USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 54
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Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
2 FULL NAME
3 SEX
male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name
(o:) WIFE of
7 IF STILLBORN, enter that fact here.
8
Months.
Days
AGE
76 Years
Usual
9 Occupation:
salesman
Industry
10 or Business:
advt
Il Social Security No.
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
17
Informant.
(Address)
50m-10-'39. No. 8427-f
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
(State or country)
Boston
(write the word)
DIVORCED
widowed
chine. Leclair
(Husband's name in full)
6 Age of husband or wife if alive. years
If less than 1 day
Hours.
.Minutes
12 BIRTHPLACE (City)
(State or country)
Boston Mass
13 NAME OF
FATHER
Joseph Carroll
Relation, if any
son ········
A TRUE COPY francis
ATTEST:
(Registrar of city or town where death occurred)
9/2/41
DATE FILED IS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Aug 28 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
to.
That I attended deceased from
8/1/41
19
8/28/47
19
I last saw h ... ].m ... alive on
Aug
19.41
death is said
to have occurred on the date stated above, at.
1/18A
m.
Immediate cause of death ..
resolving broncho pneumonia
7 wk
Duele and septicemia
7 ..... wks V
Due to
Other conditions
arteriosclerosis
(Include pregnancy within 3 months of death) Parets ... disease.
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?..
20 Was disease or Injury in any way related to occupation of deceased ?
If so, specify.
(Signed)
S Hamilton
. M. D.
(Address)
Boston
Date 8/28/19 47
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL.
(Cemetery)
Aug 30 1941
.19
22 NAME OF
FUNERAL DIRECTOR
M
Kirby
ADDRESS
Winthrop
Received and filed.
1
19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
(County)
Roston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
163
(City or town making return)
Registered No.
7484
1
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Patrick 0
Carroll
(If deceased is a married, widowed or divorced woman, give also maiden name.)
497a Shirley
.St.
Winthrop
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and state)
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Outfolk
No ... ......
Mass .... General .... Hospital
St. 1
Date of ...
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
(City or Town)
Robit Carrollf
Traz 8
Duration
RM R-301
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
200m-10-'39. No. 8427-d
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www . Childrenx
(Signature of Agent of Board of Health of others Health Officer 9/4/4/ /(Official Designation) (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
(write the word)
DEATH
September
18 DATE OF
2 1941
Month)
(Dav)
(Year)
P I HEREBY CERTIFY. That I attended deceased from
July 17
19 ... , to ............
Deplomber de 1941.
I last say h.( ........ alive on .......
Lept. 2, 1941, death is said
Duration
to have occurred on the date stated above, at .15%.
Immediate cause of death byel5-1
acute
pielo-Repliitis
...
Imo
Due to
Uremia
3 days
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
none
.Date of
Of autopsy
What test confirmed diagnosis :
Clinicaly locally
charged sta-
20 Was disease or Injury In any way related to occupation of deceased ? ......... £
If so, specify.
M. D.
(Signed)
(dayoss) 56 2 Shirley Dat ask04
21
Holyhoola Brookline
Place of Burial, Cremation or. Remoyal.
(City or Town)
DATE OF BURIAL september
194
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
54 roxbury street, ROX,
Received and fled D
DO 1041 19
A TRUE COPY ATTEST: (Registrar)
suffolk
(County)
winthrop
1
(City or Town)
No ........
inthrop, Hospital
PLACE OF DEATH
Thomas
2 FULL NAME
(a) Residence. No ...
(Usual place of abode)
· ength of stay: In hospital or institution
Hospital
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
M
5 SINGLE
MARRIED
WIDOWED
Married
or DIVORCED
5a If married, widowed.
wasadivored McGovern
HUSBAND of
(Give maiden name of wife in full)
(oz) WIFE of.
(Husband's name in full)
61
7 IF STILLBORN, enter that fact bere.
8
63
AGE
Years.
Months.
Days
Usual
9 Occupation:
Electrical Engineer
II Social Security No.
none
12 BIRTHPLACE (City)
poston
(State or country)
Massachusetts
I3 NAME OF
FATHER
Jeremiah Haley
14 BIRTHPLACE OF
FATHER (City)
bangor
(State ot country)
Maine
15 MAIDEN NAME
OF MOTHER
Mary A. Harney
PARENTS
16 BIRTHPLACE OF
boston
MOTHER (City)
(State or country)
Massachusetts
17
Mrs, Susan G. Haley
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
10 or Business:
Dept. of School Building
BOSTON NOTIFÍŁO The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
164 ...
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
7. Haley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
63 St. Andrew Road
...... St. ..... a.s.t ..... o.s.t.o.n ..
(If U. S.
War Veteran.
specify WAR) ...
-
2
years
×
months 2 days.
(If nonresident, give city or town and state)
In this community
yrs.
mos. 4 days.
6 Age of husband or wife if alive.
Fears
If less than 1 day
Hours
Minutes
Informa
(Address)
65 st. Andrew Rd.,
Last Dosto
Relationig any
PHYSICIAN Underline the cause to which death should be
no
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 wbom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section onc, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of bealth 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 sball exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No sueh permit shall be issued until there shall have been 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 be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by tbc selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such 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 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 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 buried or the funcral is to be beld, or from a person appointed to have tbe 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 bave 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 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 busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 19 Buckthorne Terrace
The Commontoralth of Massachusetts ffollOFFICE 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.
165.
Hyf ( If death occurred in a hospital or Institution, tgive its NAME instead of street and number)
2 FULL NAME
John Stahl Royal
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Buckthorne Terrace
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
( Before death)
(Specify whether)
years
months
days.
In this community
yrs.
25
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Lektember
2
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
19 ..
... ,
to
19
I last saw h .......
.alive on
19
.. , death Is sald to
have occurred on the date stated above, at
10:10 A.m.
Duration IMPORTANT
Immediate cause of death .....
Natural carraca
01
Due to.
Andden heart Failure
Due to Coronam arten disease
5/ 120
Other conditions.
(Include preguancy within 3 months of death)
IMPORTANT
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 in any way related to occupation of deceased ?...... k.Q.
If so, specify ..........................
(Signed) Lunch ...........
(Address) Slash Brandt, Date 9/
194
M. D.
21 Riverview Cemetery Saugus
l'lace of Burial, Cremation or Removal.
(City or Town)
OpPATE OF BURIAL
September 4,
1941
19
22 NAME OF
FUNERAL DIRECTOR.
Charles R. Bennison
ADDRESS
Winthrop Mass
(Signature of Agept of Board of Health of ather)
Hallte Officer 9/4/44
Official Designation ) ( Date of Issue of Permit) mit)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
Married
Sa If married, widowed, for
HUSBAND of
Katherine .... Mildred .... Hatch
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
55.
If less than 1 day Hours Minutes
Usual
Insurance
manager
Industry
Gilmore, Rother Co.
10 or Business:
012-05-5586
Roscoe Royal
15 MAIDEN NAME
OF MOTHER
Mary Montaire
17 .Mr.g ... Buckthorne
Relation, if any S.Roy pracy inthe
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued:
100m (d) - 1-41-4667
....
Received and filed 16.11 19
1
No.
-
(a) Residence. No.
(Usual place of abode)
3 SEX
Male
4 COLOR OR RACE
White
7 IF STILLBORN. enter that fact here.
9 Occupation :
11 Social Security No.
12 BIRTHPLACE (City)
Bath
(State or country)
Maine
13 NAME OF
FATHER
14 BIRTHPLACE OF
Ba th
FATHER (City)
(State or country)
Maine
PARENTS
16 BIRTHPLACE OF
Ba th
MOTHER (City)
(State or country)
Maine
Informant.
( Address)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoitai to that effect.
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
8
AGE 65
Years
X .. Months.
.1.
Days
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
19.41
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 faneily 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 hy seetion 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.
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 I'nited 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 saine. 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 seetions 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, he deemed to have taken place hetwcen 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 health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the 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 by law to he 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 pbysi- cian who is a member of the hoard of health. or employed by it or by the aelectinen 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 euch certificate. If such a permit for the removal of a liuman 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 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 counter-ign it and transmit it to the clerk of the town for registration. The person to whom the perotit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other peces sary information which can be obtained as to the drerased, or as to the manner or cause of the death, which the clerk or registrar way require .- Chap. 114. Sec. 45. G. L., (Tercentenary Edition).
No undertaker or other person shall bury a lutoian 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 primits, or if there is no such hoard, 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 liea ausd take charge of the same; ...- General Laws, Chap. 38, Sec. G.
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 aa those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent nicdical attendance or whose pbysi- cian is ahsent 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 inelude not only deaths caused directly or in- directly by traumatism (including resulting aepticemia), and by 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 ocoupation, 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 ia 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 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 not gainfully employed may be returned as at school or at bomne. For a woman whose only occupatiou was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
i C 1
1 1 ( i
1 1
1 1 1 1
1 3 1
R-301
1
PLACE OF DEATH
Suffolk (County) Winthink
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.
166
( ( If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
alfred Puerro
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
0
21 Woodside ave St.
(a) Residence. No.
(Usual place of abode)
Length of stay : In hospital or Institution.
( Before death)
(Specify whether)
years months days.
In this community / 0 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male White
4 COLOR OR RACEJ
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Sinde
5a If married, widowed, or divorced HUSBAND of
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