USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 9
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¿ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR).
no
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
.....
That I attended deceased from
Duration IMPORTANT June 40.
IMPORTANT PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
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, definded ag 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 bis 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 from one grave or tomb other than the receiv- ing tomh 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, f 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 medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred. from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a perinit 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 transmit t to the clerk of the town for registration. The person to whom the permit s so given and tbe 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 asbes tbereof which have been brought into the commonwealth until he has received a permit 80 to do from the board of health or Its agent appointed to issue such permits, or If there is no such board, from the clerk of the town where the body Is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . , Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
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 deatbs 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 dlsease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not tbe mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid conditions, if any, related to the principal cause and any Important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation ls 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 business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa 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
M R-301 A
Suffol '
(County)
Winthrop
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
25
Registered No (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
William E.
Burke
(If deceased is a married, widswed or divorced woman, give also maiden name.)
15 Willams St
St
(If nonresident, give city or town and state)
In this community 30
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED farried
Sa If married, widowed, or divorced
HUSBAND
ar
Haves
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
66
.years
7 IF STILLBORN. enter that fact here.
AGE
70 Years
Months.
Days
If less than I day
Hours.
Minutes
9 Occupation :
Clerk
10 or Business :...
U. S. Postoffice
Il Social Security No.
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Michael Burke
14 BIRTHPLACE OF
FATHER (City) ....
Boston
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Bridget Doran
16 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Nova Scotia
V
I HEREBY CERTIFY that a satisfactory standard certificata of death was filed with me BEFORE the Burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
Health Officer
1/3/41
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ....
e minary.
2%.
(Month)
(Day)
(Year)
19
19 / I HEREBY CERTIFY.
That I attended deceased from
ANvaryIN, 194%, to -
.. ,
I last saw heil alive on ~ 2h 1201
., 19 ........ , death is said to
have occurred on the date stated above, at
Immediate cause of death
Duration
IMPORTANT
Due to
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings: Of operations
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
M. D.
(Signed)
(Address)
Date ...
..... 19 ........
Walden
Place of Burial, Cremation or Removal.
DATE OF BURIAL Jan
......
24 1941
19
22 NAME OF
FUNERAL DIRECTOR ..
ADDRESS.
Solu F. O Maley
Winthrop
Mars
Received and filed
19
(Registrar)
100m-2-'40-D-729-a
I 3 SEX Male 8 Usual PARENTS 17 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state is very important. Sce 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
PLACE OF DEATH
(City or Town) 15 Willams St
No ..
...
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
(If U. S. War Veteran. specify WAR).
1441
(write the word)
Burke
Relation. If any
Wife
Informant
(Address)
IS Williams
St.
21.
(City or Town)
Date of.
Cast Boston
6 Age of husband or wife if alive.
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 hy 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 hury 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 receiv- ing tomb to another in the same cemetery, until he has received a permit from the hoard 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 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 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 hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall 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- 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 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 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 hrought 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 huried 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).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ohservance 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 Heaith 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 ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposabiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, 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 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 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 Iliness. If the deceased had retired from husiness, 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
RM R-303
PLACE OF DEATH No
Sulloek (County) Winthrop (City or Town) Bruttrop Community Hispital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return) 26
Registered No. § (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME Daniel Terrance Cunningham
(If deceasedis, a married, widowed or divorced woman, give also maiden name.) 268 River Road Withich
(a) Residence. No ... (Usual place of abode) Length of stay: In hospital or institution (Specify whether)
(write the word)
MARRIED
WIDOWED
or DIVORCED Tidomed
5a lf 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
lf less than 1 day
Hours.
Minutes
12 BIRTHPLACE (City)
(State or country)
MISS
13 NAME OF
FATHER
Patrick Cunningham
14 BIRTHPLACE OF
FATHER (City)
(State of country)
Ireland
15 MAIDEN NAME
OF MOTHER
Johanna Sheehan
50m-10-'39. No. 8427-h
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Nr. S. Children (Signature of Agent of Board of Healthpor other) Health Officer 1/27/41 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Jan -
25-1941
(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.) Exposure Sprain Right ankle contusion Scalp
20 Accident, suicide, or homicide (specify) accidental
Date of occurrence Iam- 25-1941
19
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)
Injury
Manner of
Ide puto suoa bank
Injury
Nature of
as above
While at work?
no - Was there an autopsy ?..
yes
21 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
(Signed)
Hm Brickley
M. D.
(Address)
Boston
Cama- 251941
22 Yinthron linthron
Place of Burial, Cremation or Removal.
DATE OF BURIAL an.
23
(City or Town)
I941
23 NAME OF
FUNERAL DIRECTOR
.....
Not
lohn FT@ maleo
ADDRESS
Winthrop
Received and filed ...
19
A TRUE COPY ATTEST:
(Registrar)
(If U. S.
War Veteran.
specify WAR)
(If nonresident, giye city or town and state)
years
months
days. In this community JO yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
1
3 SEX
4 COLOR OR RACE; 5 SINGLE
mite
(or) WIFE of
7 IF STILLBORN, enter that fact here.
8
AGE.S.A ...
.. Years
Months.
Days
Usual
9 Occupation:
Accountant
11 Social Security No ...
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Ireland
17
Ralph Cunningham
Informant
(Address)
4 Paine St
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
10 or Business:
Cool & Oil
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 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 Industry
Boston
Relation, if any
McGillicuddy
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 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 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 tomh other than the recelving 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 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 early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permlt. 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., as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
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 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. as amended.
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 body lies and take charge of the same; ... - General Laws, Chap. 38, Scc. 6.
. . He shall in all cases certify to the town clerk or registrar in the place where the deceased dicd his name and residence, if known ; otherwise a description as full as may be, with the cause and man- ner 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 observ- ance 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 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.
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