USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 49
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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
< / Rec houp. 7/25/46
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.
Registered No. 132
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) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution (Before death)
(Specify whether)
-
years
4 months 24 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
General
4
COLOR OR RACE
what
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
planned
5a If married, widowed or divorced HUSBAND of ...
(or) WIFE of. George
(Give maiden nameof wife in full)
Ramille
(Husband's name in full;
6 Age of husband or wife if alive
SI
years
7 IF STILLBORN, enter that fact here.
8 AGE.S . .Years Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
housquesta
Industry
10 or Business:
at home
11 Social Security No.
12 BIRTHPLACE (City)
(State or Country)
hortons wills
Vermont
13 NAME OF
FATHER
Phitop Boverbeau
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or Country)
Canada
15 MAIDEN NAME
OF MOTHER
Julia Fillion
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
Canada
17 George Rainville ipn, if any )
Informant (Address 49 Rockwell St Saten ??
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of/ transit permit was issued:
(Signature of Agent of Board of Health & other) Health Officer (Official Designation) (Date of Issueof Permit
78/31/46
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jun
19
(Month)
((Day)
1944 (Ycar)
19
I HEREBY CERTIFY,
Feb. 25,
, 19
44,10
That I attended deceased from
July 19.
19 76
I last saw h alive on
have occurred on the date stated above. at 3.50€. m.
Immediate cause of death
T. Po. of Kidney
Due to T. B. Pericculites Perforation ? Banel Due to Pericoloniti V
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
T. B. Kudry
renii
Date of. Zab, 27,19 46
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Siegel
(Signed)
, M. D.
(Address) 12 Slice An Fim Da
7/20
19 46
21 Holy Cross/
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
July 22
19 +6
22 NAME OF
Gerard E. Carroll
FUNERAL DIRECTOR
ADDRESS
721 Salem St. Walder
Received and Filed
JUI 24 1945
(Registrar)
Sce instructions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
00m-9-44-14955
1
2 FULL NAME
Marquante m. Rainville mee Boverbeau (If deceased is a marfied, widowed or divorced woman, give also maiden name.)
49 Rockwell
Malden St.
(If nonresident, give city or town and State)
19 19 76 death is said to
Duration IMPORTANT 6 mg. 2 mo 3 weeks
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
Martin
19
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 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 110 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 ivity . 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 forum 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
301 A
extract from the laws on back of certificats. If deceased was a U. S. War Veteran, G. L. Chap. 45. Ssation 10, requires physiolans to Insert a reoltal to that effeot. PARENTS
100m-(g)-1-45-15510
PLACE OF DEATH r
Suffolk. (County) Wanthow
THUY
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.
133
Registared No. ......
{ (If death occurred in a hospital or institution, St. { give its NAME instead of street and numher)
PHYSICIAN - IMPORTANT
2 FULL NAME
( If deceased Is a/married, widowed or divorced
woman, give also maiden name.)
04- Highland live - Gambridgest
(a) Rasidanca. No.
(Usual place of abode)
Langth of stay: In mosoltet or institution
(Before death)
( Specify whether )
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Stopth)
(Day)
(Year)
19/1 HEREBY CERTIFY ,
19.
Vlast sawh M
alive on may22. 49/ cooth is said to
have occurred on the data stated above, at. 11.40 F m.
Immadlaje Dausa of death ..
Capitais/ chin
100
Due to
Due to
Other conditions
( Include pregnancy within 3 months of death)
Mejor findings :
Ol operetions
Oata of
Of autopsy.
What test confirmed diagnosis?
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? If so, specify ...
M. D.
(Signed)
(Address) Wohn
Data .. 7-23-1946
{City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL ..
7-25-1944
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Cambridge 19
Recaived and Aled JUL-24 1946
19
7(Oficial Designation)
( Date of Teque/of Perunit)
21
Relation, Many
Daughter
17 Lamse Ceravlay
Informant.
( Address)
I HEREBY CERTIRY that a satisfactory standard certificata of daath was filled with me BEFORE the Budal or, transit permit was Issued :
Valley ATakelded
(Signature of Agoat of Board of Health, or other) Health Oficer 7/24/46
years L months L days.
In this community
yrs.
6
mon:
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEĮ
W.
5 SINGLE
( write the word)
Wide
Se If married, widowed, or divoroed HUSBAND of
(Cice maiden name of wie in full )
( or) WIFE of
( Husband's name in full)
6 Age of husband or wife if etiva
years
7 IF STILLBORN, enter that fact here.
8 AGE 80 Years
Montha Oays
If less then 1 dey Hours Minutes
Usual
9 Occuoetion :
Petried
Industry
10 or Business :
Homenaje
11 Social Security No.
12 BIRTHPLACE (City)
( State or country)
Cambridge Mass
13 NAME OF
FATHER
14 BIRTHPLACE OF FATHER (Clty) (State or country)
breland
15 MAIDEN NAME
OF MOTHER
Close Halen
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
Ireland
1
>
No.
alice Bestünde Lunch
MUNDOF )
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
22
15+6
MARRIED
WIDOWED
or DIVORCEO
That I attendad deceased from
1920 09 July 22
16
...
Duration
IMPORTANT
( Registrar) r)
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 2 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 herennder. If the death certificate contains a recital, as required
by section ten of 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 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commontoralth 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.
13.1
S ( If death occurred In a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Mary .... Taylor .... Pepper.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 9 .Wilshire St ....
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
-
yeara
months
days.
In this community
18 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEJ
5 SINGLE
( write the wurd)
MARRIED
WIDOWED
or DIVORCED
Widowed
Sa If married, widowed, or divoroed
HUSBAND of
(or) WIFE of
Thomas ... Pepper
(Ihnshand's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here.
8
AGE .86 ... Years
-
Months
10Days
-
If less than 1 day
Hours
.Minutes
Usual
9 Oocupation :
Housewife
Industry
10 or Business :
At ... Home
11 Social Security No. none
12 BIRTHPLACE (City)
(Siate or country)
England
13 NAME OF
FATHER
not known
Taylor
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
not known
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
not .... kom
17 Informant ( Address) 9 Wilshire St. Winthrop
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bufiat or transit permit was Issued : Matter & Pable
(Signature of Agent of Board of flearth or other)
7/24/46
Dorm
18 DATE OF
DEATH
July
22
1946
(Month )
(Day)
(Year)
19 | HEREBY CERTIFY, That 1 attended deceased from
paly 20 19 ... 1.2 .. to.
2
19 ........
last saw h .. allve on ...
have occurred on the date stated above, a
3D .m.
Duration IMPORTANT
3 day .......
Due to.
Due
myocarditis, hypestatic
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