USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 43
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(City or Town) 42
19.
22 NAME OF
ADDRESS 57 Manuel, Medford, Dass
Received and filed
L 21 972
.. 19
(Registrar)
Duration IMPORTANT
1year. 0 2 Jeux
IMPORTANT
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
100m-2-'40-D-729-8
1 Usual Cker. but. Linehan PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry
-
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
No ..
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 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 hody in a town, or remove therefrom a human hody 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 tomh other than the receiv- ing tomb 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 huried. No such permit shall he issued until there shall have been delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to he returned and recorded. which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in 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 in- sufficient, a physician who is a member of the hoard of health, or em- ployed hy it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence the medical examiner shall make such certificate. If such a permit for the reinoval of a human hody, 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 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 he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual forin for the re- moval of such body has heen sooner ohtained 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 hoard of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can he ohtained 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 hrought 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 he 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 ohservance 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 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 supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia). and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from dlsease resulting from injury or infectlon related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husiness, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-3011
AUG 1 0 1942 Suffolk (County)
Winthrop
(City or Town)
No Winthrop Community ... Hospital .......
. St. ¿ give its NAME instead of street and number)
2 FULL NAME
John ... Alexander.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
99 ... Falcon.
.St.
...
.East ... Boston
(If nonresident, give city or town and state)
(Usual place of ahode)
Hospital
ears
-
months
18
lay's.
In this community
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowerz
5a If married, widower1ud//988ethElliot
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 74 Years 10 Months 14Days
If less than 1 day
Hours ...........
Minutes
9 Occupation:
Starter
10 or Business:
Boston Elevated R.R. Co.
11 Social Security No.
12 BIRTHPLACE (City)
Belfast
(State or country)
Ireland
13 NAME OF
FATHER
John Alexander
14 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Margaret McGowan
16 BIRTHPLACE OF
MOTHER (City)
Unknown
(State or country)
Ireland
Informar
Mrs.Ina ... McBournie
daughter
(Address)
99 Falcon St. E. Boston, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
nmschilder
(Signature of Arvi or Board of Health or other) July 25/42
(Official Designation) (Date of Issue of Vermit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
July.
23.
Month)
(Day)
(Year) attended deceased from
19 July
HEREBY CERTIFY, That 1922 to ...
23
19. .... 2 1 Gast saw b ... Imalive on Call /23
to have occurred on the date stated above, at ...
....... m.
Duration
Immediate cause of death. Broncho - Preciorica
Due to
Due to
Cardiac Orcompensation
3 days
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Chillystaloany
orfeustintol, Date of 7/15/02
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 ?
If so, specify
Tronga. H. Schwartz
M. D.
(Address)
Date.
Everett
21 Woodlawn
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL ...... J.u.17 .... 26.
22 NAME OF
FUNERAL DIRECTOR
DE Parku
ADDRESS 300 .... MeridianSt. .. E.Boston
19
A TRUE COPY ATTEST:
(Registrar)
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 200m-10-'39. No. 8427-d
1 PLACE OF DEATH per hospital 3 SEX Male 8 Usual 17 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 Industry
DOSTON HOTIVTE !!
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No
129
§ (If death occurred in a hospital or institution,
- (If U. S. War Veteran. specify WAR)
Length of stay: In hospital or institution
(Specify whether)
(write the word) DEATH
1942
19.42
death is said
2 vais
PHYSICIAN
(Signed)
19 Procenta S/ E/3
7/23
19 /2
Received and filed . 01. 2 7 1942
Relation, if any
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or rogistered 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 regis- tration a standard certificate of death, stating to the best of his knowledge and helief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... Gen. Laws, Chap. 16, Sec. 9.
No undertaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been 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 sueh 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 one cemetery to another, or from one grave or tomh 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 de- livered to sueli board, agent or elerk, as the case may bc, a satisfae- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate eannot he obtained early enough for the purpose, or is insufficient, a physician who is a member of the hoard of health, or employed by it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused 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 within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a reeital, as required hy seetlon 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 healtlı, or its agent, upon receipt of such statement and certifieate, shall forthwith countersign it and transmit it to the elerk 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 hury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to Issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral Is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Seo. 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 eare during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will eertify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medieal attendance or whose physician is absent from home when the certificate of death is needed.
(3) Modical Examinors will investigate and certify to all deaths supposably due to injury. These inelude not only deaths caused directly or indirectly hy traumatism (including resulting septice- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disoase resulting from injury or infection related to occupa- tion, the sudden deaths of porsons not disablod by recognized diseaso, 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 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 husi- ness, 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 oceupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
.
SPACE FOR ADDITIONAL INFORMATION
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. 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
200m-10-'39. No. 8427-d
Im leheldien (Signature of Agent) of Board of Health or other) July 28/42 (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
24
1942
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from July 23 1942 to ........ tools 24 19 ..
42
......
.... , death is said
last saw be ...... ............ alive on ..... Jules 024 1942 to have occurred on the date stated above, at 6:52 Pm Immediate gause of death ........... atelectasia leonatouch
Duration
16/2
Due to
Primative Butt
...
Jul 23
Placenta Piros
Due to Premature Separation Placede
.. $23
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of ..
Of autopsy
What test confirmed diagnosis ?
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was diseaso or lujury in any way related to occupaties of deceased ?
If so, specify
(Signed)
Y
M. D.
(Address) ...
Da 524
1942
Place of Burial, Cremation or Removal. DATE OF BURIAL we can or 3.194219
22 NAME OF
FUNERAL DIRECTOR . UM Plano dell your
ADDRESS
Received and filed
19
(Official Designation)
4 COLOR OR RACE
(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
Years .Months. Days
Li less than 1 day .Hours .. Minutes
Usual 9 Occupation:
Industry 10 or Business:
11 Social Security No.
Winthrop
12 BIRTHPLACE (City)
(State or/country)
13 NAME OF James Leroy Leurs
PARENTS
14 BIRTHPLACE OF FATHER (City)
(State or country)
15 MAIDEN NAME Dorothy Poulman
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Informant (Address) sociange.ce
Relation, if any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
....
Winthrop (City or town making return)
1618
Registered No (If death occurred in a hospital or institution, give its NAME instead of street and number)
Houby lames Leroy Lewis h.
(If decsesed is a married, widowed or divorced woman, give also maiden name
(a) Residence. No ....
(Usual place of ab.x' Length of stay: In hospital or institution Capital (Specify ymether)
years
- months
/
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX quale white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
50 Range ave, Lynn Man.
...
(If U. S. War Veteran. specify WAR).
2 FULL NAME
RM R-301 | AUG Suffolk.
· PLACE OF DEATH
(City or Tony)}
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
St. l
(If nonresident, give city or town and state)
JUL 2 7 1942
A TRUE COPY ATTEST:
(Registrar)
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 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 regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the discase of which he died, defined as required 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.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove thcrefrom 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 shall exhumc 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 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 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 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 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 a removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner ohtalned 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 United States in any war in which it has been engaged, such recital shall appcar upon the permit. The board of health, or its agent, upon receipt of sueh 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 buried or the funeral Is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice:
(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 diseasc 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 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 hy traumatism (including resulting septice- mia), 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 occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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