USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 32
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FLAMANENI ALUMNO Every TUIN OF Information
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to Insert a recital to that effeot. 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 should De careruny Supprieu, HUL Silviu VỤ 2016 -
PLACE OF DEATH
Suffolk
(County)
·inthron
(City or Town) 32 Prospect Ave
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.
Registered No.
90
" ( If death occurred in a hospital or Institution, St. { give its NAME instead of street and number)
2 FULL NAME Eleanor. Viola Tobin Perry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
32 Prospect Ave
St.
( If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
in this community22
yrs.
-
mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
45
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE
43 Years
Months.
-
.Days
if less than 1 day
Hours
Minutes
Usual
9 Occupation :
Industry
10 or Business :
Our Home
11 Social Security No.
12 BIRTHPLACE (City)
St. John
(State or country )
N.B.
13 NAME OF
FATHER
Tilliam Tobin
14 BIRTHPLACE OF
FATHER (City)
St. John
(State or country)
N.B.
15 MAIDEN NAME
OF MOTHER
Agnes Ferrie
16 BIRTHPLACE OF
MOTHER (City)
St. John
(State or country)
N.B.
20 Was disease or injury in any way related to occupation of deceased 2020 If so, specify ... (Signed) Jacob
(Address) 562
Sturlyst
Date 5/31/499.
21 Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL
21
(City, or Town)
1942
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 of other Health Officer Fiche 26/1/2
Received and filed.(
2
1942
19
(Official Designation) ( Date of Issue of Permit)
18 DATE OF
DEATH
may
30
1942.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
May 28
1942
May 30
to
That I attended deceased from
alive on
last saw h
en
May 29
death Is said to
have occurred on the date stated above, at
9 A:
m.
Immediate cause of death
Cerebral Hemorrhage
IMPORTANT
Due to.
Due to.
Other conditiona.
none
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
none
Date of
Of autopsy
What test confirmed diagnos!
clinical
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
PARENTS
17 Philip Perry
Relation, if any
Informant
( Address)
Prospect Ave
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
talmoviemaker
19
inthron
( Registrar)
100m (d)-1-41-4067
1
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
den name of wife in full)
19
42
Duration
.. M. D.
uniron
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 tbe 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 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, Scc. 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 be 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 scetinus 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 Mexi- can bnrder 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, froin 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 front the hoard of health or its agent aforesaid or from the clerk of the town where the hody 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 contaimug 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 selectinen for the purpose, shall upon application make the certificate re- quired nf 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 conunouwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided aud 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 herennder. 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 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 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 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., (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 rules of practice :
(1) Attending physicians will certify to such deatha 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 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 pbysi- 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 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 tbe 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 soine 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 hy the appropriate terins, as bousekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
Ri R-301 A
if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoital to that effect. 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
100m (d) -1-41-4667
I HEREBY CERTIFY that a satisfactery standard certificate of death was filed with me BEFORE the buriay or transit permit was Issued : Childrenkg
Signature of Ageny of Board of Healthy or other) Leatthe Office 6/2/42
(Official Designation) (Date of Issue of /Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
31.
1942
(Month)
(Day)
(Year)
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 here.
8
AGE .22
Years
8
Months
12 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
2nd Lieut., Air Corps
Industry
U. S. Army
10 or Business :
11 Social Security No.
--
12 BIRTHPLACE (City)
(State or country)
Massachusetts
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Lowell Mass.
(State or country)
15 MAIDEN NAME
OF MOTHER
Agnes T. O'Shea
Massachusetts
(State or country )
21
Halyhood
Place of Buriel, Cremation or Removal.
(City or Town)
DATE OF BURIAL
June
3
1912
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
254
Beach St Rever
Received and filed
--
8 1047
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.
91
{ ( If death occurred in a hospital or Institutlon, St. į give its NAME Instead of street and nuniber)
PHYSICIAN - IMPORTANT
(Was deceased a
would
U. S. War Veteran,
if so specify WAR) # 2
(a) Residence. No.
161 Woodland Road,
(Usual place of abode)
st. Brookline
Mass
( If nonresident, give city or town and State)
hospital
- years
- months
8
days.
In this community -
yrs.
-
mos.
8
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEJ
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Male
White
19 1 HEREBY CERTIFY,
May 23.
19
42
to ...
May 31,
19.
42
I last saw h
im
allve on
May .... 31,
19.42
death Is sald to
have occurred on the date stated above, at
10:45
p.s.m.
Immedlate oause of death.
Scarlet Fever
Duration
IMPORTANT
8 da.
Due to.
Due to ..
Other conditions.
Uremia due to Nephritis
(Include pregnancy within 3 months of death)
acute.
Major findings :
Of operations
Physician
Underline the cause to which death
Of autopsy ...
Nephritis,acut
What test confirmed diagnosis? Routine clinical
charged sta-
tistically.
study
20 Was disease or injury in any way endedto occupation of deceased ?.
NO
(Signed)
Robert M. Glendy,
M. C.
M. D.
(Address) Fort Banks Mass.
Dateune
1
1 .. $1912
Brasileira
17 Edmund B. Roche
Relation, if any
Informant.
161 Woodland Rd., Brookline, Masc.
If so, specify
Robert & deux
boda. IMPORTANT
13 NAME OF
FATHER
Edmund B. Roche
Date ofJune 1.1912
16 BIRTHPLACE OF
MOTHER (City)
JUI
No.
Winthrop (City or Town) Station Hospital, .... Fort ... Banks, .... Mass ..
Registered No.
2 FULL NAME
EDMUND D.ROCHE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
That I attended deceased from
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physloian or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during hia 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 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 hia 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, 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 sanie. 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 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 ita agent appointed to issue such permits, or if there is no such board, froin the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and reniove 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 fromn the board of health or its agent aforesaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there shall have been delivered to sueh board, agent or clerk, as the case may be, 8 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 aelectmen 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
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 furnish for registration any other neces- sary information which can be obtained aa to the deceased, or aa 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 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 ia made. . . . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examinera 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 ia within his county the body of such a person, he shall forthwith go to the place where the body lles and take charge of the same; ... - General Lawa, 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 deaths only as those of persona to whom they have given bedside care during a last illnesa from disease unrelated to any form of injury.
(2) Board of Health physiolans will certify to auch deatha 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 traumatiam (including resulting aepticemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from Injury or infection related to ocoupation, 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 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 honie 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
M R-302
1
PLACE OF DEATH
SUFFOLKI (County) BOSTONJ,
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
41222
S (If death occurred in a hospital or institution, St. give ite NAME instead of street and number)
2 FULL NAME
Mary W
Tewksbury
(If deceased is a married, widowed or divorced woman, give also maiden name.)
282 Pleasant
St.
Win.the
(If nonresident, give city or town and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
monthe
daye.
in this community
yre.
moe.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEO
single
5a if married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband'e name in full)
6 Age of husband or wife If alive years
7 IF STILLBORN, enter that fact here.
8 69 Years. Months .. .. Oays
If less than 1 day Hours Minutes
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass
13 NAME OF
FATHER
John S Tewksbury
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Winthrop
15 MAIDEN NAME
OF MOTHER
Mary Green
16 BIRTHPLACE OF
MOTHER (City)
Nantucket Mass.
(State or country)
17
Informant ..
Fred Tewksbury
Relation, if any (cousin
A TRUE COPY.
Cyrancis
ATTEST:
(Registrar of city, or town where death occurred)
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 7 1942
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
5/4/42
19
That I attended deceased from
to ...
5/7/42
19
I last saw h
5/7/42
19
death Is sald to
have occurred on the date stated above, at
.10 P
m.
Duration
Immediate cause of death.
carcinoma of stomach with
metastases
mos
Que to nyelonephritis left
obstruction, left uraten
d.v.s
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Oate of
Physician Underline the cause to which death should be charged sta- tistically.
Of autopsy.
above
What test confirmed dlagnosis?
autong.y.
20 Was disease or Injury In any way related to occupation of deceased ?.
If so, specify
HBenjamin
(Signed)
M. O.
(Address)
Boston
Dato ..
5/8/19 42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Inthron Mass
(Cemetery )
(City or Town)
OATE OF BURIAL
May 11 1942
19
22 NAME OF
FUNERAL DIRECTOR
C R Bennison
ADDRESS
Winthrop
Reoelved and filed
AIN
0 193
19
(Registrar of City or Town where deceased resided)
3 SEX
fem
(or) WIFE of
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