USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 50
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PNEUMONial
Other conditions.
(luclude pregnancy within 3 months of death)
Major findings : Of operations.
Date of.
Of autopsy
What test confirmed diagnosis?
IMPORTANT Physician t'underline the cause to which death shouht be charged sta- tistically.
20 Was disease or injury in any way related to ocoupation of deceased ?.
If so, specify.
...
(Signed)
(Address)
Trhy 20 Date 7/20
winthrop
M. D. 1946
21
winthrop
l'lace of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL.
July 25, 1946
19
22 NAME OF FUNERAL DIRECTOR Richard 16 HChute
ADDRESS
147 Winthrop St . Winthrop
Received and filed JUL 24 1946
19
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 effeot. PARENTS
00m (d)-1-41-4667
ErnestPepper
Relation, if any
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
St.
(If nonresident, give city or town and State)
death Is said to
Immediate oause of death.
(Give maiden name of wife in full)
Female White
No. 9 ... Wilshire .... St ......... Winthrop
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 iluring his last illness, at the request of an umlertaker or other authorized person or of any member of the faniily 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 hy the preceiling section or by section forty- five of chapter one hundred and four- teen, shall, if the deceased. to the best of his knowluilge and belief, served in the army, navy or marine corps of the I'nited States in any war in which it has been engagent, insert in the certificate a recital to that effect, spr-ci- 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 ilollars. 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 wonl "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen humlred and sixteen and nineteen bundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human boily 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 huried. No such permit shall be issued until there shall have been delivered to such board, ageut or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he returned aml recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law. 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 attenling physician. If death is caused hy violence, the niedi- 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 carly 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 l'nited States in any war in which it has hren engaged. such recital shall appear upon the permit. The board of health, or its agent. ujem receipt of such statement atut certificate, shall forthwith counter-ign it all transmit it to the clerk of the town for registration. The person to whom the perinit 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 or canse of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. L., (Tercentenary Edition).
No uialertaker or other person shall bury a human hody or the ashes thereof which have been hrought 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 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 amminteil to have the 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 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 boily lies and 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 deaths only as those of persons to whom they have given boilside 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 atteinlance or whose physi- cian 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 inchile not only deaths caused directly of in- directly by traumatism (including resulting septicemia), and by the action of clinical ( drugs or poisons). thermal, or electrical agrids, 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 moile of dying. e. g .. heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, natne 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 discase causing death, report the usual occupation prior to illness. If the ileceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed inay be returned as at school or at home. For a woman whose ouly occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
1
PLACE OF DEATH
SUFFOLK BOSTON
...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return) 135
Registered No.
6656
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Mary Lina Woods
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
23 Atlantic Ave
St.
Winthrop
.Mass ..
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
10 days.
In this community 60 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Wid
5a If married, widowed, or divoroed
HUSBAND of
1
19 | HEREBY CERTIFY,
That I attended deceased from
19
to
19
I last saw h.
allve on.
19
death Is sald to
have ooourred on the date stated above, at
m.
Duration
Immediate cause of death Toxic cirrhosis of liver
Ter
Pulmonary ..... doma
dys
8 AGE ... 68 Years 1 Months .. 1.7. .Days
If less than 1 day Hours Minutes Due to.
Usual
9 Occupation :
At Home
Industry 10 or Business :
11 Soolal Security No .... None
12 BIRTHPLACE (City)
(State or country)
Boston, Mass.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be
charged sta- tistically.
Of autopsy What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased?
if so, speolfy.
(Signed)
W R Dudon
M. D.
(Address)
Boston
Date
7/25 29
46
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Cometory, Win,
DATE OF BURIAL
July 29/48
(Cemetery
(City or Townthro
19
22 NAME OF
FUNERAL DIRECTOR
A B Marsh
ADDRESS
Winthrop Mass.
Jul 20/16- 19
Received and filed.d&G ··· 7 ······- 1946
( Rowietrar of City or Town
where derpased reside
!
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
50m- (b).6-44-14607
17 Ardelle Woods
Relation, if any
Informant ..
(Address)
Daughter
A TRUE COPY, DYchuel & Morning
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
9/30/46
19
18 DATE OF
DEATH
July 25/46
(Month)
(Day)
(Year)
(Give maiden name of wife in full)
(or) WIFE of
Phares Lurton Ho&
(Husband's name in full)
6 Age of husband or wife If allve
years
7 IF STILLBORN, enter that faot here.
PARENTS
13 NAME OF
FATHER
James McDougall
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Lucetta Celia Phillips
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
New York
Due to.
Underline the cause to
which death
(City or Town)
No.
Peter Bent Brigham Hospital
St.
(If U. S.
War Veteran,
speolfy WAR)
H
R-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 65 Brewster Ave.,
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.
136
St. (If death occurred in a hospital or institution, ! give its NAME instead of street and number) )
2 FULL NAME
Susan G.Wood, (Peirce)
(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) No
(a) Residence.
No.
28 Gilmore St.,
Everett
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
2 months
days.
In this community
73
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
5a If married, widowed or divorced
HUSBAND of
Giro paigenHameg de 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.
8
73
AGE
Years
3
Months
Days
21
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Housework
Industry
10 or Business:
Own Home
11 Social Security No ..
None
Everett
12 BIRTHPLACE (City)
(State or Country)
Massachusetts
13 NAME OF
FATHER
George W.Pierce
14 BIRTHPLACE OF
Everett
FATHER (City)
(State or Country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Esther Wiley
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
New Hampshire
17
Miss Helen G.Wood
(
Beluigh ter )
Informant
(Address)
28 Gilmore St., Everett, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transt? permit was issued: Walter A. Saker (Signature of Agent of Boary of health or other)
Health
(Official Designation)
officer
(Date of Issue of Permit) 7/29/46
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
)
(Month)
22
(Day)
4.6 Ycar)
19
I HEREBY CERTIFY,
That I attended deceased from
7/1/44
19
,
I last saw her alive on
7/20
have occurred on the date stated above, at
, death is said to
/ 46 19 ga, m. Immediate cause of death Ingocarditis
Duration
IMPORTANT 2 yrs
500
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
(Signed) James 7 Brus
(Address)
Everett.
, M. D.
Date 7/27
12/6
Woodlawn-sverett, Massachusetts 21
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Juży 29, 1986
19
22 NAME OF
FUNERAL DIRECTOR
J. E.Henderson Company
ADDRESS
517 Broadway Everett, Mass.
Received and Filed
JUL 3 1 1946
19
(Registrar)
Y
Due to
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings:
Of operations
no
Date of
Of autopsy 200
What test confirmed diagnosis?
Clinical Signs
Conway
100m-9-44-14955
No.
. See 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. PARENTS
Peirce
, to
7/27/46, 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 hy section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... Gen. 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 helief, served in the army, navy or inarine 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 hoth 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, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder 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 hody 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 hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomh 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 hoard, 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, 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 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 hody, not previously interred, from one town to another within the commonwealth cannot he 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 hody shall he 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 recital, as required
by section ten of chapter toriy-six, toat 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 nianner 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 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 lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall hury 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 such board, from the clerk of the town where the hody 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 hedside 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 hy 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 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 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 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 he 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
C
R-302
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
25M-(f)-11-42 10746
PLACE OF DEATH
Middlesex (County)
Everett (C'ity or Town)
No. Whidden Hospital
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
EVERETT
(City or town making return)
(If death occurred in a hospital or institution, St.
giv give its NAME instead of street and number)
2 FULL NAME
Baby Shuman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17
Hutchinson
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution .... ho.s.p.i.t.al
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
daye.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
m
4 COLOR OR RACE
white
5 SINGLE
(write the word)
single
(Month)
(Day)
(Year)
19
ITHEREBY CERTIFY,
That i attended deceased from
19.
.4.6
to
19 .. 46 ..
I last saw h
allve on
19.4.6, death Is said to
have occurred on the date stated above, at
m.
Duration
Inimedlate cause of death
Stillborn
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify.
(Signed)
J. C. Henken
M. D.
(Address)
Everett
Date ..
7-5 19 46
Beth Israel, Everett
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
((gity or Town)
19
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
HI. J. Torf
Chelsea
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred) 7-9- .19 46
Received and filed
AUG 1 2 1946
.19 46
DATE FILED
18 DATE OF
DEATH
July
5,
1.946
MARRIED
WIDOWED
or DIVORCED
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
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