USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 38
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(Signature of Agent of Board of Wealth of other)
Health Officer
6/22/42
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
20
1942.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Sept. 20,,
35
19.
That I attended deceased
from
to
June 19,
19
42.
/ last saw
her
allve onJune 19
19
42
death Is said to
have occurred on the date stated above, at.
6:00 P
Immediate cause of death
Cerebral Hemmerhace
Due to.
Chronic hypertension
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Of autopsy
What test confirmed diagnosis ?
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?... Q.
if so, specify
(Signed
Robert K. Gordon
(Address)
44
Winthrop Date
6/20 1 42.
19.
......
21
Tinthron
vinthrow
Place of Burial, Cremation or Removal.
DATE OF BURIAL
June2
(City or Town) -
42
19
........
22 NAME OF
FUNERAL DIRECTOR.
............ John F. Q'Maley.
ADDRESS
intrrop
Received and filed "': 2 4 149
19
( Registrar)
100m (d) -1-41-4667
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to Insert a reoital to that effeot. extracts from the laws on back of certificate. Terms, 30 that it may be properly classified. Exact Statement of decorATION Is very Important. See instructions and PARENTS
PLACE OF DEATH
1
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
( If nonresident, give city or town and State)
Duration
IMPORTANT
2 wks
..... 8 yrs.
IMPORTANT Physician
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physloian or registered hospital medloal officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an umulertaker 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 ss re- quired by section one, where same was contracted. the duration of his last illness, when last seen alive by the physiciau or officer and the date of his death ... Gen. Laws, Chsp. 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, 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 sud 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 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, 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 tonib to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the body is 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 faets 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 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 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 inake such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-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 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 desth shall thereafter furulsh 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., (Tercentensry 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 permita, 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 hield, or from a person appointed to have the care of the cenietery or burial ground in which the interment ia made. ... Chap. 114. Sec. 46. G. L., (Terccuteuary 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 ia 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 deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such desths 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 traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deathe following abortion, 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. Aa 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 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
R-301 A
1
PLACE OF DEATH
BOSTON NOTIFIED SUL 1942 Suffolk (County)
Winthrop (City or Town) Winthrop Community Hospital
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health cr its Agent.
Registered No.
113
. { (If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
238 Webster Street
St.
East ... Boston
2
(Ii nonresident, give city or town and State)
Length of stay : In hospital or institution.
(Before death)
years
months
days.
In this community
ĮTS.
nios.
daya.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE)
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED 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 here.
Stillborn
8
AGE .
Years
Months.
Days
If less than 1 day Hours. Minutes
Usual
9 Occupation :
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Winthrop
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ? If so, specify
(Signed)
(Address) 238 MHavende 9
6 24/4532
21 St. Michael 25
Boston
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
June
27
42
19
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 6/24/42
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
June 22, 1942
(Month)
(Day)
(Year)
19 )HEREBY CERTIFY,
Lum
22
19.
42. to
That I attended deceased from 22 1942
I last saw halive on
22 19 - death is said to
have occurred on the date stated above, at
1 P
m.
Duration IMPORTANT
Immediate cause of death
Due to
Due to
13 NAME OF
FATHER
James Grana
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston ,
15 MAIDEN NAME
OF MOTHER
Marion Sullivan
16 BIRTHPLACE OF
MOTHER (City)
( State er country)
Boston
17 James Grana
Rfathorn
Informant
(Address)
238 Webster St. East Boston
22 NAME OF
FUNERAL DIRECTOR ..
Malino
ADDRESS
9 Chelsea Street East Boston
Received and filed
19
(Registrar)
100m (d)-1-41-4667
No.
Baby Boy Grana
(Was deceased a
U. S. War Veteran,
if so specify WAR)
· (a) Residence. No.
(Usual place of abode)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
Male
White
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 If deocased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that offoot. PARENTS
& M. D.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medioal officer shall forthwith, after the death of a person whom he has attended during bis 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 bis last illness, when last seen alive by the physiciau or officer and the date of bis death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required hy 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 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 hetween 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 hury or otherwise dispose of a hunian hody in a town, or remove therefrom a human body which has not been buried, until he has received a perinit 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 tuwn, 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 be issued until there shall bave been delivered to such board, agent or clerk, as the case may be, 8 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 licu 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, frou one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as ahove 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 ohtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-aix, that the deceased acrved 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 ueces- 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 .- Cbap. 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 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 fromn a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Cbap. 114. Sec. 46. G. L., (Terccuteuary 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 Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calls for the observance of the following rules 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 illness 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 physl- 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 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 hot 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 tbe disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and auy 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 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
R-302
Juftolle
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
4
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Douglas .... T
Craig
(If deceased is a married, widowed or divorced woman, give also maiden name.)
125 Cı1ff Ave
St.
Winthrop
(If nonresident, give city or town and state)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
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 if alive.
years
7 IF STILLBORN, enter that fact here.
8
AGE
84 Years
Months. Days
If less than I day Hours Minutes failure
Usual 9 Occupation:
bookkeeper
Industry
10 or Business!
retired
Due to
11 Social Security No ........
12 BIRTHPLACE (City)
(State or country)
Scotland
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis ?
26 Was disease or Injury In any way related to popupation of deceased ? Gainsbury
If so, specify
(Signed)
243 Charles St Boston, M. D.
(Address)
Date 6/25/19 42
17 Welfare .... Dept
Relation, if any
Informant
(Address)
Winthrop
A TRUE COPY.
ATTESTI
(Registrar of city or town bere death occurred
......
DATE FILED
6/29/42
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ....... Winthrop Mass
(City or Town)
DATE OF BURIAL
(Cemetery)
June 27 1942
19
22 NAME OF
FUNERAL DIRECTOR
C R Bennison
ADDRESS
Winthrop
Received and Bled 19
JUL 3
1942
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
PLACE OF DEATH
(County)
Mton
(City or Town)
-
No. Mass .... Eye ... & .... Ear ..... I.n.f.i.rmary ..
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.)
PARENTS
13 NAME OF
FATHER
William Craig
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Frances Taylor
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
18 DATE OF
DEATH.
June 24 1942
(Month)
(Year) (Day) That I attended deceased from
19 | HEREBY CERTIFY.
6/13/42
19
to ...
6/24/42
19
I last saw h.1 g ...... alive on .. 6/.24 42 .... , 19 ........ , death is said to have occurred on the date stated above, at .. 11./.44.0m. Duration Immediate cause of death .... acute .... congestive .... cardiac
2 ... dy.s
Due to
carcinoma ... of ..... larynx
4-5mos
Underline the cause to which death should be charged sta- tistically.
Etans
Registered No ....
5477
(I U. S. War Veteran, specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
R-301 A
I
PLACE OF DEATH
suffolk (County)
Winthrop
(City or Town) Winthrop
Community Hospital
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.
115
ffIf death occurred in a hospital or Institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usua! place of abode)
(If nonresident, give city or towu and State)
Length of stay: In hospital or Institution:
( Before death )
( Specify schaller)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACEI
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEDSingle
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Inshand's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here.
8
AGE ..... 7 Years
18
If less than 1 day Hours. Minutes
Usual
9 Occupation :
Scholar
Industry
High School
10 or Business :
11 Social Security No.
026-16-0666
12 BIRTHPLACE (City)
(State or country)
Worcester
Mass.
13 NAME OF
FATHER
Vernon Skillings
14 BIRTHPLACE OF
Oakland
FATHER (City)
(State or country)
Me.
15 MAIDEN NAME
OF MOTHER
Ruth Hoyt
16 BIRTHPLACE OF
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