USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 37
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FATHER
Ephraim D Downes
14 BIRTHPLACE OF
FATHER (Clty)
Roxbury
(Stale or country)
Masg.
15 MAIDEN NAME
OF MOTHER
Elizabeth Sargent
16 BIRTHPLACE DF
MDTHER (City)
( State or country )
Mass.
Roxbury
17 Elizabeth Smyth Ra. Milton
Niecer any
Informant ( Address) 294 Edgehifi
I HEREBY CERTIFY that a satisfactory standard oartiffoata of death was filled with me BEFORE the budet or transit parmit was Issued ? Www. D. (tul dress
( Signature of Arest of Board of faith as other) Health Office 5/31/45
(Omcial Designation) ( Date of Inause of Permit)
18 DATE OF
DEATH
May
28
1945
(Month)
(Year)
19 | HEREBY CERTIFY,
May24
19 ...
45.
to.
May 28
1945
I last saw h .. C ........... aliva on.
May 28, 1945, daath Is sold to
hava occurred on the date stated above, at.
7.201Pm.
Duration
Immadlate pause of death.
Cerebral Hemorrhage
Due to Chronic Hypertension
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findings:
Df oparations
Data of
Of autopsy
What test confirmed diagnosis ?.
Clinical Sighs
IMPORTANT
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 ? No If so, spaolfy
( Signad)
, M. D.
(Address)
Winthrop,h
1. Data May29 1935
Boston
21
Mt ..... Hope.
Place of Burial, Cremation or Removal.
(City or Town)
DATE DF BURIAL
May
31
1945
22 NAME DF
FUNERAL DIRECTOR award
Howard SeJumolds
ADDRESS
Winthrop muss.
Reosived and Alad TUN 1 1945 19
( Registrar)
4 years ....
PARENTS
100m(:) -1-44.13634
1
No.
(City or Town) 63 Prospect Ave
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Day)
That I attendad deoassed from
IMPORTANT 4 days
Roxbury
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 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.
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 United States in any war in which it has been engaged, insert iu 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 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 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 or 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 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 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 cause 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
-- -
PLACE OF DEATH
Suffolk (County)
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.
107
St. { {If death occurred in a hospital or institution, { give its NAME instead of street and number) )
2 FULL NAME
Robert
W. Wilson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN- IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) .
(a) Residence.
No.
205 Cliff Ave
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
PERSONAL ANO STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE (write the word)
MARRIEO
WIDOWED
or DIVORCEMarried
Male
White
5a If married, widowed or donath
HUSBANO of ..
M. Neilson
(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.
00 AGE60 Years
Months
-
Oays
If less than 1 day
Hours
Minutes
Usual
9 Occupatio
Heating Engineer
Industry
10 or Business:
Heating
11 Social Security No.
309 -- 03 -- 4304
New York
12 BIRTHPLACE (City)
(State or Country)
N.Y.
13 NAME OF
FATHER
Robert S. Wilson
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
N. Y.
15 MAIOEN NAME
OF MOTHER
Sophie D. Millburn
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
N. Y.
17 Edith M. Wilson ( Wife ifany )
Informant (Address) 205 Cliff Ave
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit pofmit was issued: "Mm. D. Children x (Sinature of Agony of Board of Health or other) Healthe officer
(Official Designation) (Date of Issue of Permit) 5/31/ 45.
18 OATE OF
DEATH
may
29
(Month)
(Day)
1945
(Year)
19
I HEREBY CERTIFY,
That I attended deceased from
march 9
1945.
to
May 29
. 19 255
I last saw him
alive on
may
29. 1985
, death is said to
have occurred on the date stated above, at
2:30 A.M
Duration
Immediate cause of path
acute Cormany Thrombosis
IMPORTANT 24 hours 3 mas
Due to
augura Pectoris
Que to
Other conditions
none
(Include pregnancy within 3 months of death)
Major findings:
Of operations
nome
Oate of
Of autopsy
none
What test confirmed dia
clinical x laburating
no
20 Was disease or injury in any way related to occupation of deceased? It so, specify (Signed) Jacob, alamo M. (Address 56 2 Henley Ma Date May 29
. M. D. 19755
21
Winthrop
Winthrop
Place of Burial, Cremationer Removal. June 19h& or Towny DATE OF BURIAL
22 NAME OF FUNERAL DIRECTOR AOORESS Winthrop, >>
Received and FHled
JUN 1
1945
19
( Registrar)
100m-9-44-14955
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terius, so that it may be properly classified. Exact statement of OCCUPATION is very important. PARENTS
IMPORTANT
Physician Underline the cause to which death should be Charged sta- tistically.
New York
Haverstraw
R-301 A 1 inthrop (City or Town)
No. .
205 Cliff Ave
years
months
days.
In this community -
mos.
-
days.
60
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 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.
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 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 bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been 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 or chapter forty-six, tuat 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 forin 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 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 cause 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
RM R-301
PLACE OF DEATH
Suffolk (County)
16A Lincoln Street
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
1.08
Registered No. ยง (If death occurred in a hospital or Institution, St. { give its NAME instead of street and number) PHYSICIAN-IMPORTANT
2 FULL NAME.
Cora M.E. (Davison) Irwin
(If deceased ls a married, widowed or divorced woman, give also maiden name.)
16A Lincoln Street
St
Length of stay: In hospital or institution.
-
years
months
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
8 SINGLE
(write the word) | 18 DATE OF
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
Ba If married, widowed, or divorced
HUSBAND of.
(Give malden name of wife In full)
(or) WIFE of.
Samuel Irwin
(Husband's name in full)
177
years
8
74
7
Months
11
If less than 1 day
Days
Hours
Minutes
11 Social Security No ...
None
Winthrop
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
John Davison
FATHER (City) ...
Gloucester
13 MAIDEN NAME
OF MOTHER
LovKCV
White
18 BIRTHPLACE OF
MOTHER (City) ..
Pomfret
(State or country)
Vermont
(Address):
Date May 31 1945
Everett
Place of Burial, Cremation or Removal.
DATE OF BURIAL
June 2
19.
22 NAME OF
Howard S Rynoldo
FUNERAL DIRECTOR ADDRESS
Received ond filed "JUN-1" 1945
19
A TRUE COPY ATTEST: (Registrar)
100m(b)-1-41-4695
Chil dress y (Signature of Agent of Board of Health or other)~ Health Aplicar
(Date of Issue of Permit) 6 1/47 (Official Designation)
19 | HEREBY CERTIFY. That I attended deceased from May 15 19/0, to 14 ay 31 19 45
I last saw her alive on May 30 19.5.3., death is said to have occurred on the date stated above, at 10.45-9m. Immediate cause of death. Coronary Thrombosis
Duration Important Sudden
Important
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations.
Date of.
Of autopsy
What test confirmed diagnosis? ClinICA/ Signs
PHYSICIAN Underline the cause to which death should be charged sta- tiatically.
20
W'as disease or injury in any way related to occupation of deceased ?.
20
If so. specify
(Signed)
Winthrop
M. D.
Relation, If any 21 Woodlawn Crematory
(City or Town) .45
Informant. (Address) 16A Lincoln Street Winthrop
1 HEREBY CERTIFY that a satisfactory standard certificets of death yas filed with me BEFORE the burial or transit permit was issued:
Husband
1
Winthrop
(City or Town)
No
(a) Residence. No.
(Usual place of abode)
3 8EX
Female
4 COLOR OR RACE
White
8 Age of husband or wife if alive
7 IF STILLBORN. enter that fact here.
AGE
Years
Usual
9 Occupation:
Housewife
Industry
10 or Business :..
Own .... Home
1
14 BIRTHPLACE OF
PARENTS
17
Samuel Irwin
mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect.
See instructions and extracts from the laws on back of certificate.
DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item or Ihror-
(State or country)
Mass.
(Was deceased a U. S. War Veteran? If so, (specify WAR)
mos.
11
days.
(If nonresident, give city or town and State)
In this community 7 4 yrs.
7
DEATH.
May
31
1945
Due to.
Due to.
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 iliness, 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 required by section one, where same was contracted, the duration of his last iliness, 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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