USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 34
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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 namc the disease causing death. As related causes, namc 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 bealthfulness 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 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
R-301 A
1
PLACE OF DEATH
SUFFOLK1 County) WINTHROP (City or Town) Winthrop Comm Hosp No.
The Commonturalth 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. 102
Registered No.
$ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. 69 jucusx
(Usual place of abode)
Hospital
years
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
months
2
days.
In this community@ D
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX F.
4 COLOR OR RACEJ
5 SINGLE
( write the word)
Divorced
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(or) WIFE ofJamie9
(Ilusband's name in full)
6 Age of husband or wife if alive
28
years
7 IF STILLBORN, enter that fact here.
8 AGE O
Years Months
Days
If less than 1 day .Hours .Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
At home
11 Social Security No ... none
12 BIRTHPLACE (City)
(State or country)
Chelsea
MINI
13 NAME OF
FATHER
Harry Levine
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
then BERGER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 HARRY LevINE Infofman ( Address) 68 Locu St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Www.D. Children& ·
(Signature of Agent of Board of Health or other) / Maltle (pfucer 6//6/41
Official Designation y/ (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
15.
1941
(Year)
(Day)
19 | HEREBY CERTIFY,
That I attended deceased from
June 13,
1971
.. ,
to June 15 19. 41 ....
I last saw her
alive on
Jambe 15, 1941.
death is sald to
have occurred on the date stated above, at. 4.45 P .m.
Immediate cause of death.
Intestinal Obstruction
Duration IMPORTANT 2 days
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Intestinal obstruction
Date of June 15,194
Of autopsy
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ? If so, specify
(Signed)
72 dlily Ane
·A ..
(Address)
...
M. D.
Dato keine 16 194/
21 Beth
Israel Everett
Place of Burial, Cremation or Removal.
DATE OF BURIAL
142016
(City or Town)
14/1
22 NAME OF
FUNERAL DIRECTOR
ADDR
1272 Blue Hill and May
Received and filed JUN 1 0 1341
19
( Registrar)
100m (d)-1-41-4667
extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. PARENTS
2 FULL NAME. pene Cohen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
(If nonresident, give city or town and State)
1
IMPORTANT
Physician
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan or registered hospital medical officer shall forthwith. after the death of a person whom he has attemled during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deccased, 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 liis 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 hc can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition 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 Mexi- 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 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 cxhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tonib to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such 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 hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the connnonwealth cannot be obtained carly enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased scrved in the army, navy or marine corps of the United States in any war In which it has been engaged, such recital shall appcar upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit It to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sais information which can be obtained as to the deceased, or as to the maier 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 hody or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or Its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the 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., (Terceutenary 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, lic shall forthwith go to the place where the body lies and take charge of the same; ...- General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the chacrvance of the following rules of practice :
(1) Attending physiclans will certify to such deaths only as those of persons ta whont 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 discase unrelated to any form of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injory. These include not only deaths caused directly or in- directly hy traumatism (including resulting septicemia), and by the action of chentical (drogs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled 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, c. g., hcart failure, asphyxia, asthenia, etc. As principal cause name the discase causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal causc.
Statement of Occupation .- Precise statement of occupation is very Im- portant, so that the relative healthfulness of various pursuits can be kuown. 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 illucss. 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 cugaged 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)
34 Sunnyside Ave
No.
PLACE OF DEATH
-
2 FULL NAME.
Agnes Ella Cyr
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE | 5 SINGLE
Fem- le
White
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
8
42
If less than 1 day
Hours.
AGE
Years
Months.
Days
Usual
9 Occupation:
Bookeener
10 or Business:
11 Social Security No.
012-03-7250
12 BIRTHPLACE (City)
East Boston
(State or country)
Lass
13 NAME OF
FATHER
Joseph J. Cvr
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
Rosanna Paquette
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
17
Informant.
Fæancis Cyr
(Address)
34 Sunnysia!"
Ave
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
se alle
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
Industry
N. E. Coal & Coke Co
200m-10-'39. No. 8427-d
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
6 Age of husband or wife if alive years 7 IF STILLBORN, enter that fact here.
Minutos
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed/with me BEFORE the burial, or transit permit was issued:
(Signature of Agent of Board of Health or other) 6/18/4/
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
16
1941
(Month)
(Day)
( Year)
19 J HEREBY CERTIFY, That I attended deceased from
man 9
19.41
...... , to ..........
I last saw her alive on.
Sunce 16, 1941, death is said
to have occurred on the date stated above, at 5 m.
Immediate cause of death ....... ..........
Terminal broncho - pneumonia
Cerebral embalmal 2
...
5
Due to
Carcinoma of recto-sigmoid
...
Other conditions
Libroid interna
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Carcinoma objecto-signori
with liver metastasi Date of 4/16/4
Of autopsy
What test confirmed diagnosis? Laparotomy
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)
(8) Winthrop Mass. Date 6/17/194/1
(Addre
21 Winthroo Winthrop
Place of Burial, Cremation or Removal. I(City pr Town)
DATE OF BURIAL.
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Vinthron
Received and filed ..
19
JUN 19 WAT
A TRUE COPY ATTEST. A TRUE
Registrar)
1
years
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No. (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
(If U. S.
3war Veteran.
specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
34 Sunnyside Ave
St.
(If nonresident, give, city or town and state)
months
days.
In this community
yrs.
mos.
days.
Anne 16
19.41
Duration
Due to .
Pelvic Phlebitis
...
M. D.
Relation, if any
........
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 & 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 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 hoard, 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 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 heen 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 he obtained early enough for the purpose, or is insufficient, a physician who is a member of the hoard 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 hy violence, the medical exam- iner 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 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 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 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 hedside 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 hy 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 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 husi- ness, 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 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 AJ Suffolk (Countyy Winthrop
PLACE OF DEATH
1
(City or Town)
86 Johnson
No ..
2 FULL NAME
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution 20
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 9EX
4 COLOR OR RACE
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
Five maiden
(or) WIFE of
michael J
(Husband's name in full)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact hore.
8
84.
AGE
Years.
Months
Days
Usual
House work
9 Occupation:
10 or Business:
II Social Security No.
none
12 BIRTHPLACE (City)
East Boston
......
(State or country)
u asa.
(State or country)
wass.
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17
Michael
Kelly
CAUSE OF DEATH in plain terms, co that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Industry
own home
(write the word)
Married
Kelly
86 years
¡If less than 1 day
Hours
Minutes
13 NAME OF
FATHER
William Cathcart
14 BIRTHPLACE OF
FATHER (City)
nantucket
15 MAIDEN NAME
OF MOTHER
Catherine O'Sullivan
Ireland
Polation,if any (husband)
Informant. (Address) 86 Johnson Avey Wir
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William D. Childress (Signature of Agent of Board of Health or other) agent- June 18/4/ (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
6
16
41
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
URW- 1941,
to.
....
6/16
That I attended deceased from
I last saw hin alive on
6/16
10.41, death is said
to have occurred on the date stated above, at. 710,2m.
Immediate cause of death
Duration IMPORTANT
Due to
Due to Varevil Catering Salerno
2 yrs 0
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
PHYSICIAN Underline the cause to which death
Of autopsy
should be charged sta- tistically.
20 Was disease er Injury In any way related to occupation of deceased?
If so, specify.
(Signed)
(Address) ..
200 Pleasant St
Dato 6/17/14 15 41
21 Holy Gross,
Malden
ce /8"y or Town)
19.46.1
Place of Bury, Cremathen Remove
DATE OF URIAL.
M. r. Kelly
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
11 Meridian St., E. B.
Recefvod and filed 19
JUN IO. 1941
(Registrar)
(Official Designation)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
104
CERTIFICATE OF DEATH Are.
St.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran. specify WAR)
(If deceased ich married, widowed or divorced woman, give also maiden name.)
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