USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 86
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
r
I R-303-A
Suffolk u
(County)
(City or Town) 33 Crest ave
The Commantoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or Its Agent.
Registered No.
245
St. { ( If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
anna L. Roberts
(If deceased is a married, widowed or divorced roman, give also maiden name.)
33 Crestave Withro 12
(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
days.
in this community 30 yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACEI
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
5a If married, widowed, or divorced
HUSBAND of
Geofiresiden mové rite ig full)
(Husband's name in full)
53
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that fact here.
8
AGE.49 .... Years
4
Months.
1 Days
If less than 1 day
Hours
.. Minutes
Usual
9 Occupation :
Housewife
Own Home
11 Soolal Security No ..
None
Chelsea
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Donald J McNeil
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Prince Edward Isle.
15 MAIDEN NAME
DF MOTHER
Alice G Dinning
16 BIRTHPLACE OF
MOTHER (City)
Chelsea
(State or country)
Mass.
17 George A Roberts
Informant.
( Address)
35 Crest Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlal or transit permit was Issued : Walter A. saber
Signature of Agent of Board of Health or other)
.
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
Dec-19-
1948
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the "CAUSE AND MANNER thereof
Thrombose. of Splence artery
Circusis of Liver.
20 Aooldent sulolde, or homlolde (specify)
Date of /ooourrenoe
19
Where did
Injury/ooour ?
(City or town and State)
Did Injury ooour in or about home, on farm, In industrial place, or In publio
pisoe?
(Specify type of place)
Manner
Injury
Found dead on her own led
Nature of
Injury
While at work ?.
-
.Was there an autopsy ?.
21 Was disease or Injury in any way related to ocoupation of deoeased ?
If so, speolfy.
(Signed)
Borsten
(Address)
Dele-19-1948
22
Winthrop
Winthrop
Place of Burial. Cremation or Removal.
(City or Town)
DATE OF BURIAL
Dec. 22
1948
1
23 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Reoelved and filled
DEC 2-1946
.. 19.
(Registrar)
50m-(i)-1-45-15510
Health Millet
12, 2, 148
MEDICAL CERTIFICATE OF DEATH
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
(a) Residence, No.
PLACE OF DEATH
1 No. 3 SEX Female (or) WIFE of PARENTS should be carefully supplied. MEDICAL EXAMINERS should stare GAUSE AND MANNER OF DEATH In prain terms, Industry 10 or Business : If deceased was a U. S. War Veteran. G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effeot extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
M. D.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physlolan or registered hospital medloal offloor 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 required by section one, where same was contracted, the duration of his last illness, when last seeit alive by the physician or officer and the date of his death .. . Gen. Laws, Chap. 46, Sec. 9.
A physlelan 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 ariny. navy or marine corps of the United States in any war in which It has been engaged, insert in the certificate & 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 sud of sections forty five, forty-six and forty-zeven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall. for said purposes, be deemeil to have taken place between Felirusry fourteentli, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mex- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall 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 perinlt froin 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 exnume a liuman hody and remove it from a town, from one cemetery to »notlier, or from one grave or tomb other than the receiving tomb to another in the same cemetery, untli be has received a permit from the board of health or its agent aforesald or from the clerk of the town where the body is buried. No auch 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 accompanled, 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 attemling physician. If death Is caused by violence, the medical examiner shall make such certificate, If such a permit for the removal of a buman body, not previously interred, from one town to an- other within the commonwealth cannot be obtained eurly enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to make suchi renioval shall constitute a perinit for such removal; provided, that suchi body shall be returned to the town from which It was removed within thirty-six hours after such re- moval, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contalus a recital, as required by section ten of chapter forty-xix, that the deceased served in the army, navy or marine corps of the United States in any war in which
it has hecn engaged, such recital shali appear upon the permit. The board of health, or. its agent, upon receipt of such statement and certificate, shall forthwith countersign It ail transmit It to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer tifying the cause of death shall thereafter furnish for registration any other necessary information which can be ohtsined as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- Chap. 114, Suc. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have bren brought into the commonwealth until he has re- ceived a permit so to do front the board of healthi or its agent appointed to issue such permits, or if there is no such bosrd, from the clerk of the town where the boily is to be buried or the funeral is to be held, or from a per- son appointed to have the cure of the cenietery or burial ground in which the interment is niade. .. . Chup. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Medical examiners shali make examination upon the view of the dead bodies of only such persons as are supposed to have dled 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. 3S, Sec. 6.
. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full ss may be, with the cause and manner of death,- General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifles the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illnesa from disease unrelated to any forin of injury.
(2) Board of Health physlolang will certify to such deaths only aa those of persons who, though dissbled by recognized disease unrelated to any form of Injury, have died withtout recent inedical attendance or whose phyaf- cian is absent fromn hoine when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all desthe qus- posably dus to Injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal, 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
Medical Examiners in certifying to a death wili state the cause and manner thereof, and will specify : (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of Its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam rallway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, sulcidal." "Syncope while under the influence of ether adininistered aa a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation ahowa the death to have been due to disease, specify: (1) Under cause its known or presumable nsture; aturl (2) umler manner, indicate tbe circum- atances leading to inedico-legal Inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglla) ( found dead in bed)." "Heart disease, presumably coronary sclerosia. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
+
Suffolks (Count, )
Winthrop (City or Town)
No. 26 Circuit Road
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. 246
St. § (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number) }
2 FULL NAME
Jennie Elizabeth Wood
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
26 .... Circuit ..... Road
......
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Orin George Wood
Husband
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8 AGE83 Years 3 Months 12 .... Days
If less than 1 day
Ilours
Minutes
Usuai
9 Occupation:
AT .... home
Industry 10 or Business:
11 Social Security No .. none
12 BIRTHPLACE (City) ... East Boston, Mass. (State or Country)
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Scotland
15 MAIDEN NAME
OF MOTHER
unable to obtain
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
unable to obtain
17 Informant. Mr.s ....... Orion ..... Fisher (Relation, if any)
(Address)
26 Circuit Rd. daughter I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Watter F. 19 alles (Signature of Agent of Board of Health or other) 1 Health Officer 12/24/48
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE CF
DEATII
December
2.2
(Month)
(Day)
1948
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
nov. 10
1942
to
Dec 22
19 48
I last sawh In alive on Dec 22 19 .... d., death is said to have occurred on the date stated above, at 3 15 Pm.
Immediate cause of death
Coronary Thrombosis
Due to.
Due to
Other conditions
Chronic Myreadità
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of.
Of autopsy
What test confirmed diagnosis?
Duration IMPORTANT 1 day .....
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 ?. 20
If so, specify ..
.......... ,M. D.
Louis 7 Salerno
(Signe
(Address) 175 Pleagany Sp Date Dec23 1946
21.
Place of Burial, Cremation or Removal.
DATE OF BURIALDecember 24 .1948
(City or Town)
.19
22 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS
Received and Filed
DEC 201948
.. 19.
(Registrar)
100M-10-47-22153
T
M R-301 A
PLACE OF DEATH
1
Registered No.
PHYSICIAN-IMFORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
35
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 terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
13 NAME OF
FATHER
George Mac Millin
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 ana 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, eightcen 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. Chep. 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 anoter, 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 aforcsaid 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 hercinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained carly 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 cler'x 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) theninal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupetien. 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 r .. ode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name egriier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Cccuration .- 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
I R-303-A
PLACE OF DEATH
No. + Sullui (County) Wuttrop (City eJATown 148Store Juve
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agent.
Registered No.
217
St. { { If death occurred in a hospital or institution, I give its NAME instead of street and number)
2 FULL NAMEL Michael h& Rou
(If deceased is a, thatried, widowed of divorced woman, give also maiden name.)
148h Sture Thive Withrob
(a) Residenoe. No.
(Usual place of abode)
Length of stey : In hospital or Institution.
( Before death)
(Specify whether)
years
months
days.
In this community
JTE.
mos.
4 days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE!
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divoroed HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If alive years
7 IF STILLBORN, enter that faot here.
8
AGE
1
Years
10
.Months
Days
if less than 1 day
Hours.
Minutes
PORTSI
VIRGINIA
13 NAME OF
FATHER
WILBERN E RAY
AKRON
FATHER (City)
(State or country)
OHIO
OF MOTHER
NELLIE KRAKOWIAK
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
NEW YORK
17
Informant ..
( Address)
148 WINTHROP ShONE DRIVE
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial os transit permit was Issued : Walter Smaller
(Signature of Agent of Board of Health or other)
1.0. Dec. 24 1918
11
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December-23-1948
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) hemmas coccus acterenca
20 Accident, sulolde, or homlolde (specify)
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