USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 25
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No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received 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 observ- ance 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 ill- ness 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 un- related to any form of injury, have dicd without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatisni (including resulting septice- mia), 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 occupa- tion, 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 con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, 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 deceased had retired from busi- ncs3, 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, 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 (County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
3692
(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Patrick J. Lane
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5 Washington Avenue
Winthrop
(a) Residence. No ...
(Usual place of abode)
hospital
years
months
14 days.
(If nonresident, give city or town and state)
In this community
18Vrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX M
4 COLOR OR RACE: 5 SINGLE
(write the word)
W
MARRIED
WIDOWED
or DIVORCED
Widowed
(Month)
(Year)
(Day)
That I attended deceased from
19 I HEREBY CERTIFY.
6 /20/39
19.
to
4/17/40
19
I last saw h.1.m .... alive on
4/17/40
to have occurred on the date stated above, at.
10:10P
Duration
Immediate cause of death .....
Myocardial
disease with congestive heart
1 mon.
AGE
70 Years
Months. Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation:
Associate Justice
Industry
10 or Business:
District Court
11 Social Security No .....
none
12 BIRTHPLACE (City)
Boston
(State or country)
13 NAME OF
FATHER
Patrick Lane
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis ?
20 Was discase or lajury In any way related to occupation of deceased ?
If so, specify
(Signed)
W .... J ... Smith
(Address)
2.6.4 .... Beacon
Date4/18/40
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop-Winthrop
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
R.C .... Kirby.
ADDRESS.
Boston
Received and filed
19
(Registrar of City or Town where deceased resided)
Ve towa 44 cest tuc detcasco festaco in another city of town at the tune
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. )
50m-10-'39. No. 8427-f
PARENTS
15 MAIDEN NAME
OF MOTHER
Margaret Mahoney
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Informant.
(Address)
Edward Lane
Relation, if any Son
A TRUE COPY.
ATTEST:
Vamos Lidé.
(Registrar of city or town where death occurred)
DATE FILED
4/22/40
19
18 DATE OF
DEATH
April 17 1940
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Catherine .. A .... Pomfret ..
(or) WIFE of
(Husband's name in full)
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
failure
Due
Coronary disease with
10 mos
Cardiac infarct
Due to
Other conditions
Cancer of prostate
(Include pregnancy within 3 months of death)
PHYSICIAN
Mass
14 BIRTHPLACE OF FATHER (City) (State or country) Ireland
Underline the cause to which death should be charged sta- tistically.
(Cemetery)
4/20/40
¿City or Town)
19
-
No .... Mass ..... General Hospital
(If U. S. War Veleran, specify WAR)
Length of stay: In hospital or institution
(Specify whether)
St.
19 ..
death is said
R-301 A:
Suffolk Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be fled for burial pormit with Board of Health or its Agent.
Registered No.
81
CERTIFICATE OF DEATH
Winthrop Community Hospital de No. Омлан . Ш .: Жания
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also/maiden name.)
25 Plummer Are. St. Winthrop
(a) Residence. No ...
(Usual place of abode)
Тереть
years
(Sperny! whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
1940
(Year)
19 I HEREBY CERTIFY. That Lattended deceased, from
I last sav h.L.Malive on.
Wheel/1) 946), death is said
to have occurred on the date stated above, at 2.355 m.
Immediate cause of death
Duration
IMPORTANT
Temin
De futuro com of
Due to
nuestros
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN Underline
Date :apr 15,1940
which death
Cf autopsy
should be
charged sta-
What test confirmed diagnosis ?
tisticaily.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed) ..
, M. D., (Address) 4 30 2hits Co Date 4/15 1940
21
Winthrop
Winthison
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
April 20,
1940
22 NAME OF
FUNERAL DIRECTOR
M. J. Kelly
ADDRESS
11 Meridian St.
JET 13.
Received and filed
aprit
22
19.400
(Registrar)
100m-10-'39. No. 8427-e
1 (or) WIFE of 2 60 AGE Usual 9 Occupation: PARENTS information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry 10 or Business: CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
4 COLOR OR RACE
3 SEX Female White
5 SINGLE
MARRIED
WIDOVIED
or DIVORCED
(write the word) Widowed
5a If married, widowed, or divorced HUSBAND of
Give maiden name (1, wie in full)
(Husband's name in full)
6 Age of husband or wife if alive ( Delecture 7 IF STILLBORN, enter that fact here.
years
lf less than 1 day
Years
Months
Days
Hours.
Minutes
House work
own home
11 Social Security No.
12 BIRTHPLACE (City)
East Rostou
(State or country) mass.
13 NAME OF
FATHER
Thomas J. M: Gulfla
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
que Falia Sherlin
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Dieland
17 Mary J. M: Manus dangliter)
Informant (Address) 250 Plummer Are, Win.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Theal or Hunsiypermit was issued: Mm. D. Children (Signature of/Agent of Board of Katthe
Kosher ) Health Officer (Official Designation
4/1.9/40
(Date of Issue of /Permit)
(M. Gulpha) (If U. S. War Veteran. specily WAR)
give its NAMIE instead of street and number)
(lf nonresident, give city or town and state)
Length of stay: In hospital or institution ...
months
4
days.
In this community 23 yrs.
mos.
days.
IF
myy 18
Edward 1.
PLACE OF DEATH
Major findings :
Of operations
The Cause 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 illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration 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 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.
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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner 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 commonvcalth cannot be obtained early enough for the purpose, the certificate of death madc 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 hercunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deccascd 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 glven and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary 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.)
No undertaker or other person shall hury a human body or the ashes thereof which have been brought Into the commonwealth until he has received a permit so to do 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 body is to be huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurlal ground in which the interment is made. .. . Chap. 114, Seo. 46, G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ohserv- ance 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 ill- ness 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 un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), 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 occupa- tion, 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 deatlı. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, 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 busi- ness, 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, 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
RM R-301
SUFFOLK
....
(County)
WINTHROP
1
(City or Town)
PLACE OF DEATH
(a) Residence. No .......
35 .. Shirley ... St.
(Usual place of abode)
Length of stay : In hospital or institution
28 days
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Tale
4 COLOR OR RACE
White
5 SINGLE
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.
7 IF STILLBORN, enter that fact here.
4
8
ÅGE ... 6.0
Years.
If less than 1 day
Hours ...
Months 6
Day
Usual
11 Social Security No ..
None
...... hanoy .... Ci.t.y ..
13 NAME OF
FATHER
John Joseph Jenner
15 MAIDEN NAME
OF MOTHER
Elizabeth Hughs
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Unknown
(State or country)
Unknown
17
Informant.
Mrs Vellie . Jenner
(Address)
35 Shirley St, Winthrop,
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
10 or Business:
is very important. See instructions and extracts from the laws on back of certificate.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
Btry, 9th CA,
Signature of Agent of Board of Healthlor others
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
(State or country)
forme
Lithuania
200m-10-'39. No. 8427-d
(write the word)
DEATH
April 22, 1940
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
Larch 26
19 .. 40, to ... April .. 22
19.40
I last saw him ...... alive on .. April ... 22 19.40., death is said to have occurred on the date stated above, at 6:35Pm. Immediate cause of death Cerebral hemiplegia 28 days Duration
... ..... ...
Duc to
Due to
One .... year
Other conditions Mitral ... resuscitation (Include pregnancy within 3 months of death)
Major findings :
Of operations .
None
.Date of
Of autopsy ........ autopsy ...
What test confirmed diagnosis ?
Lone
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury lo any way related to occupation of deceased ?
No
If so, specify Polert J. Holdeon
(Signed).
Robert y. Holdson, ISU LU, y
M. D.
(Address) .. Station.090.08 ..........
Date 4/2201940
21
nKs, Lass
(City or Town) Place of Burial, Cremation or Removal. DATE OF BURIAL winthropY Apr 25. 19 40
22 NAME OF
FUNERAL DIRECTOR
John F. O+Taley
ADDRESS
Winthrop Tass
Received and filed ... 19
(Official Designation) (Date of Issue of Permit)
The Conmonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
82
(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
(If U. S.
Spanish
Y WA
WORLD
(If deceased is a married, widowed or divorced woman, give also maiden name.)
years
months
days.
In this community 30 yrS.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
married
59
years
Minutes
9 Occupation :.
Retired soldier USA Ist Set Hg
12 BIRTHPLACE (City)
(State or country)
66h4364 La
Lithuania
14 BIRTHPLACE OF
FATHER (City)
Unknowm
Germany
Relation, if any Wife
I HEREBY CERTIFY that a satisfactory standard certificato of death was filed with me BEFORE the burial of transit permit was issued /m2. Chuldress
4/23/40
No ... Station Hospital Fort ... Banks., Mass ...........
2 FULL NAME.
JOHN (None) JENNER (Verdad).
St. (If nonresident, give city or town and state)
A TRUE COPY ATTEST:
(Registrar)
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 regis- tration 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 seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Scc. 9.
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 dicd ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from onc 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 de- livercd to such board, agent or clerk, as the case may be, a satisfac- tory 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 physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner 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 cnough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary 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.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received 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 lield, 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 observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as these of persons to whom they have given bedside care during a last ill- ness 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 un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only dcathis caused directly or indirectly by traumatism (including resulting septice- mia), 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 occupa- tion, 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 con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, 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 busi- ness, 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, 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.
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