USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 4
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by section ten of chapter forty-aix, that the deceased aerved In the army, navy or marine corps of the l'uited Statea in any war in which it has breu 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 physiclan certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, ar as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tereentenary Edition).
No undertaker or other person shall bury a human hody or the ashes thereof which have been hronght into the commonwealth nutil 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 he buried or the funeral is to be held, or from a persou 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 dird 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 hody lies and take charge of the same; ... - General Laws, Chap. 38, Sec. G.
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 physiclans will certify to such deaths only as those of persons who, though disabled by recognized disease uurelated 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 cansed 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 abortion, but also deaths from disease resulting from injury or infection related to ocoupation, the sudden deaths of persons not disabled by recognized dlsease, and those of persons found dead.
Statement of Cause of Death .- Callse 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, namne carlier 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 discase causing death, report the usual occupation prior to illuess. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private faittily, cook- hotel, etc. For a person who liad no occupatiou whatever write none.
SPACE FOR ADDITIONAL INFORMATION
ORM R-301 AMI Suffolk (County) Minatural 1
KEVERE NOTIFIED
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Health or its Agent.
Registered No 9
Winthrop Community Hospital No
St. 3
Frank S. McGarry , mac Larry)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
118 Kimball Le Kens.
Tuncelas
-- years
-
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
(write the word)
5 SINGLE
MARRIED
WIDOWÉD
Or DIVORGRD
5a If married, widowed, HUSBAND of ...
cerrah Malah
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
69
.years
S Age of husband or wife if alive 7 IF STILLBORN, enter that fact here.
8
AG 69 .. Years
- Months - Days
Hours Minutes Due to Carmona floruache. 1Tra
Usual
9 Occupation:
Retired
Industry 10 or Business:
Printer
11 Social Security No.
NONE
12 BIRTHPLACE (City)
new Haven
(State or country)
13 NAME OF
FATHER
Jahn ManGany
PARENTS
(State of country)
15 MAIDEN NAME
OF MOTHER
María Furey
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Freband
100m-10-'39. No. 8427-@
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with me BEFORE the burigl cr transit permit was issued: Www. D. Cheil dream (Signature of Agent of Board of Health by other)) health Officer (Official Designation) (Date of Issue of Fermit) 1/7/42
18 DATE OF
DEATH.
Jan
16
(Day)
(Month)
1942 (Year)
19 I HEREBY CERTIFY. That I attended deceased from
non - 25
19.1. to
Jan 16
42
I last saw h In alive on ..... 1942, to have occurred on the date statod above, al.
8.300 ......
Duration
Immediate cause of death ..
Due to
Other conditions
(Include pregnancy witbin 3 months of death)
Major findings : Of operations
Date of .......
Of autopsy
charged sta-
What test confirmed diagnosis ?
tistically.
20 Was discase or Injury lo any way related to occupation of deceased?
If so, specify.
(Signed)
(Address) 20 Cheuy Un
Dat 1/ 7
,
M. D.
21 Haly Such
Place of Burial, Cremation ef Removal.
DATE OF BURIAL
Jan /City of Town)
13:42 .......
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Je meite
19
Received and filed. JAN ..... 1. 0 1942
(Registrar)
Frankst. mac Harris
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. See instructions and extracts from the laws on back of certificate. per the cree heill 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
(City or Toya)
STANDARD CERTIFICATE OF DEATH
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(I! U. S. War Veteran, specify WAR)
2 FULL NAME
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution ..
(If nonresident, give city or town and state)
death is said
PHYSICIAN
Underline the cause to which death should be
mardin2
17 laformand (Address) 118 Kimball Que Rene
Relation, if any
14 BIRTHPLACE OF
FATHER (City)
Freland
If less than 1 day
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 wbom 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 regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, tbe disease of which he died, defined as required by section one, wbere same was contracted, the duration of his last illness, when last secn 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 buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from onc cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemctery, 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 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 thercof 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 physician who is a member of the board of health, or employed by 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 by 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 witbin 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 sucb 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 tbe 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 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, 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 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 huried 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 :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside 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 by recognized diseasc un- related to any form of injury, have died without recent medical attendance or whose physician is absent 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 by traumatism (including resulting septice- mia), and by tbe 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 occupa- tion, 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, aspbyxia, asthenia, etc. As principal causc name the disease causing death. As related causes, name earlier morbid con- ditions, 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 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 busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman wbose 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
RM R-301 A
Suffolk
(gounty) Winthrop
(City or Town) 255 Placesand 88
The Commonforalth ot Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Winthat
To be filed for burlai permit with Board of Health or its Agent.
10
Registered No.
(( If death occurred in a hospital or institution,
St. [ give its NAMIE instead of street and number)
PHYSICIAN - IMPORTANT
Catharina H Mc Govern (O'Sullivan)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
255 Placeand & Winthook
St.
(Usual place of abode)
Sons
Length of stay: In hospital or Institution
( Before death )
(Specify whether)
years
months
days.
In this community
10 yrs. -
mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
( write the word)
Widow
Sa If married, widowed, or divorced HUSBAND of
(Give maiden name of wifedin full)
(or) WIFE of
Barnara ). The governo
( Flushand's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN. enter that fact here.
8 AGE 80 Years Months - Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Houswork
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
E Bastian.
mass
PARENTS
14 BIRTHPLACE OF
FATHER
roland
(State or country)
15 MAIDEN NAME
OF MOTHER
Jane titresald
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 John Mc Govern.
Relation, if any
Informant. 169 Pond & So Weymouth
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlal of transit permit was Issued : m. D. Children
Signature of Agent of Board of Health for other)
He alta Officer 1/19/42
(Official Designation) (Date of Issue/of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
January
16
1942
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
Dec.15
1941
to
Van. 16.
1942
I last saw h Or alive on
Van 15
19 4/ 2 death Is said to
have occurred on the date stated above, at.
1.1
m.
Immediate cause of death
Myo carditis
Que to ... Arteriosclerosis
Due to.
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?
Clinical Signs
Physician l'nderline The cause to which death should be charged sta- 11stically.
20 Was disease or injury in any way related to occupation of deceased ? ? If so, specify
( Sigred)
Daniel 1.10/2
... , M. D.
(Aadress)
21 St Joseph Cem.
l'lace of Burial, Crematiga or Removal.
(City or Town)
DATE OF BURIAL
Jan 19
1942
22 NAME OF
FUNERAL DIRECTOR.
Edwin & Lane
ADDRESS
201 Bowdown off Dos
Received and filed. JAN TT TOAZ. 19
( Registrar)
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physloians to Insert a reoltal to that effect. extracts from the laws on back of certificate.
100m (d)-1-41-4667
PLACE OF DEATH
1
No.
2 FULL NAME
(Was deceased a U. S. War Veteran, if so specify WAR)
Horas
(If nonresident, give city or town and State)
Duration IMPORTANT
3 yours
13 NAME OF
FATHER
John O'Sullivan
Date of
Date Jean 171947
Bostan
MARRIED
WIDOWED
or DIVORCED
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 suy niemher of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest of his knowledge and belief the name of the deceased, bis supposed agc, the discase 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 ariny, navy or marine corps of the I'nited 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, he deeined 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 perinits, or if there is no such board, froin the clerk of the town where the person dicd; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case inay be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the hoard of health, or employed by it or by the selectnien 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, front one towir to another withiu the commonwealth cannot be obtained carly 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 reinoval, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the l'nited 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 perinit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can he 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 ashea 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 hoard, from the clerk of the town where the body is to he buried or the funeral is to be held, or front a persou 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, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Scc. 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 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 alwent from home when the certificate of death is needed.
(3) Medioal 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 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 Deatn .-- Callse of death means the disease. or complication which causes death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- l'recise statement of occupation 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 ou account of the discase 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 occupatiou whatever write none.
SPACE FOR ADDITIONAL INFORMATION
.
FORM R-302
2 FULL NAME
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