
U. S. War Veteran,
if so spaolfy WAR)
St.
(If nonresident, give elty or town and State)
months
days.
In this community07 yrs. 7
mos.
29 days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
25
1943
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attendad deosased from
grame 8
1943. to Coat 25
1943
I last saw he alive on.
Gef 25, 1943, death Is said to
hava oocurred on tha data stated above, at.
8.50 %.
n.
Immediata oause of death.
Duration 2days
"IMPORTANT
Due to
art. Salmon
Due to
denility
Other conditions.
( Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
Clinical
Underlina the cause to which death should ba charged sta- tistically.
20 Was disease or injury in any way related to occupation of dacaased ? June If so, spaolfy
('Signed)
(Address)
M. D.
Date Ca-26 1943
21
Winthrop :: :
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
October 28
1943
22 NAME OF
FUNERAL DIRECTOR.
toward & Vingnoles
ADDRESS
nitrop mars
Recalved and Alad 19
...
.....
( Registrar)
100M-6 -2-42-8855
-
(Signature of Agent of Board of Leuth or otber) Theatthe office
( Date of Issue of Pormit) 10/28/43
(Omelal Designation)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Winthrop
1
(City or Town)
210 Main St.
No.
-
2 FULL NAME
Lucy Amanda Floyd
(a) Residence. No.
210 Main St.
(Usual place of abode)
Length of stay: In hospital or Institution
years
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Single
Female
White
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
years
> IF STILLBORN. enter that fact here.
AGE
Usual
9 Occupation :
Housework
Industry
Own Home
10 or Business :
11 Social Security No.
None
12 BIRTHPLACE (City)
Winthrop
( State or country)
Mass
13 NAME OF
FATHER
Edward Floyd
14 BIRTHPLACE OF
FATHER (City)
Winthrop
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Lucretia Tewksbury
16 BIRTHPLACE OF
PARENTS
Winthrop
MOTHER (Clty)
...
(State or country)
Mass.
17
Leroy Colvell
Informant
.....
( Address)
210 Main St. Winthrop
Relation, If any
.......... N.e.phew
-
I HEREBY CERTIFY that a satisfactory standard oartifioata of daath was
filled with me BEFORE the burjat or transit permit was Issued:
If deceased was a U. S. War Veteran, Q. 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
8
87
Years
7
Months
29 Days
--
If less than 1 day
Hours
Minutes
...
IMPORTANT Physician
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physicien or registered hospital medical officer shali forthwith, after the death of a person whoin he has attended during his last illness, at the request of an undertsker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, steting to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as re- quired hy section one, where seme wss contracted. the duration of his last iliness, when isst seen aiive by the physician or officer and the date of his death ... Gen. Laws, Chlap. 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 helief, served in the army, usvy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate a recitai to that effect, speci- fying the war. snd shall also certify in such certificate both the primary and the secondary or immediste cause of death as nearly as he can stete the saine. For negiect to comply with any provision of this section, such physician or officer sheli forfeit ten doliars. For the purposes of thia sec- tion end of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "wsr" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, 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 horder service of nineteen hundred aud sixteen and nineteen hundred and seventeen. G. L. Chsp. 46, Sec. 10.
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