USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 2
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(Before death)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCER
Married
Sa If married, widowed, ar divorced
HUSBAND of
Miriam
"Haywood
(Give maiden name of wife In full)
(or) WIFE of
( Husband's name In full)
63
years
IF STILLBORN. enter that fact here.
8
AG63
Yeara
-
Months ........... Days
If less than 1 dey
Hours ..
.. Minutes
Usual
9 Occupation :
Sales ..... Enginee.p.
Industry
Lumber
10 or Business :
11 Social Security No.
Roxbury
12 BIRTHPLACE (City)
( State or country)
Masg
13 NAME OF
FATHER
John C. Clark
14 BIRTHPLACE OF
FATHER (City)
Liverpool
(State or country)
Eng
15 MAIDEN NAME
OF MOTHER
Anna Ward
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
17
Miriam Clark
wife
Relation, If any
( Address)
2T
Grovers ave
I HEREBY CERTIFY that a satisfactory standard certificate of death wes filed with me BEFORE the burlal or transit permit was Issued ? WMD- Children
(Signature of Agent of Board of Health or other)
Health Officer 1/14/ 48
(Official Designation)
(Date of Issue of Permity
18 DATE OF
DEATH
(Month)
(Day)
1444 (Year)
19 | HEREBY CERTIFY,
1-4-
944.
1.
That I attended deosased from
1-80
19.
44
I last saw h ......
am alive on
1-7-
19.7 .... , death Is sald to
have occurred on the date stated above,
at.
3 H
m.
Immedlate cause of death
Duration IMPORTANT
...
Due to antun Milion
Due to
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT
Mejor findIngs:
Of operations
Date of.
Of autopsy.
What test confirmed diagnosis ?.
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
so, spsolf
('Signed)
5)y Warhigh in Date +5-19204
9 ........
21
Calvary
Boston
Place of Burial, Crenistion of
DATE OF BURIAL ..
TO(City of Town )
19
22 NAME OF
FUNERAL DIRECTOR ..
ADDRESS
Winthrop
Received and Aled Je 1 8 1014 19
( Registrar)
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
extracts from the laws on back of certificate.
100M-6 - 2-42-8855
PLACE OF DEATH
Suffolk
(County)
-
No.
(City or Town)
2I Groverg Ave
.........
+ St.
(Was deceased a
U. S. War Veteran,
if so apoolfy WAR)
30
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
8
Male White
6 Age of husband or wife if alive
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot.
PARENTS
Informant
Needham
. M. D.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medloal officer shall forthwith, after the death of s person whoin 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 died. defined as re- quired by section one. where same was contracted. the duration of his last illness, when laat seen slive by the physician or omcer and the date of his deatb ... Gen. Laws, Chap. 46, Sec. 9.
A' physician or officer furnishing s certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, slisll. 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 iinmediate 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 sec- tion and of sections forty-five, forty-six and forty seven of said chapter one bundred and fourteen, the word "war" shall inclittle the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetween February fourteenth, eighteen hundred and ninety- eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen bundred and seventeen. C. L. Chiap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in s 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 lasue sucb permits, or if there is uo such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and retnove it froin a town. from one cenietery 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 aforewaid or from the clerk of the town where the body is buried. No such permit sball be Issued until there shall have been delivered to sucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facta required by law to be returned and recorded, which shall be accompanied. in case of an original interment, by a ostiafactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate ao hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or le 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 niake the certificate re- quired of the attending physician. If death ie caused by violence, the medl- cal examluer chall 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 renioval shall constitute a permit for ruch removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unleas 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 physiclan 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 tha 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 re- ceived a permit so to do from the hoard of health or its agent appointed to Issue such jern,its, 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 from a person apointed 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 ouly such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within lils county the body of such a person, he shall forthwith go to the place where the lxxly lles aud take charge of the same; ... - General Laws, Chap. 38, Suc. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persons to whom they have given hedside care during a last Illness from disease unrelated to any form of Injury.
(2) Board of Health 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 pbyaf- cian is absent from home when the certificate of death le needed.
(3) Medioal Examiners will Investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or In- directly by traumatiam (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aml deaths following abortion, but also deaths from diseass 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 more of dying, e. g., heart failure, asphyxia, astbenia, etc. As 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 la very 1m- portant, so that the relative bealthfulness 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 dixcase 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 as at school or at boine. For a woman whose only occupatiou was that of honie bousework, write housework. For a person engaged in domestic service for wagen, however, designate the occupation by the appropriate terms, aa housekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to insert a' recital to that effeot. 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 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
PLACE OF DEATH
Suffolk
(County) Winthrop
(City or Town)
Maple Rest Home
The Commonmoralth 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.
5
S ( If death occurred in a hospital or institution, ·¿ give Its NAME Instead of street aud nuniber)
2 FULL NAME
William J. Henry
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
26 Sturgis St
(Usual place of abode)
1
years
months
days.
In this community23
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE1
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
Married
58 If married, widowed, Ma divorced Howell
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
56
years
9 IF STILLBORN. enter that fact here.
8
AGE 66
Years
Months
... Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Salesman
Industry
Shoe
10 or Business :
11 Social Security No.
Boston
12 BIRTHPLACE (City)
(Siate or country)
Mass
13 NAME OF
FATHER
John J. Henry
14 BIRTHPLACE DF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Della O'Dowd
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Mary A. Henry Måtte if any
Informant.
( Address)
26 Sturgis st
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filled with me BEFORE the burial or transit permit was Issued : WMED. Childrensx ... (Signature of Agent of Board Of Health or other) ( featthe Office 1/10/44
...... (Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
January
8
1944
( Month
(Day)
(Year)
19 | HEREBY CERTIFY,
March 15
19 2/3, to
Van. 8
That I attended deosased from
1944
·
I last saw him
„alive on
Van ),
1944, death is said to
have occurred on the date stated above, at ..
2.50A
m.
Immediate oause of death ....
Carmona of Lung
IMPORTANT
About ....
15 mos.
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Df operations
Of autopsy
What test confirmed diagnosis?
X-Ray(Clançar
IMPORTANT Physician Underline the cause to which death should be charged sta- fistically.
20 Was disease or injury in ony way related to occupation of deceased?
ff so, specify
daniel. 012
(Signed)
(Address)
Winthrop
Date Vany
Boston
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Jan Io
TO4giy or Town)
19
22 NAME DF
FUNERAL DIRECTOR.
ADDRESS
www Tomater
Winthrop
Received and Aled.
JAN1-01944
1.9
(Registrar)
100M-6 - 2-42-8855
1
No.
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so speolfy WAR)
St.
( If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Refnre desth)
(Specify whether)
6 Age of husband or wife if alive
PARENTS
...
M. D.
21
Calvary
Date of
Duration
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 whoin he has attemled during his last illness, at the request of an undertaker or other authorized person or of snr member of the family of the deceased, furnish for registration a standard certifcate 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 same was contracted. the duration of his last illnesa, 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 s 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 any war in which it has been engaged, insert in the certificate a recital to that elect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate csuse of death as early 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 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 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 body which has not been buried, until he has received a permit 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 person died; aud 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 iaaued until there aball have been delivered to such board, agent or clerk, as the case inay he, 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. 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 the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cai 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 obtained early enough for the purpose, the certificate of death made as above provided and in the possession ot the undertaker deairing to make such removal shall constitute a permit for such removai; 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 contains a recitai, 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 forthwltb countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other nece+ sary information which can be obtained as to the deceased, or as to the manter ot 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 hunian hody or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the haard of health or its agent appwanted to issue auch 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. ... Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
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 iiea aud 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 as those of persons to whom they have given hedside care during a last iliness from disease unrelated to any form of injury.
(2) Board of Health physiolans will certify to such deaths only as those of persons who, though disshled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death is needed.
(3) 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 traumatiam (including resulting septicemia), and by the action of clientical (drugs or poisons), thermal, or electrical agents, and dealbs following abortion, but also deaths from diseass resulting from Injury or infeotlon related to occupation, the sudden deatha of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of deathi meana the disease, or complication which causes death, not the mode of dying, e. g., heart fallure, asphyxia, asthenia, etc. As principai cause name the disease causing death. Aa related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation ia very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. if the occupation had 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 businesa, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at hoine. For a woman whose only occupatiou was that of honie housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terma, aa housekeeper-private family, cook-hotei, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
ORM R-3011
1 PLACE OF DEATH 3 SEX Female (or) WIFE of 8 29 10 or Business: PARENTS N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. Sec 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 (State or country) 200m-10-'39. No. 8427-d
Suffolk
(County)
Tinthrop (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No 6
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Mary Patricia Christopher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
I52 Lincoln St
.St.
(If nonresident, give @ty or town and state)
years
I months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCESingle
(write the word)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
AGE
Years.
Months
Days
If less than 1 day
Hours ...
Minutes
Usual
9 Occupato11 .... Worker
Industry
Maverick
.
Mills
II Social Security No ..
025-12-7765
12 BIRTHPLACE (City)
East
Boston
Mass
13 NAME OF
FATHER
John J, Christopher
14 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country) Mass
15 MAIDEN NAME
OF MOTHER
Catherine Johnson
16 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country)
Mass
17 Catherine Johnson Relation, if any
Mother
(Address)
152 Lincoln St
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: m. S. Childress
(Signature of Agent of Board of Health or other)
Health Alicer (Official Designation) (Date of Issue of Permity
1/17 /4/
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
gan
15
1944
1
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from See 26
19 .. 23., to ....
ge-15
1944
I last saw h ......... alive on .......
U15
, 1944 .. , death is said
to have occurred on the date stated above, at 10.30Am. Immediate cause of death ..
...
Fabrino poulet Partoncho
... ... Fikriun purulent perite. it's
Due to
Perforation of Segnacional & colon
Due to
.....
Other conditions
Teramal Brancho
(Include pregnancy within 3 months of death)
3dage PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was diseason or lojory In any way related to occupation of deceased ? 200
If so, specify.
M. D.
(Signed)
148 Winthrop St.
Date 1/15
(Address)
1944
21
Winthrop Winthrop-up mas
Place of Burial, Crematipag Rem8 ICGAYLor Town)
DATE OF BURIAL
.19
22 NAME OF
FUNERAL DIRECTOR
Jahwe tomatey
ADDRESS
Winthrop
Received and filed,
A TRUE COPY ATTEST: JAN 1 8 10 (Registrar) 19
Major findings :
Of operations
Of autopsy ...
1/15/44
Date of 1/11/44
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