USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 34
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Relation, if any
William J. Cunningham
Son
(Address) 26 Yeamar St . Revere Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was ffled with me BEFORE the burjal or transit permit was issued: Wir D. Childrens x
(Signature of Agent of Board of Health/or other)
Thealle Officer 6/2/42
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
June2
1942
(Month)
(Day)
(Year)
19) I HEREBY CERTIE January 6, 193%, to. Yine 2
19 42
I last saw her alive on.
June1, 1943 death is said to
have occurred on the date stated above, at ..
2:30 am.
Immediate, cause,of death ........
aceite Coronary Thrombosis
Duration IMPORTANT 2 weeks ...........
5 years ...
5 year
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings:
Of operations
none
Date of
Of autopsy.
none
What test confirmed diagnosis? Clinicalx
laboratory
20 Was disease or injury in any way related to occupation of deceased?LO
If so, specify!
(Signe
Jacob
M. D.
(Address) 562 Hurley IT. Chu Patero
6/2/29.200
21.
Holy Cross
Malden Naee
Place of Burial, Cremation or Removal.
June
1942
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR Richard 96 White
ADDRESS
147.Winthrop-stwinthrop
Received and filed JUN 8
19
(Registrar)
100m-2-'40-D-729-a
1 3 SEX Jemele (or) WIFE of 8 73 Usual 9 Occupation : PARENTS 17 Informant. ...... W/DITE DI AINI V WITH FINEADING BLACK INETHIS ICASDLUMANENGELCORD information should be carefully supplied. Aur should be stated LAACILI. THISICIANS should state Industry 10 or Business :... 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
2 FULL NAME
Catherine Mc Coart Cunningham
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
-
(Specify whether)
years
months
days.
In this community
30
MEDICAL CERTIFICATE OF DEATH
That I attended deceased from
Due to
arteriosclerosis
Due to.
chronic Interstitial
nephritis
Underline the cause to which death should be charged sta- tistically.
(City or Town)
PLACE OF DEATH
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 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 dled. defined as required hy section one, wherc same was contracted, the duration of hls last illness, when last scen 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 heen huried, 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 hody 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 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, or in lieu thereof a certificate as herelnafter provided. If there Is no attending physician, or if, for sufficlent reasons, his certificate cannot be obtained early enough for the purpose, or 18 In- sufficient, a physician who Is a member of the board of health, or em- ployed hy it or by 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 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 sooncr obtained hereunder. If the death certificate contains a recital, as required by sectlon 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).
SPACE FOR ADDITIONAL INFORMATION
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 hoard, from the clerk of the town where the body is to he buricd 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 physiclans will certify to such deaths only as those of persons to whom they have given bcdside carc 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 will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting scptlcemla), and by the action of chemical (drugs or poisons), thermal. or clectrical 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, nat the mode of dying, e. g .. heart failure, asphyxia, asthenla, etc. As principal cause name the disease causing death. As related causes, name earlier morhld 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 he known. Make some entry In this section for every person aged 10 years or ovcr. 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 hausewark. For a person engaged In domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, caak-hotel, etc. For a person who had no occupation whatever write none.
·
FA R-302
PLACE OF DEATH
SUF kdounity ) 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.
492899
5 (If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
Catherine A McCollom
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No.
(Usual place of abode)
441 Winthrop
St.
Winthron
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before desth)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
female
white
MARRIED
WIDOWED
or DIVORCED
single
5a If married, widowed, or divoroed
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 faot here.
8
AGE.
85
Years
Months.
Days
If less than 1 day
Hours ............ Minutes
Usual
9 Oocupation :
at home
Industry
10 or Business :
11 Social Security No ...
Boston Mass
13 NAME OF
FATHER
John McCollom
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland"
15 MAIDEN NAME
OF MOTHER
Ellen Carlan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Informant
(Address)
James McCollom
(
Relation, if any
nephew
A TRUE COPY.
ATTEST:
(Registrar of city or town where desth occurred)
DATE FILED 6/8/42
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June 4 1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
5/26/42
.. ,
19.
to 5/ 26/42
19
I last saw h
er alive on.
5/26/42, 19
death Is sald to
have ooourred on the date stated above, at.
5 P
m.
Duration
Immediate oause of death carcinoma of breast
vra
........
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis ?.
clin
20 Was disease or Injury In any way related to oooupation of dooeased?
If so, spoolfy.
(Signed)
M. D.
(Address)
Boaton.
Date ..
6/4/19
......
42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Glenwood
Everett
DATE OF BURIAL
June 6 1942
19
22 NAME OF
FUNERAL DIRECTOR
W D Casey
ADDRESS
Chelsea
Reoelved and filed. .19
JUL 3 1942
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
--------
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
1
No.
Gustavson .... Conv ..... Home
......
2 FULL NAME
(If U. S.
War Veteran,
spoolfy WAR)
That I attended deceased from
Physician
12 BIRTHPLACE (City)
(State or country)
Underline the cause to which death should be charged sta- tistically.
(Cemetery)
(City or Town)
a
f
t
1: 0 1 h
I
I
C
€
f
F4 R-302
1
PLACE OF DEATH
SUFFOLK! BOSTON
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.
50
100
S (If death occurred in a hospital or institution, 3 give its NAME instead of street and number)
2 FULL NAME
Frank Adlam
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
90 Shore Drive
St.
Winthron
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
single
MARRIED
WIDOWED
or DIVORCED
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.
AGE.
8
65 Yes
9
Months
18
.. Days
If less than 1 day .Hours ......... .Minutes
Usual
9 Occupation :
ignitor
Industry
10 or Business :
Apartment House
11 Social Security No ...
020-12-2124
12 BIRTHPLACE (City)
(State or country )
England
13 NAME OF
FATHER
George Adlam
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Mary A Sharp
16 BIRTHPLACE OF
MOTHER (City)
England.
(State or country)
17
Informant
Dorothy R Peckler(
Relation, if any
(Address)
A TRUE COPY.
ATTEST :
(Registrar of city of town where death occurred)
DATE FILED
6/11/42
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June 7 1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
6/4/42
19
That I attended deceased from
to
6/7/42
19.
I last saw h.
im ..... alive on
6/7/42
19
death Is sald to
have occurred on the date stated above, at
2/43P
m.
Duration
Immediate oause of death.
generalized enteringclerici
2 vro
intracerebral hemorrhage
Due to.
bilateral
.... 4 dya
Due to
hunontpochy
Other conditions
cardiac hypertensiveł
(Include pregnancy within 3 months of death)
tyne
Physician
Major findings:
Of operations
Date of
Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis?
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify
(Signed)
G F Houser
M. D.
(Address)
Boston.
Date 5/4/ 192
21 PLACE OF BURIAL,
Winthrop Lass
CREMATION OR REMOVAL
DATE OF BURIAL
(Cemetery)
(City or Town)
.19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
J S Waterman & Sono
Boston
Received and filed
"JUt. ... 3 .......... 1942
.19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
r
No.
(City or Town)
Mass General Hospital
St.
(If U. S.
War Veteran,
speolfy WAR)
....
R-303 B
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
1
(or) WIFE of
Usual
9 Occupation:
13 NAME OF
FATHER
Informant
(Address)
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
10 or Business:
.......
4 COLOR OR RACE| 5 SINGLE
(write the word)
MARRIED
WIDOWED
Or DIVORCED married
5a If married, widowed, or divorced HUSBAND of
full)
(Husband's name in full)
6 Age of husband or wife if alive.
62
years
7 IF STILLBORN, enter that fact here.
8
AGE 60
Years
.Months ..
Days
If less than 1 day
.Houra.
.Minutes
II Social Security No.
12 BIRTHPLACE (City)
(State or country)
Cupland.
Dolno Thomas.
14 BIRTHPLACE OF FATHER (City) ... England.
(State or country)
15 MAIDEN NAME
OF MOTHER
martha Malheur
16 BIRTHPLACE OF MOTHER (City) (State or country)
England
17 George e Clac
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial-er transit permit was issued:
(Signature Of Agent of Board of Health or other)" Healite Office
6/8 8
(Official Designation) (Date of Issue of Permit ??
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
June - 7-1942
(Month)
(Day)
(Year)
19 I 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.) Cacute Cardiac Failure Pulabez Cormary Sclerosis
collapsed ated quickly after
ascending 5 tours
Was there an autopsy?
no
(See reverse side for description for unknown person)
20 Where did
injury occur ?.
war With
(City or town and State)
21 Was disease or injury la any way related to occupation of deceased? 1
If so, specify.
M. D.
(Signed).
Boston
(Address)
22 Wintuito
Place of Burial, Cremation pr Removal. (City of Town)
DATE OF BURIAL .....
1942
23 NAME OF
FUNERAL DIRECTOR
JohnJ@ Madey
ADDRESS
Received and filed ...
JUN 8
1942
19
(Registrar)
101
Registered No. § (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
PLACE OF DEATH
Sulluck (County)
(City or Town)
No 229 Washington av
Kate Bensonclark
(If deceased is a married, widowed or divorced woman) give also maiden name.) (a) Residence. No. 224 Washington Live Writersi
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
...
years
months
days.
(If U. S. War Veteran, specify WAR)
(If nonresident, giys city or town and state)
In this community & yrs. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female Mute
5m-10-'39. No. 8427-j
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
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 regls- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccased. 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 bury 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 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 shail 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 tomh 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 hody is buried. No such permit shall he issucd 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 he 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 he 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 by 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 certificate. 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 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 hody has been sooner obtained hereunder. If the death certificate contains a recital, as required hy section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has heen 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. 15, G. L., as amended.
DESCRIPTION (for unknown person)
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 elerk of the town where the body Is to be hurled or the funeral is to be held, or from a person appointed to have the cure 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 hody 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.
... He shall in all cases eertify to the town clerk or registrar In the place where the deceased died 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 hedside 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 hy recognized disease un- related to any form of injury, have died without recent inedical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examinere will Investigate and certify to all deaths anpposabiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from Injury or infection related to oreupa. tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners In eertifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences ; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused hy a steam railway ac- eident." "Pistol shot wound of the chest with associated hemor- rhage, homicidal." "Asphyxiation hy suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal Injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If Inves- tigation shows the death to have heen due to discase, specify: (1) Under cause, its known or presumahle nature; and (2) under man- ner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the hrain (basal ganglia) (found dead in bed) ." "Heart disease, presumably coronary sclerosis. (Sudden death ) ."
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
VR-301 S
Suffolk (County)
Winthrop
(City or Town)
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.
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