USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 30
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No undertaker or other person shali hury a human body or the ashes thereof which have heen 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 he hurled 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 madc. . . . 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 hedside 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 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 wili Investigate and certify to all deaths supposahly due to Injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemla), and hy 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 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 varlous pursults can be known. Make some entry In this section for every person aged 10 years or over. If the occupation had heen 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 galnfully 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
OFA R-302
PLACE OF DEATH
WORCESTER (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
TEMPLETON
(City or town making return)
Registered No. 25
No Hospital Cottages for Children
St. 1
Baldwinsville)
Patricia Louisè Nolan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
21 Somerset Avenue
St.
Winthrop,
Mass
Length of stay: In hospital or institution ....
Hospital 1 years 10 months
10days.
(If nonresident, give city or town and state)
In this community 1 yrs. 10 mos. 10
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
15,
1942
(Month)
(Day)
(Year)
19 - JuI HEREBY CERTIBY . 19
Mary attended deceased fr2 2
I last saw h.
er
alive on
May
14
42
19.
death is said
to have occurred on the date stated above, a
2:50AM
.m.
Duration
Immediate cause of death Bronchopneumonia
Organism unknown
Due to
Chronic Encephalitis
Due to
Mental deficiency
Winthrop,
Mass
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Underline the cause to which death
Of autopsy
Bronchopneuminia
What test confirmed diagnosis? Autopsy
should be charged sta- tistically. no
20 Was disease or Injury In any way related to occupation of deceased ? If so, specify.
(Signed).
Edwin St. John Ward
(Address) Templeton Mass.
Date
5-15-42
M. D.
Relation, if any
( Mothe
A TRUE COPY.
ATTEST:
Orent. Stillianne
(Registrar of gity or town where death occurred)
DATE FILED
May
16.
19.42
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Winthrop, Winthrop, Mass (Cemetery) May 18
(City or Town) 19 42
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
John F. 0' Maley
ADDRESS
Winthrop,
Mass.
Received and filed. MAY 1 .8 .1942 19
(Registrar of City or Town where deceased resided)
t
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE' 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
Female
5a lf 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
AGE
17
Years.
6
Months.
Usual
9 Occupation:
8
Days
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Nancy Marshall
16 BIRTHPLACE OF
MOTHER (City)
Scotland
PARENTS
(State or country)
17
Informant.
Mrs.W.L.Nolan
(Address)
Winthrop,
Mass.
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)
Boston,
Mass.
(write the word)
Single
years
If less than 1 day
Hours.
.Minutes
13 NAME OF
FATHER
William Lewis Nolan
Major findings :
Of operations
Date of.
1 day
7 years
THIS IS ASPERMANENT RECORD
×
1
TEMPLETON (City or Town)
give its NAME instead of street and number) -
(If death occurred in a hospital or institution,
(lf U. S. War Veteran, specify WAR)
to
19.
K
M R-301 A
1
PLACE OF DEATH
Suffolk (County)
The Commonforalth 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.
86
No. Station Hospital, Fort Banks. Mass. " ( If death occurred In a hospital or Institution, St. [ give its NAME instead of street and number)
2 FULL NAME
VICTOR (None ) ... DAHLQUIST
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
World
U. S. War Veteran,
If so specify WAR) ..
War #1
(a) Residence. No.
65 Revere St., Winthrop, Mass.
St.
(Usual place of abode)
Length of stay: In hospital or Institution .. Hospital
( Before death)
(Specify whether)
years
months
27
days.
In this community
17 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACEĮ
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
SigheAlvida ... Anderson
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
60
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
8
ÅGE 69.
Years .3 ..
Months
24 Days
If less than 1 day
-
Hours .....
Minutes
Usual
9 Occupation :
Ist Sgt-Retired
Industry
10 or Business :
US Army-Retired
11 Social Security No ..
Sweden
12 BIRTHPLACE (City)
(State or country )
13 NAME OF
FATHER
Unknown
14 BIRTHPLACE OF
FATHER (City)
Sweden
(State or country)
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
17 Informant.Arvid Dahlquist (Address) 05 Revere St, Winthrop, Mass.
Relation, if any .Son
I HEREBY CERTIFY that a satisfactory standard certificate 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 5/19/42
(Official Designation) (Date of Issue of Permits
18 DATE OF
DEATH
May
18th
1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
April 21
1942
to
May 18
,42
1 last saw h.
im ..... allve on
May 18
1942
death Is sald to
have occurred on the date stated above, at
11:05
a
m.
Immediate cause of death
Cerebral hemorrhage
Duration
IMPORTANT
4 weeks
Due to
Cerebral arteriosclerosis
Due to
Hypertension
Other conditions.
None
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
None
Date of
Of autopsy
None
What test confirmed diagnosis ?..
Clinical Obsn.
charged sta- tistically.
NO
20 Was disease or inpary in any way related to occupation of deceased ?..
If so, specify
Albert & Solely-
(Signed) ROBERT
.... GLAND ...
(Address) Fort .... Banks, ... Mass ..
Date.May 18
21
inthron Cemetery
inthrop
Place of Burial, Cremation or Removal,
DATE OF BURIAL
27 21.
(City or Town)
1942
19
22 NAME OF
FUNERAL DIRECTOR
Char es -
Bennison
ADDRESS
inthron
ass
Received and filed
MAY 2 1 1942
19
( Registrar)
100m (d) -1-41-4667
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to insert a reoital to that effect. PARENTS extracts from the laws on back of certificate.
Physician Underline the cause to which death should be
...
Winthrop
(City or Town)
Registered No.
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
That I attended deceased, from
19
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan or registered hospital medloal officer ahall 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 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 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 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 snd fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deented to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- csn 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 ageut 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 rentove 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 shall bave heen delivered to such board, agent or clerk, as the case may be, 8 satisfactory written statement contaimng the facts required by law to be returned aud 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 enougli 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 aelectinen 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 connnonwealth 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-aix, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it aud transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the 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 hody or the ashes thereof which have been brought into the commonwealth until he haa 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 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, be shall forthwith go to the place where the body liea and take charge of the same; ...- General Laws, Cbap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of theae laws calla for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whoin they have given bedside care during a last illneas from disease uurelated to any form of injury.
(2) Board of Health physiclans will certify to such deaths only as those of persons who, though 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 ineInde not only deaths caused directly or in- directly by traumatism (including reaulting 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 .- 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 cauae 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 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 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 honte housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, aa housekeeper-private family. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FORM R-301 |
X
(City or town making return)
Registered No.
87
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME BABY WHITE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ...
271
CRESCENT AVE
(Usual place of abode)
Length of stay : In hospital or institution (Specify whether)
+years
months
22 days,
In this community
yrs.
mos.
days.
221
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Findlis
4 COLOR OR RACE
White
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)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact bere.
8 AGE
Years .Months.
Days
... 2 .... 2 ... Hours .....
Minutes
Usual
9 Occupation:
NONE
Industry
IO or Business:
II Social Security No.
12 BIRTHPLACE (City)
UINTHPIN
(State or country)
SUFFOLP T.
13 NAME OF
FATHER
JOHN A. WHITE
PARENTS
14 BIRTHPLACE OF
FATHER (City)
REVERE
(State or country)
SUFFELN- MASS.
15 MAIDEN NAME
OF MOTHER
GERTRUDE WALSH
16 BIRTHPLACE OF
MOTHER (City)
BOSTON
(State or country)
17
JOHN WHITE
Relation, if any
Informaat. (Address HCRESCENT AU REVERE
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or trangit permit was issued: Www. D. Childress
Signature of Agent of Board of Health or other)
health Officer 5/20142 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
(Month
18
1942
(Day)
( Year)
19 I HEREBY CERTIFY. That I attended deceased from
may
17
1942.
.....
May 18
1942
......
I last saw b ............ alive on
18
19.4 Y death is said
to have occurred on the date stated above, at.
2.35Am
Immediate cause of death ......
Pulmonary atelectasia
May 17. 42
?
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
PHYSICIAN Underline the cause to which death
Of autopsy ...
What test confirmed diagnosis ?.
should be charged sta- tistically.
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify ....
7. Collins
, M. D.
(Signed)
......
Premere Mari
5/18
1942
Date ....
MALDEN
Place of Burial, Cremation or Removal (City or Town)
DATE OF BURIAL ..
MAY 20
1942
22 NAME OF
FUNERAL DIRECTORA
JOSEPH MURRAY
ADDRESS
262
BEACH OTTENERE
Received and filed 19 ......
MAY 2 1 1942
A TRUE COPY ATTEST:
(Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of MANGIN
is very important. See 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
PLACE OF DEATH
REVERE NOTIFIED
SUFFCLIY
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
WINTHROP (City or Town) WINTHROP COMMUNITY HOPP No.
(If U. S. War Veteran. specify WAR)
REVERE 2
(If nonresident, give city or town and state)
........ , to .....
Duration
Due to
Breathing before buth
If lesy than I day
200m-10-'39. No. 8427-d
(Address).
(FATHER) 21 HOLY CROSS
....
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 bla 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 hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defincd as required hy section one, where same was contracted, the duration of his last illness, 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 body which has not been 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 board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving 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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 licu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient rcasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the hoard of health, or employed hy it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy violence, the medical exam- iner shall make such certificatc. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot he 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 a 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 ohtained hereunder. If the death certificate contains a recital, as required hy scetlon 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 hoard 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 perinit 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, Seo. 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 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 observ- ance of the following rules of practice:
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