USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 14
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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 perinit. The board of health, or its agent, upon receipt of such statentent and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whoin the permit ia so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained aa 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- ccived 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 froin 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 Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whom they have given bedside care during a last illneas 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 disahled 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 traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, 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 ia very im- portant. so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed 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 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 fainily, cook -- hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
A R-302
1
PLACE OF DEATH
SUFFOLKI BOSCOUN
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
38
(City or town making return)
Registered No
1657
§ (If death occurred in a hospital or institution, No .... Peter Bent Brigham Hospital Gt. { give its NAME instead of street and number) Boylan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
................
St.
Winthrop
(If nonresident, give city or town and state)
years
months
days.
In this community
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Feb 20 1942
(Month)
19 I HEREBY CERTIFY.
2/10/42
19
... , to ...
2/20/42
19
I last saw h .......... alive on ..
2/20/42
.. , 19.
death is said
to have occurred on the date stated above, at 12/56Am
Immediate cause of death
myocardial infarction
Duration
Due to
hypertensive cardio
vascular disease
9 yrs
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
2/20/42
What test confirmed diagnosis ?........ autopsy
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify
H Benjamin
(Signed)
(Address)
Boston
Date .. 2.20/19.1.2
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
WInthoop
Winthrop
DATE OF BURIAL (Cemeter)23 1942City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS
Winthrop
Received and filed.
MAR 9
1942
19
(Registrar of City or Town where deceased resided)
MANEN
2 FULL NAME
Mary M
(a) Residence. No ..
156 Pauline
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE 5 SINGLE
(write the word)
white
single
MARRIED
WIDOWED
or DIVORCED
female
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
Months.
AGE
Days
65 Years
If less than 1 day
Hours
Usual
9 Occupation:
at-home
Industry
10 or Business:
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass
13 NAME OF
FATHER
Stephen J Boylan
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Catherine Mccauley
18 BIRTHPLACE OF
PARENTS
MOTHER (City)
PET
(State or country)
17
Relation, if any
bro
Informant
Daniel .... Boylan
(Address)
50m-10-'39. No. 8427-f
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
(State or country)
Prince Edward Is
Years
Minutes
A TRUE COPY.
ATTEST:
(Registrar of tity or town where death occurred)
DATE FILED
2/25/42
(19.
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
(If U. S.
War Veteran,
specify WAR)
(Day)
That I attended deceased from
(Year)
dys
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, 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 aa required by the preceding section or by section forty-five of chapter one hundred and four- teen, sha!l, if the deceased, to the best of his knowledge and belief, aerved 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 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 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-eight and July fourth, nineteen hundred and two, and the lexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, fromn 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 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- 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 human hody, not previously interred. from one town to another within the conunonwealth 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 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 atatement and certificate. shail forthwith countersign it and transmit it to the clerk of the town for registration. The person to whoin the permit ia so given and the physician certifying the cause of death shail thereafter furnish for registration any other ueces- sary information which can be obtained aa 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 appoluted to issue such permits, or if there is no such board, froin 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 ia 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.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whom they have given bedside care during a last illncaa from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only aa those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or wilose 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 inelnde not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deatha 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 .- 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 .- l'recise 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 illuess. 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 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
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50m-10-'39. No. 8427-f
1
PLACE OF DEATH
SUFFOLK! BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
38
(City or town making return)
Registered No .. 1657
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
156 Pauline
......................
.St.
Winthrop
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX female
4 COLOR OR RACE 5 SINGLE
white
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
5a If married. widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife ff alive
Years
7 IF STILLBORN, enter that fact here.
AGE
65 Years
Months.
Days
If less than 1 day
Hours
.Minutes
Usual
9 Occupation:
at home
Industry 10 or Business:
Il Social Security No.
12 BIRTHPLACE (City)
(State or country)
Winthrop Mas's
13 NAME OF
FATHER
Stephen J Boylan
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Prince Edward Is
15 MAIDEN NAME
OF MOTHER
Catherine Mccauley
18 BIRTHPLACE OF
MOTHER (City)
(State or country)
P"E" T
17
Relation, if any
Informant.
Daniel .... Boylan
(
bro
A TRUE COPY.
ATTEST:
(Registrar of tity or town where death occurred)
C
DATE FILED
2/25/42
:19.
18 DATE OF
DEATH.
Feb 20 1942
(Month)
(Year)
19 I HEREBY CERTIFY.
2/10/42
19.
..... ,
(Day)
That I attended deceased from
to ......
2/20/42
, 19.
I last saw h .......... alive on.
2/20/42, 19.
death is said
to have occurred on the date stated above, at 11/56Am
Immediate cause of death
myocardial infarction
Duration
Due to
hypertensive cardio
vascular disease
9 yrs
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of ......
Of autopsy
2/20/42
What test confirmed diagnosis ?.
autopsy
20 Was disease or injury In any way related to occupation of deceased ?
If so. specify
H Benjamin
(Signed)
M. D.
(Address)
Boston
Date 2/20/19 42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
WInthoop
Winthrop
DATE OF BURIAL (Cemeteg323 1942City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS
Winthrop
Received and filed. 19
9
1942
(Registrar of City or Town where deceased resided)
Underline the cause to which death should be charged sta- tistically.
PARENT3
(Address)
No. Peter Bent Brigham Hospital St. 1
Mary M
Boylan
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
(If nonresident, give city or town and state)
dys
-
FORM R-301 A
PLACE OF DEATH No.
Suffolk (County) Winthrop (City or Town) 62 Uhland Road
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or Its Agent.
39
Registered No.
S ( If death occurred In a hospital or Institution, Stif give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, If so specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution ..
( Before death )
( Specify whether)
years
months
days.
In this community
3 yrs. - mos.
-days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Чертеж
24 1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, That I attended deceased from
March 16
19
to.
4%.
February 24 1942
I last saw her
.alive on
February 24, 1942, death Is said to
have ocourred on the date stated above, at.
2.30Pm.
Duration IMPORTANT
Immedlate cause of death.
Broncho - Primaria
Due to.
Due to.
Other conditions ....
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
Date of.
Of autopsy
What test oonfirmed
20 Was disease or injury in any way related to ogoupation of deoeased ?. If so, specify .. -
(Signed)
(Address) Wunderye Wood Date:
... . M. D.
1925
12
a Evergreen Cemetery Leominster Mes
Place of Burial, Cremation or Removal.
February
DATE OF BURIAL
26, 1942
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
jinthrop Mass
(Signature of Agent of Board of Health or other)
agent Feb, 25/42
Received and filed.
19
( Registrar)
100m (d)-1-41-4667
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17 Walter E. HollingswoRelation, df Ony (Address) Winchester N. H.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlal or transit permit was Issued: William D, Childress
(Official Designation) (Date of Issue of/Permit)
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
Give maiden name of life in fulbirth
(Husband's name in full)
6 Age of husband or wife If alive
years
7 IF STILLBORN. enter that fact here.
AGE
67
Years
Months ............
.Days
-
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
t home
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
FATHER
Unable to obtain
Physician Underline the cause to which death should be charged sta- listically.
1 3 SEX Female (or) WIFE of PARENTS Informant ... If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effect. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain extracts from the laws on back of certificate. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information Industry 10 or Business :
2 FULL NAME.
Agnes Mary (Tarling) Hollings orun Games Hollingsworth
(If deceased is a married, widowed or divorced woman, give also maiden name.) 62 Upland Road
........ St.
(If nonresident, give city or town and State)
........
.. 10.40
Coup suck
4 COLOR OR RACE|
White
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 per-on 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 behef the name of the deceased, his supposed age, the disease of which he died. defined as re- quired 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.
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 and the secondary or immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of 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, 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 hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there ahall have been delivered to such board, agent or clerk, as the case inay be, & satisfactory written statement containing the facts required by law to he returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law. 01 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 hoard of health, or employed by it or hy the selectinen 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 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
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