USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 68
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by section ten of chapter forty-aix, 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 statenient and certificate, shall forthwith counter-ign 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 the matiner 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 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 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 hody 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 :
(]) 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.
( ") Board of Health physicians will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent nicdical 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 cansed 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 ahortion, but also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death 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 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 discase causing deatb, 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 hoine. For a woman whose only occupation was that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-botel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
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.
R
PLACE OF DEATH
Suffolk (County)
...............
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.
208
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
Dorchester mass.
(If nonresident, give city or town and state) In this community - yrs. " mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
Male
white
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Ago of husband or wifo if alive.
7 IF STILLBORN, enter that fact here.
stillborn
years
8 AGE Years Months
Days
Hours. .Minutes
Usual 9 Occupation: Industry 10 or Business:
11 Social Security No. Station Hospital Frost Bank
12 BIRTHPLACE (City)
(State or country)
Vinteroff aMars.
13 NAME OF
FATHER
Richard Patrick Sullivan
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass.
15 MAIDEN NAME
OF MOTHER
Florence Sitto
Boston
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 G. C. Sullivan
Inforkian (Address) 28 Templeton St Backeste
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filod with me BEFORE the burial or transit permit was issued: William D. Childress (Signature of Agent of Board of Health or other)
agent (Official Designation)
Movi (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
November
3,
1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
19.
., to
19
I last saw him.
e cn
11
-
3
12.4/, death is said
to have occurred on the date stated above, at 118
Immediate cause of death .... Stillborn -
Prolonged labay due to Conquista delect
Due To Stillborn
Due to
Other conditions
(Include pregnancy within 3 months of death)
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? Toweru
If so, specify .....
(Signed) Glad R. Howell lot. If. MC.
(5) Fort Banks, Mas Data 11-3 1941
Boston
21 new Calvary
Place of Burial, Cremation or RerMember 5
DATE OF BURIAL
1941
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Dorchester Anos
Received and filed 1011 19
(Registrar)
I
winthrop (City or Town)
Mx.station ... Hospital., .. Fort ... Banks ..... Mas.s ..
2 FULL NAME ROBERT (None) SULLIVAN
(If deceased is a married, widowed or divorced woman, give also maiden name.) 30 Pierce avenue Station Hospital, Ft. Banks, NESS. St.
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
R-301 A
Residence per
Besch Certificate
100m-10-'39. No. 8427 -.
PARENTS
Major findings : Of operations
Date of.
Of autopsy
No
What test confirmed diagnosis ?.
None
no
M. P.
John C. Murmure
....... m.
Duration
IMPORTANT
lf less than 1 day
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
years - months " days.
EXTRACTS FROM THE LAW'S OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registerod hospital medical officer shail 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 regls- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deecased, his supposed age, the disease of which he died, defined as required by section one. where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human hody 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 aforcsaid or from the clerk of the town where the body is burled. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfao- 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 the 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 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 ruch 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 ferm 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 transinit 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 elerk 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 hcen brought Into the commonwealth until he lius received a permit so to do from the board of health or Its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body Is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burlal ground in which the interment is made. ... Chap. 114, Soc. 46, G. L., (Tereentenary 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 eertify to such deaths only ay 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 Hoalth 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 medieal 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 suppoanbly due to injury. These include not only deaths caused dircetly or indirectly by traumatism (Including resulting septlce- mia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, but also deathe from disease resulting from injury or infoction related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Doath .- Cause of death means the disease, or complication which causes death. not the mode of dying. s. 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 complleatlon of the principal eause.
Statement of Occupation .- Precise statement of occupation Is very Important, so that the relative healthfulness of various pursults 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 discase 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 houseworls. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as howackeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write nono.
SPACE FOR ADDITIONAL INFORMATION
-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
No. 79 Johnson Avenue
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or its Agent.
209
{ { If death occurred in a hospital or institution, St. { give ita NAME instead of street and number)
2 FULL NAME
Horace Augustus Magee
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
79.JohnsonAvenue
St.
(Usual place of abode)
(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
45
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divoroed HUSBAND of
Eva Rich
(Give maiden name of wife in full)
(Husband's name in full)
68
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE
7QYears
3
.Months ...
2 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Broker (retired)
Industry
10 or Business :
Insurance
11 Social Security No.
048-05-5641
12 BIRTHPLACE (City)
rast Boston
(State or country)
Massachusetts
13 NAME OF
FATHER
Edward Magee
14 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Elizabeth Mann
16 BIRTHPLACE OF
MOTHER (City)
Ellsworth
(State or country)
Maine
17 Mrs Eva R .Magee
Relation if any
Informant
( Address)
79 Johnson Ave, Winthrop Mass
I HEREBY CERTIFY that a satisfactory,standard certificate of death was filed with me BEFORE the burhat or transit permit was Issued: Www. D. Childress
(Signature of Agent of Board of Health or other)
Health Officer 11/7/41
(Official Designation) ( Date of Issue of Permit)
18 DATE OF
DEATH
5
1241
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
SEPTEMBER 21/ 1941
to 1
Nosember 5
1941
I last saw h I'M alive on
November 3
1971, death is said to
have occurred on the date stated above, at.
900 W
m.
Immedlate cause of death
Duration IMPORTANT
3 days
Due to
Coronary Thrombosis
3 5 days "
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Of autopsy
What test confirmed diagnosis ?.
Underiine the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to ocoupation of deceased ?
If so, specify ........
(Signed) Edward Stranger
M. D.
(Address)
19
21 Winthrop Cemetery Winthrop Mass
Place of Burial, Cremation or Removal.
DATE OF BURIAL
November
(City-05
19
22 NAME OF
FUNERAL DIRECTOR.Charles R Bennison
ADDRESS
Winthrop ......... a.s.s
Received and filed.
19
( Registrar)
100m (d)-1-41-4667
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that effect. PARENTS
r
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
MEDICAL CERTIFICATE OF DEATH
(or) WIFE of
Branche PNEUMONIA
IMPORTANT Physician
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 utulertaker or other authorized person or of any member of the family of the deceased, furnish for registration a atandard 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 laat 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 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 sud 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-cight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen aud 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 liuman 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; aud 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 tonib to another in the saine cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall he issued until there shall have been delivered to such 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- ciau who is a member of the board of health, or employed by it or hy 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 oue 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 aection ten of chapter forty-aix, that the deceased aerved 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 fortliwith 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 ahall 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 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 permita, or if there is no such board, from the clerk of the town where the body ia 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 ia 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 withiu 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 lawa calls for the observance of the following rulea 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 uurelated to any form of injury.
(2) Board of Health physiclans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to auy form of injury, have died without recent medical attendance or whose physi- cian is absent from honie 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 reaulting septicemia), snd by the action of chemical (drugs or poisons), thermal, or electrical agents, aud deaths following ahortion, but also deaths from disease resulting from Injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and auy 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 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 illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed inay be returned as at school or at home. For a woman whose only occupation waa that of home housework, write housework. For a person engaged in domestic service for wages, however, desiguate 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-303A
PLACE OF DEATH No
Sultalk "EY(County) Meuthropa (City or Town)
Muthrop Community
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH Hrobital
To be filed for burial permit with Board of Health or its Agent.
210
Registered No.
......
ยง (If death occurred in a hospital or institution, St. {give its NAME instead of street and number)
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