USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 99
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is very important. See instructions and extracts from the laws on back of certificate.
100m-10-'39. No. 8427-e
1
No.
I60 Somerset Ave.
St.
e
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
(Year)
Female
PARENTS
17
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 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 sball 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 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 body 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 burlal 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 Ilealth 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 mnode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the discase 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.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual oceupation 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
1
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, Seotlon 10, requires physicians to Insert a reoitat to that effeot. PARENTS
Suffolk
(County)
Winthrop
...
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health of its Agent.
Registered No.
( If death occurred in a hospital or institution, give ita NAME instead of atreet aud number)
2 FULL NAME
Jemima Wright Keller
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
614 .... Shirley .... St ......
.
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
days.
In this community
32 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
Female
White
MARRIED
WIDOWED
or DIVORCEO
Married
5e If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Charigiye rider names rife in full)
( Husband's name in full)
6 Age of husband or wife if alive 68
years
> IF STILLBORN. enter that fact here.
8
AGE
.7.4 Years
Months Q ... Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
At Home
11 Social Security No.
12 BIRTHPLACE (City)
( State or country)
Charlest.c.w.
13 NAME OF
FATHER
Lewis Wright
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Eng land
15 MAIDEN NAME
OF MOTHER
Annie Burry
16 BIRTHPLACE OF MOTHER (City) (State or country)
Creenfiedd
Mass.
17 Charles L. geller Informent ( Address) 614 shirley St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the bariet ox transit permit was Issued :
( Signature of Agent of Board of Health ( other) Health officer /2/31/47
(Omclal Designation) ( Date of Issue of Pormity
18 DATE OF
DEATH
Dec. 29, 1943
(Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
Thet 1 attanded deosased from
OW DEC. 29, 1943
...
Ło
19
1 last saw h ....
.... aliva on
19
.. , death is said to
have occurred on the date stated above, at
2 -30+
.m.
Immediate oause of death ..
Expired on quy arrival
IMPORTANT
Due to
Coronary Thrombosis ?
20 MIN.
Due to
Other conditions
( Include pregnancy within 3 months of death)
Major findings: Of operations
Dete of
Of eutopsy
What test confirmed dlegnosis ?
20 Was disease or injury in any way related to oooupation of deceased ? YO
If so, spaolfy.
(Signed)
Coward 7 , Trangen
M. D.
(Address) 200 Washington AVE Date DEC. 30 1943
21
Winthrop
.... Winthrop
Place of Burial, Creniation or Removal.
Dec. 31,
1943
[City or Town)
DATE OF BURIAL
22 NAME OF
RichardMe. White
FUNERAL DIRECTOR
ADDRESS
147 Winthrop St., Winthpp
Reoeivad and Aled. 19
( Registrar)
H
100M-6 - 2-42-8855
1
PLACE OF DEATH
No.
(City or Town) 614 Shirley St ..
St
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. Wer Veteran,
if so speolfy WAR)
MEDICAL CERTIFICATE OF DEATH
Duration
IMPORTANT Physician
Underline the cause to which death should ba charged sta- tistically.
19
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medical officer 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 person or of sos meniber of the family of the deceased, furnisb for registration a standard certifcate of death, stating to the best of his knowledge and belief the naille of the deceased, his supposed age, the disease of which he died. deflued as re- quired by section one, where ssme was contracted. the duration of his last illness, when last seen slive 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 helief. aerved 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, sud 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, auch 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 Phillppine 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. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a buman 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 lesue sucb permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a human body and remove it froin a town, from one cenietery to another, or from oue grave or tomb other thau the receiving tomb to another in the same cemetery, until he has received a permit from the bosrd 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 sucb board, agent or clerk, as the case inay 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 Internient, 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 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 tbe aelectmen 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 shall 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 of tbe undertaker desiring to make such renioval 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 ins 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 giveu 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 manter or 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 perniit so to do 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 body is to be buried or the funeral is to he held, or from a person appointed to have tbe care of the cemetery or burial ground in which the interment is made. ... Cbap. 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 hy 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 iies aud take charge of the same; . .. - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calls for the observance of the following rules of practice :
(1) Attending physiciana will certify to sucb 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 phyalolana 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 attendance or whose pbyaf- cian is absent from home when the certificate of death is needed.
(3) Medioal Examinera will investigate and certify to all deatha sup- posably due to Injury. These include oot ooly deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal, or electrical agents, amt deaths following abortion, but also deaths from diseasa resulting from injury or Infection related to occupation, the sudden deatha of persona not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death. not the more of dying, e. g., heart fallure, 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 Oooupation .- Precise statement of occupation ia very im- portant, so that the relative bealthfulness of various pursuits can be known, Make some entry in this section for every person aged 10 yeara 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 bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at boine. For a woman wbose only occupatiou was that of honie housework. write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, aa housekeeper-private faniily, cook- hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
PLACE OF DEATH
County)
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No. 284
{ { If death occurred in a hospital or institution, give ite NAME instead of street and number)
2 FULL NAME
( It deceased is a married, widowed or divorced woman, give also maiden name.) 7 Woodside Part Wirellesok
(a) Residenca. No.
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
yeara months days. in this community 3 6 yrs. - mos. ~ days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLDR OR RACEJ
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
widows.
Sa If HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
Secret
years
IF STILLBORN. enter that fact here.
8
AGE
93 Years
2
Months
14 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Retired
Industry
Salesman. Menstudio
11 Social Security No.
none
12 BIRTHPLACE (City)
( Siate or country)
new Hampshire
13 NAME OF
FATHER
Thomas & Tasker
14 BIRTHPLACE OF
unable to obtain
FATHER (Clty)
(State or country)
15 MAIDEN NAME
OF MOTHER
Comfort Bickford
16 BIRTHPLACE DF
MOTHER (City)
(State or country)
unable to obtain
Barra
17 Informent
Ima Harriet Brewster, Ilation, with ( Address) 7- Wordanche Park wonthe wall
I HEREBY CERTIFY that a satisfactory standard certificala of death was filled with me BEFORE/ the burist or transit permit was Issued :
(Signature of Agent of Board of Health or other) He attle Oficer 17/29/43 (Dicial Designation) ( Date of Issue of Permit)'
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec
29
1943
( Mfonth)
(Day)
'Year)
19 | HEREBY CERTIFY,
Que 28
1943.
Dec 29
That I attended deceased from
to ....
19.43
i last saw h. ............. alive on Dec 29 -2 19.43, death Is said to have occurred on the date stated above, at 12.15 A .. m.
Immedlete ceuse of death.
from Brother Compram ...........
... IMPORTANT
Due to Etena selam 1
Due to
Other
malum Carae Samles
( Include pregnancy within 3 months of death)
Major findIngs: Df operations
Dete of.
Df autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to oooupation of deceased ?. 20
If so, spaolfy ..
('Signed)
(Address) 18645
St
.......
Date. 291943
21
Pine Hill Candling
l'lace of Burial, Cremation or Removal.
(City or Town)
22 NAME DF
FUNERAL DIRECTOR.
Che Ri Bonnson
ADDRESS
Reoaived and Alad
19
( Registrar)
H
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 on back of certificate. terms, w that it may be properly classified. Exact statement of decoration is very important. See instructions and PARENTS
100M-6 · 2·42- 8855
1
(City or Town) 7 Wordsis Tack winthrop No. Eli Brewster Jacker.
St.
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT
(Wes deceased a
U. S. Wer Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
Duration 24 hrs
IMPORTANT Physician
Underline the cause to u hich death should ba charged sta- listicaliy.
W. M.Tr. ..... DATE OF BURIAL
M. D.
Rochester
10 or Business :
Give meiden name of wite in full )
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physloian or registered hospital medical officer shall forthwith. after the death of a person whoin he has attended during his last illness, at the request of an uuderteker or other authorizeil person or of any meniber of the fanrily of the deceased, furnish for registration a atandard certificate of death, stating to the best of his knowledge and hehef the name of the deceased, bis supposed age, the disease of which he died. defined as re- quired hy section oue. where same was contracted. the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... Gen. t.aws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa required hy the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the hest of his knowledge and helief, 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 wer, sud 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 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 sail purposea, he deemed to have taken place hetween February fourteenth, eighteen hundred and winety eight sud July fourth, nineteen hundred and two, and the Mexi- can horder service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 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 hody which has not been buried, until he has received a permit from the board of hesith, or ita agent appointed to lesue 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 ahall exhume a human body and remove it froin a town, from one cemetery to another, or from one grave or tomh 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 huried. No such permit shall he Issued until there shall have been delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to be returned aml 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 reasons, his certificate camiot he obtained early enough for the purpose, or ia insufficient, a physi- cian who is a member of the board of health, or employed by it or hy the aelectinen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death Is caused hy violence, the medl- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously iuterred, from 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 hody has been sooner obtained hereunder. If the death certificate containa a recital, as required
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