USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 85
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SPACE FOR ADDITIONAL INFORMATION
·
R-301 A
Suffolk
(County)
Winthrop
(City or Town)
Winthrop Comunity Hospital No.
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
254 ........
§ (If death occurred in a hospital or institution. St. { give its NAME instead of street and number)
2 FULL NAME.
Lucene D. Hussey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
specify WAR)
184 Circuit Rd., Winthrop-
St
(If nonresident. give city or town and state)
Length of stay: In hospital or institution.
- years
- months
days.
In this community
7
yrs.
mos.
-
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec .
12
1941
(Month)
(Day)
(Year)
5a If married, widowed. ydufine divs8ber Kussey
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
56
years
7 IF STILLBORN. enter that fact here.
AGE
61
Years
.Months ..
Days
If loss than 1 day Hours. Minutes
Usual Traffic Manager
9 Occupation :.
10 or Business:
Dept. Store
11 Social Security No.
022-01-3686
12 BIRTHPLACE (City)
(State or country)
Tarmington
13 NAME OF FATHER Frank D. Hussey
14 BIRTHPLACE OF
Dover
FATHER (City) ...
(State or country)
N. I.
15 MAIDEN NAME
OF MOTHER Eva McDuffie
16 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
New Hampshire
Mrs. Pauline C. Hussey
Relation, if any Wife
Informant !! : (Address) 184 Circuit Id." winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William S. Childress
(Signature of Agent of Board of Health or other)
agent
Dec. 14/41
(Official Designation) (Date of Issue of Permit)
19 I HEREBY CERTIFY, 2 19& .... , to .. Oca 11 12, 194/27
I last saw halive on 8-carr 19 ... 564, death is said to have occurred on the date stated above, at 19.00 12:01 PM Immediate cause of death Condue Duration ...... m. IMPORTANT
previsto
Due to. -
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operations.
-
Date of.
Of autopsy.
What test confirmed diagnosis ?.
IMPORTANT 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 ......
-
(Signed)
(Address)
Weston, Mass
21. Heaton
Place of Burial, Cremation or Removal ..
(City or Town)
DATE OF BURIAL ..
Dec. 14,1941
.19.
22 NAME OF FUNERAL DIRECTOR.
Richard & White
ADDRESS. 147 Winthrop St., Winthrop, Mass.
Received and filed DEC 1: 1941 ...... 19
(Registrar)
1 3 SEX Male 8 PARENTS 17 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. NOR WRITE DESINE Y WITH BINEANIMALOLEN information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry 100m-2-'40-D-729-a
4 COLOR OR RACE
White
6 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
That I attended deceased from
Due to.
6 Age of husband or wife if alive.
PLACE OF DEATH
(a) Residence. No ...
(Usual place of abode)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered 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 registration a standard certificate of death, stating to the best of his knowledge and hciicf the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last iliness, when last seen alive hy the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not heen huried, until he has received a permit from the board of heaith, 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 shail exhume a human hody and remove it from a town, from one cemetery to another, or from onc grave or tomh other than the receiv- ing tomh to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforcsaid or from the clerk of the town where the body is huried. No such permit shall be issued untii there shali have been delivered to such board, agent or cierk, as the case may be, a satisfactory written statement containing the facts required hy law to be 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 board of health, or em- pioyed hy it or hy the selectmen for the purpose, shail upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shaii make such certificate. If such a permit for the removal of a human hody, not previously Interred, from onc town to another within the commonwealth cannot he obtained eariy enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shali constitute a permit for such removal; provided, that such hody shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- movai of such hody has been sooncr ohtained hereunder. If the death certificate contains a recitai, as required hy section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war In which It has been engaged, such recitai shali 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 cierk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shali thereafter furnish for registration any other necessary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the cierk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
No undertaker or other person shall hury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the hoard of hcaith or its agent appointed to Issuc such permits, or if there is no such board, from the cierk of the town where the body is to he huried or the funeral is to be ileid, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114. Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fuifiilment of the purpose of these laws calis 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 iliness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to aii deaths supposably due to injury. These inciude not only deatiis caused directly or indirectly hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermai, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease. or complicatlou which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principai cause name the disease causing death. As related causes, name eariier morhid conditions, if any. related to the principal cause and any Important complication of the principal cause.
.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 ycars or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to liiness. 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1 R-301 A
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 recital to that effect. PARENTS
100m (d)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Childrens
(Siguature of Agent of Board of Ilewith or othery / Realthe Office 12/15/41
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
12
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
19.5.1.
to ..
12/17
1941
have occurred on the date stated above, at
7
m.
Duration
Immediate cause of death
Commay Themfed
IMPORTANT
3 days .
Due to
Due to
Sen. Orleno Saker
....
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Of autopsy
What test confirmed diagnosis ?
IMPORTANT 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
(Signed) Hun
(Address)
Date :
115
M. D. .19 .... /
21
much
Place of Burial, Cremation or Removal.
DATE OF BURIAL
(City or Town)
Dec 16 Nombre/ 196
22 NAME OF
FUNERAL DIRECTOR
son
ADDRESS
Received and filed
19
( Registrar)
1
PLACE OF DEATH
Suffolk (County)
The Commonturalth 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.
255
St. ( ( If death occurred in a hospital or institution, { give its NAME instead of street and number)
Mary Frances Barry Kirkpatrick
(If deceased is a married, widowed or divorced woman, give also maiden name)
46 - Washington ave
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
( Before death )
years
months
days.
In this community
40 Yrs.
-
mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE|
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
James Give ganger page of wife Ky khaled Hast saw h.
(ITusband's name in full)
6 Age of husband or wife if alivo Z
years
7 IF STILLBORN, enter that fact here.
2
If less than 1 day Hours Minutes
Usual
9 Occupation :
at- home
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
Milfal Mass
13 NAME OF
FATHER
John Barry
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Freland
15 MAIDEN NAME
OF MOTHER
Catherine Sullivan
16 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
17 Informant .. ( Address) 46-Wasauftrag.com
Relation, if any
Registered No.
No.
(City or Town) 46- Washington are
2 FULL NAME
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so speolfy WAR)
(a) Residence. No.
(Usual place of abode)
(Specify whether)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
.
8
82 Years
Months.
Days
AGE
41
13
That I attended deceased from
allve on
12/13
19 ... 4, death Is sald to
....
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan 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, furnisb for registration a standard certificate of death, stating to the best of his knowledge and belief the nanie 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 hest of his knowledge and belief, served in the ariny, 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 bundred 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 horder service of nineteen hundred and sixteen and nineteen bundred 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 domb other than the receiving tonib 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 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 violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a humsu body. not previously interred, from one town to another within the contmonwealth 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-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 furwish 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 asbes 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 he held, or fromn 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., (Terccutenary 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 Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa 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 traumatismo (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal. or electrical agents, and deaths following ahortion, 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 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 disease causing desth, report the usual occupation prior to illness. If the deceased bad 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 ouly occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terins, as housekeeper-private family. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
I R-301 A
.. ... ......
1
PLACE OF DEATH
Suffolk
(County)
wirtiron
(City or Town)
No.
15 George It
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.
256
( ( If death occurred in a hospital or institution, ¿ give its NAME instead of street and nuumber)
2 FULL NAME
Margaret L Wilson Bloomer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
15 George St
St.
(It 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.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
Thi te
4 COLOR OR RACEJ
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDDivorced
5a If married, widowed, or divoroed HUSBAND of
(or) WIFE of
Francis bloomer
(Husband's name in full)
6 Age of husband or wife if alive
Cannot be Tarnan years
7 IF STILLBORN. enter that fact here.
8
AGE50
Years
Months.
Days
If less than 1 day Hours .. Minutes
Usual
9 Occupation :
Saming
Industry
10 or Business :
N.P.A.
11 Social Security No.
019 14 7224
12 BIRTHPLACE (City)
(State or country)
West Boston
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Finland
15 MAIDEN NAME
OF MOTHER Marianot Mckeon
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
12.88
17 Informant Julia Mulrev
Relation, if, any
( Address) Harmon St
I HEREBY CERTIFY that a satisfactory standard oertifloate of death was filed with me BEFORE the burial.or transit permit was Issued : Win. D. Muldresh. 9
...
(Signature of Agent of Board of Health or other) Malte Mlécer 12/24/41
( Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
Oui
22, 1941
(Month)
(Day)
('ear)
19 | HEREBY CERTIFY,
That I attended deceased from
19
4,
to
19
41
I last saw
alive on
21, 199 death Is said to
have occurred on the date stated above, at
1 A
.. m.
Immediato cause of death
IMPORTANT / ...
Due to.
Due to
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis ?.
-
Underline 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)
(Address)
Washington Date 12-2219
M. D.
21
inthron
(1. ( 10)
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
DAC
24
194I
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Tinthrop
Lol HO maly
Received and filed ..
19
(Registrar)
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, Seotlon 10, requires physicians to Insert a recital to that effect.
Registered No.
St. 3
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
40
(Give maiden name of wife in full)
Duration
4
(
. 13 NAME OF
FATHER
Joseph Wilson
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. bis supposed age, the disease of which he chied. 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 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 deceasedl. 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. ail shall also certify in such certificate both the primary aint 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 bumired and fourteen. the word "war" shall inchmule the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he 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 hnulred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
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