USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 4
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20 Was disease or injury in any way related to occupation of deceased If .
M. D.
(Signed)
(Address) 26 45 ambulan
Date 1/6/1947
Everett may
DATE OF BURIAL.
22 NAME OF
FUNER
Manuel Stanelaka
...
ADDRESS U Washington Ituoi
Received and filed
.. 19
(Registrar)
100m-2-'40-D-729-a
(Official Designation) 1
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 is very important. See instructions and extracts from the laws on back of certificate.
1
PLACE OF DEATH
St.
Cohen
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
1941
That I attended deceased from I last say baam alive on 10am 6, 1941
If less than 1 day .Hours .. .. Minutes
PARENTS
Underline the cause to which death should be charged sta- tistically.
2) Winthrop Con Place of Burial. Cremation or Removal/ (City or Town) 7 1941
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 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 hody in a town, or remove therefrom a human hody 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 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 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 hody 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 be accompanied, in case of an original interment, hy 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 in- sufficient, a physician who is a member of the board of health, or em- ployed by it or hy 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 he 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 hody has heen 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 whoin the permit is so given and the physician certifying the cause of death shall thereafter furnish 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 he huried or the funeral is to he 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 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 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 supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), 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 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, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name 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
tuttoIR
(County)
1
PLACE OF DEATH
(Usual place of abode)
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
white
female
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE
Years
Months.
Days
Usual
9 Occupation:
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Winthrop
(State or country)
13 NAME OF
FATHER
Stephen Ryan
14 BIRTHPLACE OF
16 BIRTHPLACE OF
MOTHER (City)
Boston
PARENTS
Informant
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
200m-10-'39. No. 8427-d
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
(State or country)
mais
(write the word)
Single
(Give maiden name of wife in full)
years
still born
1
If less than 1 day Hours Minutes
FATHER (City)
nath adams
15 MAIDEN NAME
OF MOTHER
Winifred Sannan
(State or country)
mars
17 Mrs. Delia Samman Relation, if any
grand mother)
(Address)
5 Hlorena En Revue
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial en transit permit was issued: Man. D. Children y
(Signature of Agent of Board of Health or other)
1/4/41
(Official Designation) (Date of Issue of Permit>
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Lam.
(Month)
6
1941
(Year)
19 | HEREBY CERTIFY, That I attended deceased from
19
.... , to.
19
...
I last saw h.
.. alive on
19
death is said
to have occurred on the date stated above, at.
100000
.m.
Duration
Immediate cause of death
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury io any way related to occupation of deceased ?
If so, specify.
(Signed)
M. D.
(Address)
Shirley Given Rana Date.
19
....
21
Melden
(City or Town)
1941
22 NAME OF Mura
FUNERAL DIRECTOR
ADDRESS 2.5 7
Beach st Revere
.19
A TRUE COPY ATTEST: (Registrar)
MARGIN RESERVED FOR DINDING
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
(City or town making return)
Registered No. 11
§ (If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
Baby Girl Ryan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S. War Veteran. specify WAR)
(a) Residence. No .... 48 Ocean St
Lynn
St.
(If nonresident, give city or town and state)
Length of stay : In hospital or institution (Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Winthrop. (City or Townb Winthro Community Hospital No.
CERTIFICATE OF DEATH
Place of Burial, Cremation or Removal.
DATE OF BURIAL Jan
Jument Jumuany
Received and filed
(Day)
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, fter the death of a person whom he has attended during his last Ilness, at the request of an undertaker or other authorized person r of any member of the family of the deceased, furnish for regis- ration a standard certificate of death, stating to the best of his chowiedge and belief the name of the deceased, his supposed age, he disease of which he died, defined as required by section onc, where same was contracted, the duration of his iast iliness, when iast een 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 thercfrom 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 s no such board, from the clerk of the town where the person died ; nd no undertaker or other person shall exhume a human hody and emove 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 ts 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- ivered to such board, agent or clerk, as the case may be, a satisfac- ory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate s hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for he 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- bose, shall upon application make the certificate required of the at- ending physician. If death is caused by violence, the medical exam- ner shaii make such certificate. If such & permit for the removal of human body, not previously interred, from onc town to another within the commonwealth cannot he 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 & removai shall constitute a permit for such removai ; provided, that such body shali be returned to the town from which it was removed within thirty- ix hours after such removai, unless a permit in the usual form for he removal of such body has been sooner ohtained hereunder. If the leath 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 recitai shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, hali forthwith countersign it and transmit it to the clerk of the own for registration. The person to whom the permit is so given nd the physician certifying the cause of death shall thereafter fur- ish 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 funerai is to be heid, 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 died without recent medicai attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiner« 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), thermai, or electricai 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 discase, 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 .- Precisc statement of occupation is very important, so that the relative heaithfulness 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 iliness. 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 & 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
M R-301 A
PLACE OF DEATH
Suffolk Miniprop (County) (City or Town)
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.
12
Registered No.
St.
...................
.....
~
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
Habitat
(Specify whether)
years
months
1
days.
In this community
yrs.
mos.
/ days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dannam 8
1941
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,
1/7/
1941,
to Jan
198/
.m. I last saw he alive on Jan- 8 19 .. 9./ .. , death is said to have occurred on the date stated above, at 7:30 A Duration IMPORTANT . Immediate cause of death. Intracranial hemorrhage
Minutes Due to. (newborn)
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify .................... (Signed) Arthur C. Morin Date 1/8 1941 (Address) KAuthor, mas ......... M. D.
21. clak tove
Place of Burial, Cremation or Removal.
midland (City'or Towy)
DATE OF BURIAL
Jan
Judenick & magrath
19 40 .....
22 NAME OF FUNERAL DIRECTOR ADDRESS 64 metilian
Received and filed.
.19
(Official Designation) (Date of Issue of Permit)
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
6 Age of husband or wife if alive.
.years
7 IF STILLBORN, enter that fact here.
8
AGE ..
Years
Months
Days|
If less than 1 day
9 Hours
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
Vindtudo
masa
13 NAME OF
FATHER
Charles Te. M& Carry
14 BIRTHPLACE OF
FATHER (City)
Manchester
(State or country)
mass
15 MAIDEN NAME
OF MOTHER
Margarh &. thea
16 BIRTHPLACE OF MOTHER (City) ... (State or country) mass
17 Teharba To M' County ( Future.
Relation, if any
Informan (Address) 73 ingleside line Hanchul
I HEREBY CERTIFY that a satisfactory standard certificate of death was tiled with me BEFORE the burial or transit permit was issued: Win.D. Couldrest Signature of Agent of Board of Health or other) Weath (Spf2022 1/9/4/
Minchuck Community Hospital
No.M.
2 FULL NAME
margarch Una m cleanty
(If deceased is a married, widowed or divorced woman, give also maiden name Y
73 chroleside
une
.....
....
St
(If nonresident, give city or town and state)
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
(Registrar)
Underline the cause to which death should be charged sta- tistically.
Charlestrix
1 3 SEX (or) WIFE of Usual 9 Occupation : PARENTS 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 is very important. See instructions and extracts from the laws on back of certificate. 100m-2-'40-D-729-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry 10 or Business:
4 COLOR OR RACE
Female Mete
(Husband's name in full)
That I attended deceased from
8
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 helief the name of the deceased, his supposed age, the disease of which he died, definded 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 hody in a town, or remove therefrom a human hody which has not heen 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 body 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 hoard of health or its agent aforesaid or from the clerk of the town where the hody is huried. No such permit shall he issued until there shall have been delivered to such hoard. agent or clerk, as the case may he, a satisfactory written statement containing the facts required hy aw to he 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 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- loyed hy it or hy 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 sucli a permit for the removal of a human hody, 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 desiring to make such removal shall constitute a permit for such removal; provided, that such hody 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- noval of such hody has heen sooner obtained hereunder. If the death certificate contains a recital, as required hy section ten of chapter forty- ix, 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 uch statement and certificate, shall forthwith counterslgn it and transmit t to the clerk of the town for registration. The person to whom the permit s so given and the physician certifying the cause of death shall thereafter urnish 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 hury a human body or the ashes thereof which have been hrought 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 hoard, from the clerk of the town where the body Is to he huried or the funeral is to he 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 ohservance 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 hy 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 hy traumatism (including resulting septicemia). and hy the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, hut 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.
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