USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 51
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by section ten of chapter forty-six. that the deceased served In the army, navy or marine corps of the l'uited 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 traustmit 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- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. L., (Tercentenary Edition).
No undertaker or other person shall hury a human hody or the ashes thereof which have been hronght into the commonwealth until he has re- ceived 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 buried or the funeral is to be held. or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
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, he 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 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 by recognized disease 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 injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical ( drugs or poisvus), 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, naine 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 im- portant, so that the relative healthfulness of various pursuits cau be known. Make sonie eutry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children uot gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of honie 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 occupatiou whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A futballo
PLACE OF DEATH
(County) Winthrop (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.
Registered No.
154
(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
....
James E Molan
AH deceased is a married, widowed or divorced woman, give also maiden name.)
7 Court St
St
Wobum
(If nonresident, give city or town and state)
...
years
months
days.
In this community
yrs.
mos.
2 days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Male White
5 SINGLE
(write the word)
MARRIED
WIDOWEDY
5a If married. widowed, or divorced HUSBAND of. margaret
Starken
„Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. 57 years
7 IF STILLBORN, enter that fact here.
8
10 Years
Months
Days
Usual
9 Occupation:
Retired
11 Social Security No .....
12 BIRTHPLACE (City).
(State or country)
Worum
mass
13 NAME OF
FATHER
James Alan
14 BIRTHPLACE OF
FATHER (City)
........
(State or country)
duland
15 MAIDEN NAME
OF MOTHER
Bridget Gaffigan
16 BIRTHPLACE OF MOTHER (City) ....... (State or country)
duland
Relation, if any
Informant (Address) 7 Coup & OMoleary
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
. Children1.
(Signature of Ageht of Board of Health or other) Health alice 8/26/41
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ..
avant
26
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,
19 ........ , to.
19
I last saw h.
alive on
have occurred on the date stated above, at ... 6:30 A.m.
Duration IMPORTANT
Immediate cause of death natural cancer
D
reaumatty corman occiusion
hours
S
11-14
Due to 8
1
- Generalis es arenoclemais
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) Min
11 woran M. D.
(Address) -. 1.
.19.5.4.
21 Calrar Worum
Place of Burial, Cremation or Remoral.
(Clty or Town) 28 194/1
DATE OF BURIAL
BOM Sanghlu
22 NAME OF
FUNERAL DIRECTOR.
ADDRES
54 Pleasant XX Woburn
Received and filed ... ....... AU.G ···· 2.0 ····· 1991. ......
.19
(Registrar)
X
100m-2-'40-D-729-8
1 3 SEX 4-4- 41 (or) WIFE of .. per mr. meLaughlin AGE. PARENTS 17 information should be carefully supplied. AGE should be stated LAACILI. FHIDICIAND should state Industry 10 or Business: CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
Havnen speed -SEP 1 0 1941
141 Bay Vern are
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
(If U. S. War Veteran, specify WAR)
941
That I attended deceased from
19 .... death is said to
If less than 1 day Hours. Minutes Due to al Chrome miocarditis
.......... .........
Underline the cause to which death should be charged sta- tlstically.
er
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwitb. after tbe deatb 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 deatb, stating to the best of bis knowledge and belief tbe name of the deceased. his supposed age, the disease of which he died, definded 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 buman hody in a town. or remove therefrom a buman 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 tbe clerk of the town wbere the person died; and no undertaker or otber person shall exhume a buman body and remove it from a town, from one cemetery to another. or from one grave or tomb otber tban the receiv- ing tomb to another in the same cemetery, until he bas 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 sucb 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 tbereof 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 board of bealth, or em- ployed by it or by the selectmen for the purpose, shall upon application make tbe certificate required of the attending physician. If deatb is caused by violence, tbe medical examiner shall make sucb certificate. If sucb a permit for the removal of a buman body, not previously interred, from one town to another witbin the commonwealth cannot be obtained early enougb for the purpose, the certificate of death made as above provided and in tbe possession of the undertaker desiring to make sucb removal shall constitute a permit for such removal; provided, that such body sball be returned to the town from which it was removed within thirty-six bours after such removal, unless a permit in the usual form for the re- moval of such body has been sooner obtained hereunder. If tbe deatb 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 tbe United States in any war in which it has been engaged, sucb recital sball appear upon tbe permit. Tbe board of bealth, or its agent, upon receipt of sucb 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 tbe cause of deatb shall thereafter furnisb for registration any otber necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, wbicb tbe clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or otber person shall bury a buman body or the ashes tbereof wbich bave 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 tbe town wbere the body is to be buried or the funcral is to be held, or from a person appointed to have tbe care of the cemetery or burial ground in which tbe interment is made. . . . Chap. 114, Sec. 46. G. L., (Tercentenary Edition).
RULES OF PRACTICE
Tbe fulfillment of the purpose of these laws calls for tbe observance of tbe following rules of practice:
(1) Attending physicians will certify to sucb deatbs only as tbose 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 tbose of persons who, though disabled by recognized disease unrelated to any form of injury, have died witbout recent medical attendance or whose physician is absent from bome when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deatbs supposably due to injury. These include not only deatbs caused directly or indirectly by traumatism (including resulting septicemia), and by tbe action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following abortion, but also deatbs 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 deatb means the disease, or complication which causes deatb, not the mode of dying, e. g., heart failure, asphyxia, astbenia, etc. As principal cause name tbe disease causing death. As related causes, name earlier morbid conditions, if any, related to tbe principal cause and any important complication of tbe 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 cbanged on account of tbe disease causing death, report the usual occupation prior to illness. If tbe deceased bad retired from business, report tbe usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at hame. For a woman wbose only occupation was that of home bousework, write housework. For a person engaged in domestic service for wages, bowever, designate tbe occupation by tbe appropriate terms, as housekeeper-private family, caok-hotel, etc. For a person wbo bad no occupation whatever write nane.
SPACE FOR ADDITIONAL INFORMATION
R-301 A Suffolk (County)
PLACE OF DEATH
(City or Towg) 45 Marshell
The Commontoralth 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.
Registered No.
155
+ [ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
45 marshall
St.
( If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
months
days.
In this community / o yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE!
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
5a If HUSBAND of
(or) WIFE of
([Tushand's name in full)
6 Age of husband or wife if alive 85
years
7 IF STILLBORN, enter that fact here.
8 AGE 77 Years Months Days
If less than 1 day
.Hours ...
Minutes
Usual
9 Occupation :
taday
Industry
10 or Business :
11 Social Security No. 20.000
12 BIRTHPLACE (City)
(State or country)
"Cambiadas Mars
13 NAME OF
FATHER
Ferdinand Shieldy
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland,
15 MAIDEN NAME
OF MOTHER
Ellen Mc Carmicha
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Thomas&
Informant (Address) 36
Suela Relation, if any Connell It Zumcy
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial/or transit permit was issued : Vi.D' Children
(Signature of Agent of Board of Healey on other)" Health Alice 8/27/4
(Official Designation) (Date of Issue of Permit) /
18 DATE OF
DEATH
anaust
26
1941
(fonth)
(Day)
(Year)
19 | HEREBY CERTIFY
That I attended deceased from
Had beensaved for hyper farver
1 last saw h.
tellamo por amarna or
sald to
have occurred on the date stated above, at
9:45 .m.
Duration
Immediate cause of death
IMPORTANT Presumably coronary occlusion hours
Due to,
Chance myocarditis
Due to
Generalized artino-
selene
Other conditions
(Include pregnancy within 3 months of death)
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? MO
If so, specify.
M. D.
(Signed) Arthur G. Saray
(Address) Hathran MaDate 8/2
21
New Calvary
Place of Burial, Cremation or Removal.
DATE OF BURIAL ..
august
(City or Town)
29
2941
FUNERAL DIRECTOR
22 NAME OF
Bernard Tellyttan
ADDRESS
310 Boudin of Das.
Received and filed
19
(Registrar)
ב
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
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 reoital to that effeot. PARENTS
No. Ferdinand F. Shields
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
210
if so specify WAR)
MEDICAL CERTIFICATE OF DEATH
Schauke
(Give maiden name of wife in full)
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 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 bis 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 he 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, eighteen 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 liealth, 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 fron 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 violenee, 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 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 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 bealth, 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- sary information which can be obtained as to the deceased, or as to tbe manner or cause of the death, which the clerk or registrar may require .- Cbap. 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 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., (Tercentenary 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, lie shall fortbwith 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 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 physloians 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 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 injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deathis 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 tbe principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, 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 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 housekceper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-303A
(County)
Winthrop
1
(City or Towr)
2 FULL NAME
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution.
3 SEX
Male
4 COLOR OR RACE
Thite
(or) WIFE of
6 Age of husband or wife if alive.
7 IF STILLBORN. enter that fact here.
8
AGE .... 8.8 ... Years.
Months
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