USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 11
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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.
30
Registered No.
( (If death occurred in a hospital or institution, St. { give its NAME instead of street and number) -
pocity WAR)
St ... Revere
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
(Specify whether)
years
months
3
days.
In this community 25yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDWidow
Male
Sa If married, widowed, or divorced
HUSBAND of.
Mary
Ten O'Neil
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
years
7 IF STILLBORN, enter that fact here.
8
AGE
.7.2 ... Years.
Months
Days
If less than 1 day
Hours.
Minutes
Usual
Retired-Storekeeper
9 Occupation :.
Industry
10 or Business :..
Grocery.
Store
11 Social Security No.
Boston
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Enos Lewis
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF MOTHER (City) (State or country)
Unknown
17 InformantWilliam ... Keating ...... ( ... E.r.i.end .. ... )
(Address)
Washburn Ave Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was ffled with me BEFORE the burial or transit permit was issued: Www. D. Childreng (Signature of Agent of Board of Health, or other)
2/3 /41
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
19
LeHEREBY CERTIFY .
14
36
to ..
19 ..
I last saw him alive on
Actuary 2, 1941, death is said to
have occurred on the date stated above, at.
5.20 P
m.
Immediate cause of death
Aypeutinense haut Science
Duration IMPORTANT
vyre
Due to.
Agpatención
Due to ...
Other conditions.
(Include pregnancy within 3 months of death)
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.
Schu 7 Liches
(Signed) .... ,
(Address) ..
Rever Juana
Date
Feb 2
M. D.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL. F.e.b .... 5. 1.9.41
19
22 NAME OF
FUNERAL DIRECTOR ...
Michael ? Porcella
ADDRESS.
10No .. Benett .... St.,Boston
Received and filed
19
(Registrar)
100m-2-'40-D-729-8
1
2 FULL NAME .. John ... H.Lewis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .... 5 .... Pearl Ave ..
(Usual place of abode)
ion taspital
18 DATE OF
DEATH
February 2 1941
(Month)
(Day)
(Year)
That I attended deceased from
19 41
19 41
Major findings: Of operations.
Date of
Of autopsy.
What test confirmed diagnosis ?.
Unknown
Relation, if any
(If U. S.
War Veteran,
6 Age of husband or wife if alive.
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 dled, 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 hody in a town, or remove therefrom a human hody which has not been huried, until he has received a permit 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 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 receiv- ing 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 he 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 aw to be returned and recorded, which shall he accompanied, In case of an original interment, hy a satisfactory certificate of the attending physician, f any, as required by law, or in licu thereof a certificate as hereinafter provided. If there Is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the hoard of health, or em- ployed hy it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical 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 he obtained early enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker deslring to make such removal shall constitute a permit for such removal; provided, that such hody shali 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 re- moval of such body has been sooner ohtained hereunder. If the death certificate contains a recital, as required hy 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 physiclan certifyIng the cause of death shall thereafter furnish for registration any other necessary information which can be ohtained 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 buricd 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 hy recognized disease unrelated 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 hy traumatism (including resuiting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, 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 mcans the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause namc 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 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 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, however, 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
ORM R-301 A
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state MARGIN RESERVED FOR BINDING
100m-2-'40-D-729-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of ...
PLACE OF DEATH
Suffolk
(City or Town) 11 Whittier
The Commonmealth 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 31
Registered No.
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME.
Frederick Lewis Yirrell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
11 Whittier
St.
Winthrop
(If nonresident, give city or town and state)
months
days.
In this community
10
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widersd & dfra Auley
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
65
years
7 IF STILLBORN, enter that fact here.
69 0 Months Days Hours. Minutes
2 If less than 1 day
12 BIRTHPLACE (City).
Brighton
(State or country) England
Frederick Yirrell
14 BIRTHPLACE OFLondon FATHER (City) ... (State or country) England
15 MAIDEN NAME
OF MOTHER
Emily Slater
16 BIRTHPLACE OFManchester MOTHER (City) (State or country) England
17 Frederick Yirrell
Relation, if any sone V
Informant .... (Address) 11 Whittier St. , Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Nau. S. Children
Signature of Agent of Board of Health or other) Realthe Mapider 3/6 /4/
(Official Designation) V (Date of Issue of Permit)
18 DATE OF
DEATH
(Month)
(Day)
That I attended deceased from
to. 19 I HEREBY CERTIFY Jau 1. 19 ..
41
Faitrury 4
..... , 19
last saw h th alive on Für. 4 , 4941, death is said to have occurred on the date stated above, at 12 hours m. Immediate cause of death.
Duration IMPORTANT
2 gasp
Due to.
Camar of the Monarch
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operationg.
Laparalowy.
C. A. o) Showed Date of. 2/1/40
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify uma It . Schwartz
(Signed)
(s) 19 Presenti St.E.B
.Date ...
2/5
19
21.
St. Joseph Cem. W. Roxbury
Place of Burial, Cremation or Removal.
DATE OF BURIAL
February
7
(City or Town)
1941
22 NAME OF
FUNERAL DIRECTOR .......
ADDRESS.
300 Meridian St. .. E.Boston
Received and filed
.19
(Registrar)
(If U. S. War Veteran, specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
years
MEDICAL CERTIFICATE OF DEATH
4.1941
(Year)
IMPORTANT PHYSICIAN Underline the cause to which death should be charged sta- tistically.
M. D.
(County) Winthrop 1 No .. 3 SEX Male (or) WIFE of 6 Age of husband or wife if alive. AGE Years. Usual 9 Occupation :. none 10 or Business: 11 Social Security No .... none 13 NAME OF FATHER PARENTS 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 at home
. 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 required 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.
No undertaker or other person shall hury 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 hody and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing 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 huried. 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 hy 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 in- sufficient, a physician who is a member of the hoard of health, or em- ployed hy it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical 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 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 re- moval of such body has been sooner ohtained hereunder. If the death certificate contains a recital, as required hy 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 hoard 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 necessary information which can he ohtained 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 held, or from a person appointed to have the care of the cemetery or hurial 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 by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahly due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut 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 morhid 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 important, 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 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.
1
FORM R-301 A
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state MARGIN RESERVED FOR BINDING
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mac. D-Children
(Signature of Agent of Board of Health or other) Health Officer 2/6/41
(Official Designation) ( Date of Isstteof Permit).
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE
trhili
5 SINGLE
MARRIED
WIDOWED
(write the word)
DEATH
18 DATE OF
Fab. 6-
1941
(Month)
(Day)
(Year)
Sa If married, widowed, or divorced Tennis
HUSBAND of.
(Give maiden name of wile 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.
AGE 75 Years.
.Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Dentist
Industry
10 or Business:
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
But This
13 NAME OF
FATHER
martin Buber
Major findings: Of operations.
Underlin the cause to which death
Of autopsy.
What test confirmed diagnosis? Stethoscope
should be charged sta tistically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Throw & hammer
(Signed)
M. D
(Address)
726 Saratoga Of Date 1266 194
21 ....
HMword
Place of Burial. Cremationfor Removal. (City or Town) habert 1991 DATE OF BURIAL. tab 10
22 NAME OF
FUNERAL DIRECTOR
Robert H. Cheful
ADDRE
541 Lifeway@math.Mas
Received and filed.
19
avictrat)
1
PLACE OF DEATH No
(City of Town) 15% Court
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.
32
Registered No.
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
Framjustine J. Bulger
(If deceased ista marlied, widowed or divorced woman, give also maiden name.)
1500 Court Road
St
(If nonresident, give city or town and state)
years
months
days.
In this community
8
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
19
I HEREBY CERTIFY.
That I attended deceased from
man 1
19.41,
to Feb. 6
1941
I last saw him alive on.
Fcb. 6
19.4), death is said to
have occurred on the date stated above, at 11-304 m. Duration IMPORTANT 1940
Immediate cause of death .. Chrome Myocarditis
Due to
Embolism
1941
Due to.
Other conditions (Include pregnancy within 3 months of death)
IMPORTANT PHYSICIAN
14 BIRTHPLACE OF
FATHER (City)
(State or country)
AJohn Her
15 MAIDEN NAME
OF MOTHER
Man Danse Reaula
mark
16 BIRTHPLACE OF MOTHER (City) .... (State or country)
17 May Change Q Kiler Relation, if any
Informant.2 .. (Address) 153. Comme Qual
St.
(If U. S. War Veteran, specify WAR)
20
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
Swbtulla
PARENTS
Date of.
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 hest of his knowledge and helief 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, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not beeu huried, until he has received a permit from the hoard 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 receiv- ing tomh to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he returned and recorded. which shall he 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 he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the hoard of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical 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 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 re- moval of such hody has been sooner ohtained 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 heen 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 necessary information which can he ohtained 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).
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