USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 36
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Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease 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 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, how- ever, 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
R-301 A 1
1
PLACE OF DEATH
Suffolk (County)
Winthrop.
(City or Town) Winthrop Community Hospital. No.
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.
Ragistared No.
1.04
St.
{ (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Phyllis Colby Allen.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Rasidence. No.
177 Somerset Avenue
(Usual place of abode)
Length of stay: In noepital or Institution
Hospital
( Before death)
(Specify whether)
years
months
daye.
In this community-
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
Widowed.
WIDOWED
or DIVORCED
5a If married, widowad, or divorced Robert H. Allen.
HUSBAND of
.....
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if elive years
7 IF STILLBORN, enter that fact here.
8
AGE
.5.5 Years
0
Months 11 Days
If less than 1 day
Hours
Minutee
Usual
9 Ocoupetion :
House wife
Industry
10 or Business :
A.t ..... home
11 Social Security No.
Daot BogEgn
12 BIRTHPLACE (City)
( Siste or country)
Mas.S.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Newburyport
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Elizabeth Stratton
16 BIRTHPLACE OF
MDTHER (City)
South Portland
(State or country)
Maine.
17
Miss Virginia Allen daughter
Informant
( Address )
177 Somerset Ave Winthrop.
I HEREBY CERTIFY that a satisfactory standard certifioste of death was filed with me BEFORE the burial or transityperrolt wae Hrued ? Les lehelders
(Signature of Agent of Board of Health for other) ...
140
ceft
6/25/45
.... (Official Designation) ( Date of Inque of Permit)'
18 DATE OF
DEATH
May
24 1943
( }fon/h)
(Day)
(Year)
19 | HEREBY CERTIFY,
1
1945.
OHay 24.
That I attended deceased from
1945
West saw her alive on
5/24
1945 death is said to
have occurred on tha date stated above, at
Immediate)oquea of death ...
Due to C
Due to
Dther conditions.
( Include pregnancy within 8 months of death)
Mejor findinge:
Of operations
Data of.
Of eutopsy
0
What test confirmsd dlegnoels ?
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically
20 Was discese or injury in any way related to occupation of deceased ?
If so, spoolfy
( Signed)
thay0, 1449an
M. D.
(Address)
6705 ana1099 Date 5/24 1941
Arlington National Con Arlington VA
Place nf Burial, Cremation or Removal.
(City or Town)
Va
DATE OF BURIAL ... May ... 29, 1945
19.
22 NAME DF
FUNERAL DIRECTOR
Charles R. Bennyson
ADDRESS
174Winthrop St.
arm.
19
Received and fled
MAY 28-1945
( Registrar)
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.
If deceased wes a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a reoltal to that effeot.
100m.(g)-1-45-15510
13 NAME OF
FATHER
Charles Sumner Colby.
Duration
IMPORTANT,
8.
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(If nonresident, give city or town and State)
25
0,300 m
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 died, defined as re- quired 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.
A physician or officer furnishing a certificate of death as required by the preceding section or hy 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 relicf expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been buried, until he has received a permit 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 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 hody is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall he 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 hy it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused hy violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human hody, 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 ahove provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for auch 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 torty-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 neces- sary 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).
Medical examiners shall make examination upon the view of the dead hodies 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 hody 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.
No undertaker or other person shall bury a human hody or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no suchi board, from the clerk of the town where the body is to he huried 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 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 disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician 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 indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled hy 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 conditions, if any, related to the principal cause and any iniportant complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is 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 disease 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 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, how- ever, 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301 A
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, Q. L. Chap. 46. Section 10, requires physiolans to insert a recital to that effect.
100m. (g)-1-45-15510
I HEREBY CERTIFY that a satisfactory standard certificats of death was fled with me BEFORE the burtal or transit parmit was Issued : William St, Childress -
(Signature of Agent of Board of Health or other)
agent may 28/45
(Omclal calgnation) ( Date of loque of Fermft)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Man
25 1975
(stonth)
(Day)
(Year)
19 1 HEREBY CERTIFY,
That I attended deoeesed from
Sabemper
1942.
to
may- 25
1941
I last saw h.
.allva on
S
25
19.50., death is sald to
have occurred on the data statad abova, at ...
8:30 P.m.
Immediata causa of daath
IMPORTANT
Chronic Myocarditis
2yrs-
Que to
Due to
Other conditions.
HyperTENSION - Cancer of
Unclude pregnancy |withio 8 months of death)
TONque + Rt. lover Tans.
Major findings :
Of operations
CANCEL
Date of Set- 1943
Of autopsy
What test confirmed diagnosis?
IMPORTANT
Physician Underline the cause to which death should be charged st .. tistically. NO
20 Was disease or injury in any way rslatad to occupation of deceased ?
If so, spsolfy ....................
Edward in tranger.
(Signed).
M. D.
(Address) :01 Washington AVE Date 1ay 24 1945
21
Place of Burial, Geomelico on Removal.
(City or Towns
OATE OF BURIAL ..
May 28.
19.4
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADORESS
174 Wanting Lt
Recsived and Alsd
MAY 28 1945
( Registrar)
1
PLACE OF DEATH
Suffolk (County)
Winthrop ......
(City or Town) Cottage Park yaught Club No.
St.
{ (If death occurred in a hospital or institution,
{ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Rasidenca. No.
52 Orlando avenue
SŁ.
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
years
months days.
(It nonresident, give city or town and State)
In this community. 5 8 yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
white
5 SINGLE
( write the word)
married
MARRIED
WIDOWEO
or DIVORCED
Helen 7 Hubbard
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 alive
70 years
7 IF STILLBORN, enter that fact hera.
8 77 Years AGE - Months 8 Days
If less than 1 day
Hours
Minutas
Usual
9 Occupation :
Retired
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( State of country)
Roxbury
andas
PARENTS
14 BIRTHPLACE OF
FATHER (Clty)
Baston
(State or country)
mars
15 MAIDEN NAME
OF MOTHER
Hannah French
16 BIRTHPLACE OF
MOTHER (City)
unknown
(State or country)
17 Informant ( Address )
Mas C R Gardner
Relation, If any wife
may 18
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.
105
2 FULL NAME.
Charles Russell Gardner
( It deceased is a married, widowed or divorced woman, give also maiden name.)
....
Duration
13 NAME OF
FATHER
Charles A Marcher
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 attendcd 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 last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, See. 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 armny, 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 expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 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 sanie 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 may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, 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 medi- cal 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 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 furnish for registration any other neces- sary 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).
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.
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 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 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 disabled by recognized disease unrelated to any forum of injury, have died without recent medical attendance or whose phy- sician is absent from home wben 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 indirectly by traumatism (including resulting septicemia), 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, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal carse and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is 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 disease 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 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, how- ever, 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301 A
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46. Seotion 10, requires physicians to insert a recital to that effeot.
PLACE OF DEATH -
Suffolk (County)
Winthrop
...
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. 106
St& (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Lillian Elizabeth Downes
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Rasidence. No.
63 Prospect Ave,
(Usual place of abode)
St.
(If nonresident, give clty or town and State)
Langth of stay : In nnspital nr Institution
( Before death)
(Specify whether )
years
months
days.
In this community 33 yrs. - mos. - days.
35
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 CDLOR OR RACE
5 SINGLE
( write the word)
Female
White
MARRIED
WIDOWED
or DIVORCED Single
5a If married, widowad, or divorcad
HUSBAND of
( Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if aliva ysarı
7 IF STILLBORN, entar that fact here.
8
AGE 83. Year's
3
Montha
11 Days
If less than 1 day
Hours
Minutas
Usual
9 Occupation :
Housework
Industry
Own Home
10 or Business :
11 Social Security No.
None
12 BIRTHPLACE (City)
( Siste or country)
Mass.
13 NAME OF
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