USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 94
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Statement of Cause of Death .- Cause of deatb means the disease, or complication which causes death, not tbe mode of dying, e. g., heart failure, asphyxia, astbenia, etc. As principal cause name tbe disease causing death. As related causes, name earlier morbid 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, so that tbe relative healtbfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation bad been given up or changed on account of the disease causing death, report tbe usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
7 ESuffolk
(County)
Winthrop
No.
(City or Town) 14 Sargent: St. .. con
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agere, A
Registered No.
( If death occurred in a hospital or institution, St
give ita NAME instead of street and number)
2 FULL NAME
Frances .F Low. : .
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
14 Sargent St
(Usual place of abode)
Length of stay: In hnepital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community49 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Female White
5a If married, widowed, or divorced
HUSBAND of
(Give meiden 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 85 Years 5 Months 19Days
If less than 1 day
Hours
Minutes
Usual
9 Occupetion :
Housework
Industry
10 or Business :
Own Home
11 Social Security No. .
None
East Boston
12 BIRTHPLACE (City)
( Siate or country)
Mass.
13 NAME OF
FATHER
Ebenezer Low
14 BIRTHPLACE OF
FATHER (City)
Essex
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Nancy Foster
16 BIRTHPLACE OF
MOTHER (City)
Essex
(State or country)
Mass.
17 Minnie Sampson
RNJødeany
Informent.
( Address) 14 Sargent St. Winthrop
I HEREBY CERTIFY that a satisfactory standerd certificate of death was filed with me BEFORE the Burial of transit permit was Issued : m. D. Children .....
(Signature of Agent of Board of Health or other) Heabele Officer (Official Designation) ( Date of Issue of bermit)
12/23/43
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
194 (Year)
19 HEREBY CERTIFY,
That I attended deosased from
I last saw h
.alive on
Lan 22
43
19 death Is sald to
have occurred on the date stated above,
12.30P
m.
Duration
·IMPORTANT
Due to
antero selena
Due to.
Other conditions.
( Include pregnancy within 3 months of death)
Major findinge:
Of operations
Dete of
Of autopsy
Whet test confirmed dlegnosis ?.
20 Was disease or injury in any way related to oooupation of deocesed ?
If so, spoolfy.
(Signed)
M. D.
(Address)
thestation un Date /2-12ª
19
21
Spring St.
Essex
l'lace of Burial, Cremation or Removal.
DATE OF BURIAL
De c
24
(City or Town)
1943
22 NAME OF
Howard Sterndels
FUNERAL DIRECTOR.
ADDRESS
Received and Aled .............
19
( Registrar)
100M-6 - 2-42-8855
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that effect. PARENTS
PLACE OF DEATH
1
PHYSICIAN - IMPORTANT
U. S. Wer Veteran,
if so spooify WAR)
St.
(If nonresident, give elty or town and State)
......
22
19 ..
73.
to.
19
.......
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medioal offioer shall forthwith, after the death of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized per-on or of ans meniber of the fantily of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. wltere same was contracted. the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, 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 both 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 this aec- 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, he deemed 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 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 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 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 thau 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 delivered to such board, agent or clerk, as the case inay be, a satisfactory written atatenient containing the facts required by law to be 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, o1 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or If, for sufficient reasons, hls 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 niake the certificate re- quired of the attending physician. If death is caused by violence, the medl- cal examiner ahall make sucb 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 death 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. 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 uece+ aary 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 .- 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 conimionwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permita, 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 he held, or fromn 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 Editiou).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died liy 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 hody 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 physicians will certify to such deatha only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health 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 attendance or whose pbsaf- cian is absent from home when the certificate of death is needed.
(8) Medloal 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 action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from diseasa resulting from injury or Infection related to oooupation, 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, asthenla, etc. Aa principal cause name the disease caualng death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. -
Statement of Occupation .- Precise statement of occupation la very im- portant, so that the relative bealthfulness of various pursuits caur be known. Make some entry in this section for every persou aged 10 years or over. If the occupation had been given up or changed on account of the discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at home. For a woman whose only occupatiou way that of bone housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, an housekeeper-private fanrily, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
301 A
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. § (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME.
Annie Richmond Barss
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
87 Bartlett Road .... Winthrop
.St.
(Usual place of abode)
-
years
months
8
days.
(If nonresident, give city or town and state)
In this community 34 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
{write the word)
Single
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
December
22
1943
(Month)
(Day)
(Year)
Sa 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
7 IF STILLBORN, enter that fact here.
6
AGE ....
62 ... Years.
7
Months.22 ..... Days
If less than 1 day .Hours ...... Minutes
Usual
9 Occupation :
Stenographer
Industry
Wholesale Enamel Ware
10 or Business :.
11 Social Security No ...
022-05-4436
12 BIRTHPLACE (City)
(State or country)
Masg.en
13 NAME OF
FATHER
James Richmond Barss
14 BIRTHPLACE OF
FATHER (City) ....
Bermuda
(State or country)
15 MAIDEN NAME
OF MOTHER
Annie Geldert
16 BIRTHPLACE OF
MOTHER (City) ...
Windsor
(State or country)
Nova Scotia
17 Relatlon, If any
Inf Mr.s ...... Marion Nuttig Sister)
(Address)
So. Berwick
Maine
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Childrens.
(Signature of Agent of Board of Health of other)
Mattle Officer 12/23/43
(Official Designation) (Date of Issue of Permit)
20 Was disease or injury in any way relaled to occupation of deceased ?. 200 -
If so, specify.
Daniel J.O'/Juin
(Signed)
(Address). Winthehp, Mess Date Dec 22, 1943
21.
Mt. Auburn Cemetery Cambridge
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL.
December 24
19
43
22 NAME OF
Chas. R. Bennison
FUNERAL DIRECTOR.
ADDRESS
Winthrop .... Mass ..
Received and filed
DEC 27 1943
19
(Registrar)
..
Duration IMPORTANT 6 mis
Due to.
Chronic hypertension
Due to ......
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
Major findings:
Of operations.
Date of.
Of autopsy
What test confirmed diagnosis? Clinical Sigi
ins
is very important. See instructions and extracts from the laws on back of certificate. PARENTS
100m-2-'40-D-729-a
19. I HEREBY CERTIFY.
That I attended deceased from
Dec
15
19.4 .. 3,
Dec 21,,
to ......
19 43
I last saw her alive on Dec 21, 1943 death is said to
have occurred on the date stated above, at.
3.30A
.. m.
Immediate cause of death .. Chronic interstiTial Nephutis
M. D.
1
No
Winthrop Community Hospital
Length of stay: In hospital or institution.
(Specify whether)
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 registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he dled, defined as required hy 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 hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody 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 board, 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 board of health or its agent aforesaid or from the clerk of the town where the body Is huried. No such permit shall he issued until there shall have been delivered to such board, agent or cierk, as the case may he, a satisfactory written statement containing the facts required hy 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 herelnafter provided. If there Is no attending physician, or if, for sufficlent reasons, his certificate cannot be obtained early enough for the purpose, or Is In- sufficient, a physician who is a member of the board of health, or em- 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 by violence, the medical examiner 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 ohtalned early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which It was removed within thirty-six hours after such removal, unless a permit In the usual form for the re- moval of such hody 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 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 Is so given and the physiclan certifying the cause of death shall thereafter furnish for registration any other necessary information which can be ohtalned 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 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 permits, or if there is no such board, from the clerk of the town where the hody is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurlal 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 such deaths only as those of persons to whom they have given bedside care during a last Illness from disease unrelated to any form of injury.
(2) Board of Health physicians 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 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 supposahly due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemla), 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 occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death,-Cause of death means the disease. or complication which causes death, not the mode of dying, e. g., heart failure, asphyxla, asthenla, 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 the principal cause.
Statement of Occupation .- Precise statement of occupation Is very Important, so that the relative healthfulness of various pursults 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 huslness, 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
-301 A
PLACE OF DEATH r
Suffolk
County)
The Commonturalth 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.
2.23
No.
(City or,Town) 45 Summande Ave
{ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
James
Kennedy.
(If deceased is a married, wiflowed or divorced woman, give also maiden name.)
(a) Residence
No.
(Usual place of abode)
(B) Jumped Ave
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
...
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
11 MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowed or hporced HUSBAND of (Give malden name of wife in full)
Houghton
(or) WIFE of
(liusband's name in fullo/
6 Age of husband or wife if alive 46
years
7 IF STILLBORN, enter that fact here.
8 AGE Years
Months Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Office Manage
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City) (State or country) Bast Beton mast 13 NAME OF FATHER James Kennedy
14 BIRTHPLACE OF
FATHER
(City)
(State or country)
Datin Made
15 MAIDEN NAME OF MOTHER Anna Jenkuis
16 BIRTHPLACE OF
MOTHER (City)
(State or country) .
Cheland
11
17 Informant. ( Adlılres«)
Elixie Kennedy, Relation, if any
216
( City Fora) Place of Burial, Cremation or Removal. BURIA DEUS 249999 ... 19
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with me BEFORE the burial or transit permit was Issued :
...... (Signature of Agent of Board of Health or other)
Health xieer 12123/43
( Official Designation ) (Date of Issue of Fermit)
18 DATE OF
DEATH
December 22
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, October 27 That I attended deceased from 43 December 22 1943 to ..
1 last saw
.alive on
December 221943 death is said to
have occurred on the date stated above, at.
2P:
........ m.
Immediate cause of death ...
Carcinoma
of
atomacho
1 year
Due to
General Carcinomatosis
3 mois
Other conditions none (Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
Carcinoma My stomach
Physician
Underline Dato bf an. 10/4/2 the cause to Of autopsy none Which death should be What test confirmed diagnosis clinical &
pathologie
charged sta- totically.
20 Was disease or injury in any way related to ocoupation of deceased ?.... If so, specify.
(Signes) Deof, alsama, 567 Sunday State 12/23
M. D.
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Received and filed
DEC 27 1943
19
(Registrar)
extracts from 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 recitai to that effect. PARENTS
100m (d)-1-41-4667
1
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Duration IMPORTANT
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of s person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any inember of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired 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.
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