USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 89
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If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
Community Hospital
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 ...
Registered No.
f ( If death occurred in a hospital or institution, St. [ give ita NAME instead of street and nuniber)
2 FULL NAME.
James G. Beekman
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
306 Revere
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
Hospital
(Specify whether)
years
1 months
days.
In this community 20 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACEĮ
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Married
5. If married, widowh ir derLunch
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 55
years
> IF STILLBORN. enter that fact here.
8 AGE 62 .... Years 1.O .. Montha. 27 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
SignPainter
Industry
10 or Business :
Own ..... business
11 Social Security No.
None
brooklyn
12 BIRTHPLACE (City)
(State or country)
NY
13 NAME OF
FATHER
John V. Beekman
14 BIRTHPLACE OF
FATHER (City)
Somerville
(State or country)
New Jersey
15 MAIDEN NAME
OF MOTHER
Annie Bennett
16 BIRTHPLACE OF
MOTHER (City)
Stottswood
(State or country)
New Jersey
17 John .V ...... Beekman
Relation, if any .Brother ..
Informant ( Address) Brae Burn Club.Newton Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death wes filled with ma BEFORE the burial or transit permit was Issued:
(Signature of Agent of Board of Thealth or other)
11/29/43
(Oficial Dealgnation) ( Date of Issue of PermiY
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
November-
29
1943
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
Dary
1
1940.
to
19
I last saw him alive on.
Nov 28
, 19.1.3, death Is sald to
have occurred on the date stated above, at.
m.
Immedlate oause of death.
IMPORTANT .........
Carcinoma al tares
+ small
Due to ... internet
4-1.19. 1
Due to
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findings:
Of operations
CARCINOMA
Date of.
Oct. 7.1940
Of autopsy
which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?..........
If so, speolfy
('Signed)
, M. D.
(Address)
200 Wartunghan Dato VOU 29 1943
21 Greenwood Brooklyn N. ....
Place of Burial, Cremation or Removal. (City or Town)
22 NAME OF
FUNERAL DIRECTOR
DATE OF BURIAL
Dec.2.1943
Halter A Gregg
ADDRESS
Newton
Mass.
11
Racelved and Aled
NOV 291945
...... 19
( Registrar)
100M-G -2-42-8855
extract from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to insert a reoitai to that effeot. PARENTS
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteren,
if so speolfy WAR)
That I attended deceased from Nov.
Duration
What test confirmed dlegnosis?
L'underline
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or regiatered hospital medical officer shall forthwith. after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other authorizeil person or of any meniher 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. bis supposed age, the disease of which he died. defined as re- quired by section one. where ssme wss contracteil. the duration of his last illness, when last seen alive hy 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 deceased, to the best of his knowledge and helief, served in the army, navy or marine corps of the I'nited States in auy war in which it has been engaged. insert in the certificate a recital to that effect, speci- fying the wsr. and shall also certify in such certificate hoth the primary and the secondary or iinmeiliate csuse of death as nearly as he can state the ssine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humulred and fourteen, the word "war" shall inchide the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deencd 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 sixtcen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undortaker 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 hoard 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 shail exhume a human body and remove it froin a town, from one centetery 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 hosrd of beslth or its agent aforesaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there aball have been delivered to such hoard, agent or clerk, as the case inay he, 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. 01 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient ressons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cisn who is a member of the board of health, or employed by it or hy the selectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner aball make such certificate. If such a permit for the removal of a humsn hody, not previously interred. from one towi to another within the commonwealth cannot he ohtsined early 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, thst 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 heen 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 Statea lo 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 transniit it to the clerk of the town for registration. The person to whom the permit is so given and the physiclan certifying the cause of death shall thereafter furnish for registration any other nece+ sary information which can he obtained as to the deceased. or as to the manter or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do front the board of health or its agent appointed to issue sub perinits, or if there is no such hosrd, front 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 Editiou).
Medical examiners shall mske examination upon the view of the dead bodies of only such persons ss are supposed to have died by violence. If a medical examiner bas notice that there is within lils 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 lawa calla for the observance of the following rulea of practice :
(1) Attending phyalclans will certify to such deatha only aa 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 physlolans will certify to such deaths only aa those of persons who, though disabled by recognized disease unrelated to any form of injury. have died without recent medical attemlatice or whose phyaf- cian ia absent from home when the certificate of death ia 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 hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aml deaths following abortion, hut also deaths from dlaeasa resulting from injury or Infootion related to oooupatlon, the audden deaths of persons not disablad 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 fallure, asphyxia, asthenia, etc. Aa principal cause name the disease caualug 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 Oooupation .- Precise statement of occupation la very im- portant, so that the relative healthfulness of various pursuits call he 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 hsd retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at huine. For a woman whose only occupation was that of hone housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as housekeeper-private fantily, cook- hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
-301
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. .... .. ..... IL ....
100M-6 - 2.42-8855
PLACE OF DEATH -
Suffolk (County)
1
Winthrop
(City or Town)
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.,2
Registered No.
§ ( If death occurred in a hospital or institution, St. [ give ite NAME instead of street and nuniber)
2 FULL NAME
Flora M Clarke
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
24 Lincoln Street
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
22days.
In this communit39
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
have oocurred on the date stated abova, at.
8:20 P.m.
6 Age of husband or wife if alive years
IF STILLBORN. enter that fact here.
AGE
8
67
Years
8
Months
Days
26
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housework
Industry
10 or Business :
Own Home
None
11 Social Security No.
Bristol
12 BIRTHPLACE (City)
( State or country)
Vermont
13 NAME OF
FATHER
William Clarke
Major findings:
Of operations
none
Dete of
Of autopsy
none
What test confirmed dieg clinical + lab.
Underline the cause to which death should b . charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased .
If so, spoolfy
VY381
(Signed) Kacof
Abraço In. W.
(Address) 562 Stanley IT Govert Loopes 43
21
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
December
2
,43
I HEREBY CERTIFY that asatisfactory standard certificata of death was filled with me BEFORE the burial or transit permit was Issued?
(Signature of Agent of Board of Health, or other)
Health Officer 12/1/43
(Official Designationy
( Date of Issue of Permit)
18 DATE OF
DEATH
november 29
(}fonth)
(Day)
(Year)
Thet | attanded deceased from
191 HEREBY CERTIFY,
november 5 1943
to
november 29, 1943
I last saw her
alive on November 29, 1943 death Is said to
Immadlete cause of death
Cerebral
Hemorrhage
Duration 2 2 days "IMPORTANT
Dua to
anterior
aclerosis
.... 1 year
Dua to.
Hypostatic Pneumonia
2 days
Other conditions.
none
( Include pregnancy within 3 months of death)
IMPORTANT Physician
14 BIRTHPLACE OF
FATHER (Clty)
New Castle
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Elizabeth J Monroe
16 BIRTHPLACE OF
Bristol
MOTHER (City)
(State or country)
Vermont
17 Mrs Mable Davidson
Relation.gttror
informent
Addres
" 31 Lincoln St Winthrop
22 NAME OF
FUNERAL DIRECTOR
Howard hunolds
ADDRESS
Nun map
Reoaived and fled
19
e ) (Registrar)
(WHYSIGIAN - IMPORTANT
U. S. Wer Veteran,
if so apeolfy WAR)
1943
Female
White
Hospital
No.
Winthrop Community Hospital
PARENTS
winthrop
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medioai offioer shall forthwith, after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other authorized person or of ans meniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and beitet the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. wlirre same was contracted. the duration of his last illness, when Isst seen alive by the physician or officer and the date of bis 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 f'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 shail also certify in such certificate both the primary and the secondary or immeiliste 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 aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humired and fourteen, the word "war" shall include the Chins 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 and sixtcen and nineteen bundred and seventeen. G. L. Clisp. 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 budy 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 dled; and no undertsker or other person shall exhume a human body and remove it froin a town, from one cemetery to another, or from one grave or tomb other thsu 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 boily Is buried. No such permit shall be 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 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 certificate as hiereinafter 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 physl- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death Is caused by violence, the medl- 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 early 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 removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war In which It has been engaged. such recital shall appear upon the permit. The board of heaith, or its agent. upon receipt of such 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 shall thereafter furnish for registration any other neces sary information which can be obtained as to the deceased, or as to the matmer of cause of the death, which the clerk or registrar may require .- Cbap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a hunian body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do froni the hoard of health or its agent apfminted to Issue such permita, 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 apfainted to have the care of the cemetery or burial ground in which the interment ia made. .. . Chap. 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 hy violence. If a medical examiner has notice that there is within lris county the hody of such a person, he shall forthwith go to the place where the body lles 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 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 physlolans 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 attemlance or whose phyaf- cian is ahsent from home when the certificate of death ie needed.
(3) Medloai Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths cansed directly or in- directly by traumatism (including resulting septicemla), and by the actlon of chenrical (drugs or poisons), thermal, or electrical agents, atul deaths following abortion, but also deaths from diseasa resulting from injury or Infection related to occupation, the sudden deaths of persons not disablad by 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 ilying, e. g., heart fallure, asphyxia, aatbenla, etc. As principal cause name the disease caualng death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important compliestion of the principal cause.
Statement of Oooupation .- 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 been given up or changed on account of the discase causing death, report the usual occupation prior to Illness. If the deceased hsd retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at horne. For a woman whose only occupatiou was that of bone housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as bousekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DEPARTMENT OF COMMERCE
BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH
State File No.
Registrar's No.
259
State of
Maine
1. PLACE OF DEATH:
(a) County
(b) City or town (Gast) Boothbay
(c) City or town
Winthropfl
(If outside city or town limits. write RURAL)
(d) Street No.
106
aich
mit Road
(If rural, givo location)
-
3. (c) FULL NAME mpethow ( Porgere 20. Date of death: Month . MEDICAL CERTIFICATION
3. (b) If veteran,
3. (c) Social Security
name was No. 1 Noved No. 028/05-252 21 I hereby certify that I attended the deceased from
5. Color or
4. Sex 200
race
20
6. (a)Single, widowed, marmed, divorced via
Ì that I last saw h __. .__ alive on
19
6. (c) Age of husband or wife if Il and that death occurred on the date and hour stated above.
Duration
1/Birth date of deceased Xept. 15,1873
(Day) (Year
8. AGE:
Years 6 9
Month 10
Days
25
(min
9. Birthplace Bratou mard.
Due to
(City, towaruponty) (Stato or foreign country)
10. Usual occupation Retired
MOTIVER FATHER
-
12. Name Nathaniel H. Rogers
13. Birthplace Somsoor county (Etnie biforeigncountry)
Major findings: Of operations
Underline the cause to which death should be charged sta- tistically.
16. (a) Informant's own signatur pre Helen Bennett
22. If death was due to external causes, fill in the following:
Durial (b) Date thereof Lug. 121973 (a) Accident, suicide, or homicide (specify)
(Burial, cromation, or removal) 53 (c) Place; burial or cremation Winthrofe Mand
(b) Date of occurrence
() Where did injury occur?
(City or town) (County) (State)
18. (a) Signature of funeral director immonet Harmato Did injury occur in or about home, on farm, in industrial place, in public (b) Address Toothbay Harbor mel place?
(Specify type of plaoo)
While at work? (c)Means of injury
Thisis regory (M. D. or other) . 2)
Address Portefbay Harbor Date signed
me.
8-6917
U. S. GOVERNMENT PRINTING OFFICE
10-13493 DEC 16 1943
19. (a) aug. 10,1945). (Daterosived local registrar)
Claytonm. Dodge 23. Signature (Registrar's signature)
2. USUAL RESIDENCE OF DECEASED: (a) State Mace (b) County Suffolk
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