USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 27
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SPACE FOR ADDITIONAL INFORMATION
R-301 A Sulbolle County) Winthrop I
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. 87
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
Daniel Joseph Moriarty
(If deceased is a married, widowed or divorced woman, give also maiden name.) 3797 Pleasant
St.
(If nonresident, give city or town and state) In this community &Gyrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
april
30
1940
(Month)
(Day)
(Year)
19 IHEREBY CERTIFY. That I attended deceased from
apr. 23
19.9.0 .. , to .........
afer. 20
19.5.6.
I last saw h.IM alive on Cfr. 29, 1940, death is said to have occurred on the date stated above, at ................. m. Immediate cause of death .... Duration IMPORTANT Duodenal Ulcer with hasmarsha:
Due to
Due to
....
Other conditions
asthing
(Include pregnancy within 3 months of death)
Major findings : Of operations
Date of .....
Of autopsy
none
What test confirmed diagnosis ?. Clinical
20 Was disease or Injury In any way related to occupation of deceased? RO- If so, specify ....
(Signed)
Enos E. Koura
M. D.
(Address) East Borte
Thay/ 1940
Place of Bufial, Cremation or Removal.
DATE OF BURIAL ...
may
22 NAME OF
FUNERAL DIRECTOR M. OF
Kelly
ADDRESS
11 meridian Stl, JE.13.
Received and filed
19
(Registrar)
100m-10-'39. No. 8427-e
(City or Town)
379A Pleasant
No ..
2 FULL NAME
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
3 SEX
Male white
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
64
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact høre.
8
64
If less than I day
AGE
Years
Mont'as
Days
Usual
Salesman
9 Occupation:
Industry
10 or Business:
11 Social Security No.
none
12 BIRTHPLACE (City)
1902 lor
(State or country)
mass.
14 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Mass.
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Deland
Informant
(Address)
379 A. Pleasant St; Whu.
information should be carefully supplied. AUE should be stated LAACILI. PHYSICIANS should state
13 NAME OF
FATHER
John M. Moriarty
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.
(write the word)
Married
Alice Corbett
years
Hours
Minutes
15 MAIDEN NAME
OF MOTHER
Delia Connora
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial oz transit permit was issued: M. D. Childrens (Signature of Agent of Board of Health ofother)
health officer 5/2/40
(Official Designation) (Date of Issue of Permit)
15 zes.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
17 Alice Moriarty Relation, 'if any 21 St Josephis Boston (City or Town) 1940
PLACE OF DEATH
St. 1
(If U. S. War Veteran, specify WAR)
years
months
days.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth with, 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 dicd, defined as required by 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.
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 huried, 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 hody is huried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may he, a satisfac- tory written statement containing the facts required by law to he 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 hy 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 hy 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 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 hercunder. 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 he 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 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 burled 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 Ilealth physicians will certify to such deaths only as those of persons who, though disahled 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 scptice- 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 te occupa- tion, the sudden deaths of persons net disabled by recognized disease, and those of persons found dead.
Statement ef 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 Occupatien .- 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 cvery 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
A R-301 A Suffolk (County) Wünscht 1
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATEOF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No ..
88
St.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
...........
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
years
months days.
(If nonresident, give city or town and state) In this community3
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Female
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
55
.years
If less than I day
.Days Hours Minutes
Usual
9 Occupation: Industry 10 or Business:
...............................
1I Social Security No.
12 BIRTHPLACE (City)
(State or country)
Birmingham
13 NAME OF
FATHER
francis. A. Davis
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME
OF MOTHER
Elizabetto Goademás
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Chelf.J.Quinlan
Relation, if any
Informant (Address) 123 Burg are writing
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Man. D. Children (Signature of Agent of Board of Health or other) Realthe fficer 5/2/40 (Official Designation ) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY That I attended deceased from
19. J .. . , to ...
20, 19144
hla alive all 28, 1944, death is said .m. to have occurred on the date stated above, at &,YSP. Immediate cause of death
Duration IMPORTANT
3 cm
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
PHYSICIAN Underline the cause to Date of .. Of autopsy which death should be charged sta- What test confirmed diagnosis ?. -
20 Was discass or injury in any way related to occupation of deceased?
If so, specify
(Signed)
,
M. D.
(Address)
Lake Vicio. Cochituate
21
Place of Burial, Cremation or Removal. DATE OF BURIAL 19.2.
NAME OF FUNERAL DIRECTOR
ADDRESS
winther
Roceived and filed 19
( Lake View- Com
(Registrar)
100m-10-'39. No. 8427-e
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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
PLACE OF DEATH
123 Queries cover No. marlon. Goodwin
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden namey) 123 @umay Cuer Wind Max
30 1940
(Give maiden name of wife in full)
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
AGE
8 76 Years Months
PARENTS
England
......
1940
2 me(City or Town)
tistically.
...
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 anthorized person or of any member of the family of the deceased, furnish for regls- 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 dicd, 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. Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom & human body which has not heen 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 tomh other than the receiving tomh 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 therc shall have been de- livered to such board, agent or clerk, as the case may be, a satisfao- tory written statement containing the facts required by law to he returned and recorded, which shall be aceompanled, In case of an original interment, hy a satisfactory certificate of the attending physiclan. 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 early enough for the purpose, or Is insufficient, a physician who is a member of the board of health, or employed hy it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy violence, the medical exani- 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 enongh 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 sucb removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six bours after such removal, nnless a permit in the usual form for the removal of such body has been sooner ohtalned hereunder. If the death certificate contains a recital, as required by sectlon 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 permlt. 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, Ses. 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 Ita 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 hurled or the funeral is to be held, or from a person appointed to have the care of the cemetery or burlal ground in which the interment is made .... Chap. 114, Soc. 46. G. L., (Tereentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ebserv- ance of the following rules of practice :
(1) Attending physiclans 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 discase nn- related to any form of Injury, have died without recent medieal attendance or whose physician is absent from home when the certificate of death Is needed.
(8) 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 actlon of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortlon, 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 fallure, asphyxia, asthenia, etc. Az principal cause name tbe disease causing death. As related causes, name earlier morhld con- ditiona, if any, related to the principal cause and any important complieation of the principal cause.
Statement of Occupatien .- 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 husl- ness, report the usual occupatlon 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 howcokesper-private family, cook-hotel, etc. For a person wbo bad no oceupation whatever write nonc.
SPACE FOR ADDITIONAL INFORMATION
R-302
PLACE OF DEATH
WORCESTER
(County)
RUTLAND
(City or Town)
No. Rutland State Sanatorium
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RUTLAND (City or town making return)
Registered No.
68
(If death occurred in a hospital or institution,
..... St. { give its NAME instead of street and number):
2 FULL NAME
John Thomas Bradley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
24 Dolphin Avenue
St.
Winthrop, lass.
Length of stay: In hospital or institution.
1
years
1
months 20 days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
fale
4 COLOR OR RACE 5 SINGLE
MARRIED
White
WIDOWED
or DIVORCED
(write the word)
Single
18 DATE OF
DEATH.
April
30
1940
(Month)
(Day)
(Year)
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.
AGE
8
31
Years
7
6
Months
I
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Physician
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Winthrop
(State or country)
tas's"
Other conditions
(Include pregnancy within 3 months of death)
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)
Paul Dufault
M. D.
(Address).
State San Jutlandbate 4/30 19 40
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop, inthrop, lass
(City or Town)
DATE OF BURIAL
(Cemetery)
lay 3,1940
19
22 NAME OF
John F. O'laley
FUNERAL DIRECTOR
ADDRESS
Winthrop ass.
19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Philadelphia
(State or country)
Penn.
15 MAIDEN NAME
OF MOTHER
Margaret A. Sullivan
16 BIRTHPLACE OF
MOTHER (City)
oston
(State or country)
lass
17 State San.records
Relation, if any
Informant
(Address)
"ütland, ass,
A TRUE COPY.
ATTEST:
Frances P. Hants
(Registrar of city or town where death occurred)/
DATE FILED
April 30,1940
19 I HEREBYCERTIFY
That I attended deceased from
April 50
19.39
to ..
19.
40
...
I last saw
him
alive on
April 30
1940
to have occurred on the date stated above, at
12: 45
.m.
Immediate cause of death
Pulmonary tuberculosis
14
months
,
Due to
Due to
13 NAME OF
FATHER
Joseph Bradley
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis?
Microscope
.C X-Y
Date of ..
.. , death is said
'Duration
years
(If nonresident, give city or town and state)
In this community ] yrs. 1
nos.
20 days.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ...
(Usual place of abode)
Janatorium
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. (Sce Chap. 46, Sec. 12, G. L.)
Received and filed
.19.
ROR MASS.
MAY-1940 AS1
R-305
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
ROSTOS (City or town making return)
V
Registered No.
4099
$ (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Robert
Brady
(If deceased is a married. widowed or divorced woman, give also maiden name.)
(a) Residence. No .....
252 .... Winthrop ... Shore ... Drive
........
.St.
Winthrop
(If nonresident, give city or town and state)
months
days.
In this community 4&s.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
(write the word)
divorced
5a lf married, widowed, or divorced HUSBAND of
(Give maid
Mary LiPonter
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife it alive.
50
Years 7 IF STILLBORN, enter that fact here.
8 48
AGE
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
longshoreman- shipping
Industry 10 or Business:
11 Social Security No.
.. 029-03-6696
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Boston Mass
George P Brady
14 BIRTHPLACE OF
FATHER (City)
Boston Mass
(State or country)
15 MAIDEN NAME
OF MOTHER
Annie Driscoll
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Informant ...... (Address)
"Mother
A TRUE COPY.
ATTEST:
James Q. Pur re
Registrar of city or town where death occurred)
DATE FILED
5/3/40
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH April 30 1940
(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.) Massive edema of brain with multiple foci ... of traumatic. softening. Bilateral. cerebral decompression 1936for ... subdural .hematoma. Lacerated brain-accidental
20 Accident, suicide, or homicide (specify)
Date of occurrence. Where did
Injury occur ?.
Boston
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in
public place?cardio ... renal .. disease.
Manner of Probably acc fuefter far?
Injury
post traumatic encephalopathy with"
Injury
Nature of
epilepsy.
While at work ?
Was there an autopsy ?..... y.e.s.
21 Was disease or lajury in any way related to occupation of deceased ?
Il so, specify
(Signed)
Timothy Leary.
M. D.
(Address)
Dato5/1/409.
22. Holy .... Cross .. Malden
Place of Burial, Cremation or Removal.
May 1 fgyor Town)
DATE OF BURIAL
19
23 NAME OF
FUNERAL DIRECTOR
J .... F .... O .Maley
ADDRESS
Winthrop
Received and filed
19
(Registrar of City or Town where deceased resided)
25m-10-'39. No. 8427-g
of death should be transmitted on Form R-305 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.)
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