USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 77
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If less than 1 day Hours Minutes
Usual Retired Gashier
9 Occupation :...
Industry
Boston Edison Go .
10 or Business :....
11 Social Security No .. 012-07-6422
12 BIRTHPLACE (City)
(State or country)
Boston mass
13 NAME OF
FATHER
Thomas F. Golden
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary B. Brogan
16 BIRTHPLACE OF
MOTHER (City) ....
(State or country)
Ireland
to. Galistay
17 Mabel J Golden (sister ...
Informant.
(Address)
35 Willow Ave, Wine .
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Burial or transit permit was issued: Wm.D. Chil dress (Signature of Agent of Board of Health ox other)
Health Officer 11/24/4/
t. (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Juncubas - 21 - 1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Carbon monoxide Personnes
20 Accident, suicide or homicide (specify)
Resumelts accidental
Date of occurrence.
Jur-21-
19.41
Where did
Injury occur ?.
(City or Town and State)
Did injury occur in or about home, oh farm, in industrial place, in public place?
(Specify type of place)
Manner of
F rend dead seated in auto
Injury
Nature of
in his closed garage
Injury.
While at work? Was there an autopsy? yes
21 Was disease or injury in any way related to occupation of deceased? 100
If so, specify.
HASsukles
M. D.
(Signed)
(Address)
Bieten
Karte 22-1941
22.
Holywood
Terookline
23 NAME OF
FUNERAL DIRECTOR ...
M. J. Kelly
ADDRESS
11 Meridian ST., E.B.
Received and filed. ..... ...................
19
(Registrar)
1
(City or Town) 35 Willow avc
Garage
golden
.....
2 FULL NAME
PLACE OF DEATH No .. Thomas 7.L.
years
months
days.
St.
(If nonresident, give city or town and state)
In this community 20 yrs.
mos.
- days.
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, so that it may be properly classified under the International Classification of Causes N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of ...
25m-2-'40-D-729-b
AGE
PARENTS
Relation, if any Place of Burial, Cremation or Remoyal. November 2 5its or Town) DATE OF BURIAL ..
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 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 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 froin one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he has received a perinit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk. as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded. which shall be accompanied, in case of an originalinterment, 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 in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the inedical examiner shall make such certificate. If such a perinit 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 re- moval 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 trangmit 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 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 permita, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral la 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.
. .. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 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 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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-303A
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
231
Registered No.
§ (If death occurred in a hospital or institution, St. give its NAME instead of street and number)
(If U. S.
specify WAR) -
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community
yrs.
mos.
7
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive .. years
7 IF STILLBORN, enter that fact here.
AGE .......
.Years
...... Months.
7
Days
If less than 1 day Hours Minutes
Usual
home
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
maso
13 NAME OF
FATHER
Clarence O Poston
14 BIRTHPLACE OF
FATHER (City)
Johnsonville
(State or country)
South Carolina
15 MAIDEN NAME
OF MOTHER
Evelyn Pothier
16 BIRTHPLACE OF
MOTHER (City) ....
yarmouth
(State or country)
nova Scotia
17 Clarence O Poston (Father
Informant.
(Address)
69 Cottage Park Rd, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Childreng
(Signature of Agent of Board of Health or other)
Health affiche 11/26/41
(Officlal Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
november drat 21et-1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Dronning
20 Accident, suicide or homicide (specify) Homicidal
Date of occurrence ahmet have- 21-
19 +1
Where did
Injury occur?
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place?
(Specify type of place)/
Manner of
Found dead mancutaise
Injury.
Nature of
under a brid
Injury
While at work?
Was there an autopsy ?.
21 Was disease or injury in any way related to occupation of deceased?
If so, specify.
11
1
(Signed)
I my ricklu
M. D.
(Address)
Besten
1941
Place of Burial, Gremationfor Removal.
(City or Town)
DATE OF BURIAL
november 27
19 41
<
23 NAME OF
FUNERAL DIRECTOR
R.C. Kirby
ADDRESS
Boston
Received and filed 19
(Registrar)
)
25m-2-'40-D-729-b
Winthrop (City or Town) 65 Cottage Park Road Winthrop No Richard Franklin POSTON 2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.) 69 Cottage Park Rd. witha
(If nonresident, give city or town and state)
1 3 SEX male (or) WIFE of .. 8 9 Occupation : PARENTS of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry 10 or Business:
Winthrop
Relation, if any
22
Winthrop
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 hls 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 hody in a town, or remove therefrom a human body 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 tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall he issued until there shall have been delivered to such hoard, 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 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 be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the hoard of health, or em- ployed 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 such a permit for the removal of a human hody, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose. the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such reinoval; 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 re- moval of such body 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 whom 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 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 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 funeral la 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 hy 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.
. . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 physiclans 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 by traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas hacillus) caused hy a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have heen due to disease, specify: (1) Under cause its known or presumahle nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the hrain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-301 A
PLACE OF DEATH
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Health or its Agent.
232
Baby Christopher
(If deceased is z married, widowed or divorced woman, give also maiden name.)
111 Jairun × Roman
St.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
22
(Day)
(Year))
19 I HEREBY CERTIFY. That I attended deceased from
19.
., to ....
19
I last saw h ....
...... alive
10
death is said
to have occurred on the date stated above, at m.
Immediate cause of death. stillon
Due to
Eclampsia
Premiul - 7max
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 in any way related to occupation of deceased?
If so, specify
William Stavelson
(Signed)
M. D.
(Address)
59 Alerter
/ Data /-14 194
21 It is Muchad
(City or Town)
Place of Burial, Cremation of Removal.
DATE OF BURIAL.
26
1941
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Rocefved and blod. NOV. 19
(Rezistrar)
100m-10-'59. No. 8427-c
frederick T. Chereloptik Hallott)
Relation, if any
17 Informant. (Address) 111 Salle It- Maciere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transif permit was issued: Www. D. Children (Signature of Agent of Board of Health & other) The atthe office 11/25/41 (Official Designation) (Date of Issue of Permity
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in fully
(or) WIFE of (Husband's name in full)
6 Ago of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
If loss than 1 day
Days
Hours.
Minutes
redine
13 NAME OF
FATHER
Yeterich), Christafew
Revell, .
15 MAIDEN NAME
OF MOTHER
alice Bonia
Sant Poeta 2.
County) (City or Town) No., 2 FULL NAME 3 SEX Temale Meite 8 Usual 9 Occupation: Industry 10 or Business: 11 Social Security No. ...... 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) (State or country) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 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 AGE Years. - Months is very important. See instructions and extracts from the laws on back of certificate.
STANDARD CERTIFICATE OF DEATH 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)
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution ...
years
months
dayı.
4 COLOR OR RACE
1941
Duration
IMPORTANT
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer sball forthwith, after the death of a person whom he bas 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 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 body which bas 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 reinove it from a town, from one cemetery to another, or from onc 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 such 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 bc 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 thercof 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 buman body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, tbe 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 wbich 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 deccased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition.)
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