USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 9
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(Month)
(Day)
(Year)
19 IHEREBY CERTIFY,
1/7/43
19
...
to
1/23/43
19
i last saw h
er ..... alive on
1/23/43
19
death is said to
have occurred on the date stated above, at.11 :. 0.0.a.
m.
Duration
Immediate cause of death. Uremia
Chr. progressive nephritis
Due to.
Due to
Other conditions
Cardiac hypertrophy
Physician
(Include pregnancy within 3 months of death)
and dilatation Ac bronchopneumofertile
Major findings :
Of operations
Date of
the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed dlagnosis ?.
20 Was disease or injury in any way related to oooupation of deceased ?.
if so, specify.
(Signed).
H W Ben jamin
M. D.
(Address) .. Boston
Dato ...
1/23/013
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Winthrop Cem Winthrop
19
(Cemetery)
(City of Town)
1/26/43
22 NAME OF
C R Bennison
ADDRESS
FUNERAL DIRECTOR
Winthrop Mass
Received and filed
Jan 27, 1943
19
1.1
111945
(Registrar of City or Town where deceased resided)
1
Boston
(City or Town) Peter
No.
Bent Brigham Hospital
(If U. S.
War Veteran,
specify WAR)
(a) Residenoe. No.
(Usual place of ahode)
Winthrop
Mass
Female
50m (e)-1-41-4667
DATE OF BURIAL
That L attended deceased from
RM R-302
after the close of the month in which the death occurred. (Sce Chap. 46, Sec. 12, G. L.)
50m-10-'39. No. 8427-f
A TRUE COPY
ATTESTI
" (Registrar of city or town where death occurred)
DATE FILED
Fel 2
1943
MEDICAL CERTIFICATE OF DEATH
3 SEX Female White
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alivo.
... Years
7 IF STILLBORN, enter that fact here. Stillborn
3 AGE Years Months
Days
If less than 1 day Hours Minutes
Usual
9 Occupation:
Industry 10 or Business:
II Social Security No.
0.
(State or country)
13 NAME OF
FATHER
Elmer Forhalen
14 BIRTHPLACE OF
FATHER (City)
Cambridge 9
(State of country)
mark.
15 MAIDEN NAME
OF MOTHER
margaret o Riley
16 BIRTHPLACE OF
MÔ THE
Lawell )
(State or country)
mars
21 PLACE OF BURIAL.
Relation, if any
CREMATION OR REMOVAL V
Le Patudo Jowell
(City or Town)
DATE OF BURIAL
Fel 20
19X3
22 NAME OF
Gallerie inc Lejana
FUNERAL DIRECTOR
ADDRESS.
151 Bridge de Lewell
Received and filed
1
(Registrar of City or Town where deceased resided)
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
9 Dowell (City or Town)
(County) PLACE OF DEATH No ... maureen Chances Whalen 2 FULL NAME
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lowell
(City or town making return)
Registered No.
§ (If death occurred in a hospital or institution,
give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
370 m am
.St.
Winthrop
1000
(If nonresident, give city or town and state)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
18 DATE OF
DEATH.
Jan
28,
1943
(Month)
( Day)
(Year)
IS I HEREBY CERTIFY.
That I attended deceased from
I last saw h ...
.. alive on.
19.
....... ,
death is said
to have occurred on the date stated above, at ...
............ m.
Duration
Immediate cause of death ..
Stillborn
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Underline the cause to which death
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury In any way related to occupation of deceased ?
0
If so, specify ...
half ham aufe
(Signed).
(Address ) Dalleal-
... M. D.
1/29 1943
should be charged sta- tistically.
12 BIRTHPLACE (City)
Jawell
PARENTS
(Give maiden name of wife in full)
19.
... , to ...
19.
.......
(If U. S. War Veteran, specify WAR)
(a) Residence. I (Usual place of abode) Length of stay: In hospital or institution.
I LITMANENI RECORD
17 Informant ....... (Address 370 many de, Jak tulles
if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,
1
PLACE OF DEATH
(County) Wanttrop (City or Town)
en route to truturas Community Hospital
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
23
St. [ ( If death occurred in a hospital or institution, ( give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe.
No.
16 Ocean View St. Wanttrop
(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 community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEJ
5 SINGLE
MARRIED
WIDOWED
or DIVORCED in+70
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 allve .
years
7 IF STILLBORN, enter that fact here.
8 AGE 72 Years Months ......... Days
If less than 1 day Hours. .. Minutes
Usual
9 Occupation :
Industry
Street Dent Town of inch
10 or Business :
11 Social Security No ..
12 BIRTHPLACE (City) NOTE Dich P .. On
(State or country)
13 NAME OF
FATHER
John J.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
10
15 MAIDEN NAME
OF MOTHER
Elizabeth Humprey
16 BIRTHPLACE OF
MOTHER (Clty)
(State or country)
17
Informant.
Forn Recorig
( Address) Minttron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burla or transit permit was Issued : Wu. S. Childress ...
Signature or agent. of Board of Health or other)
Health Officer (Official Dealgnation) (Date of Issue of Permit)
2/8/47
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Februares (Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows; (If an injury was infaved, state fully.) acute Cardiac Failure Pulably Coruñany ScleroRes
Permitires Cular mua
20 Aocident. sulolde, or homioide (specify)
Date of ooourrence ..
19
Where did injury ocour ?
n
Did Injury ocour în or about home, on farm, In Industrial place, or în publio
place ?
Manner of
injury ...
(Specify type of place) . Collapsed adiet quickly
Nature of Injury
While at work ?. Was there an autopsy? No
21 Was disease or Injury in any way related to occupation of deceased ?
If so, speoify
(Signed)
Baton
M. D.
(Address)
Joli-1-
1983
22 linthr; 0 finthran
Place of Burial, Cremation or Removal. (City or Town)
23 NAME OF
FUNERAL DIRECTOR. Total
ADDRESS
Received and filed.
(FEB
1943
19
(Registrar)
.. . .....
=
RM R-303-A
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information
60m (g)-1-41-4667
No .
2. Hack
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
-1-1943
2070
white
(Specify whether)
(write the word)
(City or town and State)
Relation, if any
DATE OF BURIAL
Feb & I9+3
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 forthwith, after the death of a person whom he has attended during his last illness, at the request of an umlertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of drath, 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. 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, 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, 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 this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hnudred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chiap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board. from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit froin 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 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 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 insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a perinit for the removal of a human hody, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session 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 re- moval, 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 liralth, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the decedar, or as to the mamuer or cause of the death, which the clerk or registrar may re- quire .- 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 perunit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, froin the clerk of the town where the body is to be buried or the funeral is to be held, or from s per- son appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
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.
. lle shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illuess 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 by recognized disease unrelated to any forin of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
· (3) Medical Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deathis following abortion, but also deaths from disease resulting from Injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known, For example: "Coul- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
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 presumahle nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spoll- 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
FORM R-301 11
BOSTON NOTIFIED
3/9/43
County)
Mentrofu (City or Pown)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No
24
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME Thomas 44 Jechin
(If U. S. War Veteran. specify WAR)
(If deceased is a married, widowed or divorced woman/ give also maiden name.) IL Woodard & Mest Forbury Mars
(a) Residence. No .... (Usual place of abode) ength of stay: In hospital or institution (Specify whether)
years
months
14 days.
(If nonresident, give city or town and state)
In this community
2
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
Or DIVORCED
Marques
5a If married, widowed, Or divorced HUSBAND of
Frances Doherty (Give maiden name of wife in full)
(Husband's name in full)
64
.yoars
7 IF STILLBORN, enter that fact hore.
If less than 1 day
Years .......... Months - Days Hours. .Minutes
II Social Security No. +
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Thomas H Septon
14 BIRTHPLACE OF FATHER (City) Jaunla Mass (State or country)
15 MAIDEN NAME OF MOTHER Bary Nouis
16 BIRTHPLACE OF MOTHER (City) (State or country)
... Woburn Mass
17 Bfrances Sentir Relation, if any
Informant (Address) 52 Woodard & Mosthinaus
I HEREBY CERTIFY that a satisfactory standard certificate of death was Hled with me BEFORE the burial or transit pertait was issued:
(Simnature of Agedt of Board of Health or other) He alte Officer 2/3/43
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
(Month)
(Day)
.1
1943
19 HEREBY CERTIFY.
12×3 Für.
2
13
19 ........ , death is said
to have occurred on the date stated above, at ....
44.m.
Duration
1 Day
.... 1yr .....
Due to
Other conditions .... (Include pregnancy within 3 months of death)
Major findings :
Of operations
Suporter Fall Haller
Date of ..
Of autopsy
What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupation of decoased ?
If so, specify
(Signed)
(Address) 19 (Quecalor SVEK
.Dato ...
2/2
13
21 Cabral,
Flace of Burial, Cremation or Removal. DATE OF BURIAL Get
(City or Town)
42 19
22 NAME OF
William LaSpencer
FUNERAL DIRECTOR
ADDRESS
Sorbato Mare
Received and Eled
19
A TRUE COPY ATTEST:
(Registrar)
13×3
1 last saw h ... V ...... alive on .....
Immediate cause of death ...........
Due to
...
antonio- Selemés
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
M. D.
200m-10-'39. No. 8427-d
1 PLACE OF DEATH 3 SEX Kale (or) WIFE of 8 62 AGE Usual 9 Occupation :. Industry PARENTS N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 10 or Business:
MARGIN RESERVED FOR BINDING
No ...
(write the word) DEATH
(Year)
That I attended deceased froms
Tar.
2
6 Age of husband or wife if alive.
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 whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration 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.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the 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 shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a 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 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 fur- nish 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.)
No undertaker or other person shall bury a human hody or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do 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 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 observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness 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 by recognized disease un- related 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 septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, 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 con- ditions, if any, related to the principal cause and any important complication of the principal cause.
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