USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 44
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Statement of Cause of Doath .-- 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 prlor 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 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-303A
PLACE OF DEATH
SulleRk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S
To be filed for burial permit with Board of Health or its Agent.
121
Registered No
....
[ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Jeanette lu
...
Morgan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
289 Pleasant SF. Wirthise
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ..
(Specify(whether)
minutes
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
William H Dorgan
(or) WIFE of.
(Husband's name in full)
6 Age of husband or wife if alive.
Fecemed
years
7 IF STILLBORN, enter that fact here.
8
AGE ... 55 80 -Months ......... Days
If less than 1 day
Hours ...
......
.. Minutes
Usual
9 Occupation :.
at home
Industry
10 or Business :....
11 Social Security No. none
12 BIRTHPLACE (City)
(State or country)
Boston
masa
PARENTS
15 MAIDEN NAME
OF MOTHER
Catherine marshall
16 BIRTHPLACE OF
MOTHER (City) .....
(State or country)
Ireland
17 James Shea (Brother)
Relation, if any
Informant.
(Address)
289 Pleasant at Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death war, filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health of other)
Health Ofrece 7/24/42
(Official Designation) (Date of Issue of Perinity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July- 25-1942
(Month)
(Day)
(Year)
19 | 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.). External Namorrhage
Bullet Wound Left Leg
Traset Tround Leck
.
20 Accident, suicide, or homicide (specify)
Date of occurrence.
July - 25-
19.44.2
Where did
Injury occur?
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place? ?
(Specify type of place)
Manner of Injury.
Nature of Injury .....
While at work?
.Was there an autopsy ?.
yes
21 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
Hat Tricklig
M. D.
(Signed)
Juba - 25-1942
22
Winthrop
Place of Burial, Cremation or Red
(City or Town)
DATE OF BURIAL
July
28
23 NAME OF
FUNERAL DIRECTOR
Richard C Kirly
ADDRESS
Boston
1
Received and filed JUL 2 9 1942
19
(Registrar)
25m-2-'40-D-729-b
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 information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
1
(City or Town)
No.
(If U. S.
War Veteran,
specify WAR)
Home
(a) Residence. No.
(Usual place of abode)
Hospital
years
months
days.
In this community / 7 yrs.
mos.
days.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
. .
13 NAME OF
FATHER
John & Shea
14 BIRTHPLACE OF
FATHER YCity) ......
(State or country)
Ireland
22
(Address)
Winthrop
L
CERTIFICATE OF DEATH Hospital
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. hls 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 physiclan 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 dled; 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 receiv- Ing 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 may 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, 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 be obtained early enough for the purpose, or Is In- sufficient, a physiclan who is a member of the board of health, or em- ployed by it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death Is caused by vlolence, 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 deslring 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-slx hours after such removal, unless a permit In the usual form for the re- moval of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- slx, 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 rectal 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 ls so glven 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).
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 burled or the funeral Is to be held, or from a person appointed to have the care of the cemetery or burlal 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 hodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . .. - General Laws, Chap. 38, Sec. 6.
. .. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner 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 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 disahled by recognized disease unrelated 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 supposahly due to injury. These include not only deaths caused directly or Indirectly hy 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 disahled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying 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 hacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage. homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have heen due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, Indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (hasal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person).
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
R-301 A
1
PLACE OF DEATH
Suffolk. (County) Winthrop (City or Town) No. 130 Docu2 Hannah
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
132°
Registered No.
( (If death occurred in a hospital or institution, '{ give its NAME instead of street and number)
Tugitel. Lugitch
(If deceased is a married, widowed or diyorced woman, give also maiden name.)
(a) Residence.
No.
137
(Usual place of abode)
Length of stay: in hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE!
Female White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED low
5a if married, widowed, or divorced HUSBAND of
(or) WIFE of
of
( Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
70 Years
AGE
Months.
Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Hunsework
Industry
10 or Business :
at Home
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country )
Queria
13 NAME OF
FATHER
ER braham Madde man
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
TE Lother (Commit to learned)
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Informant erael Stamlini
Relation, if any (Address) 74 Grand LX Kircherty
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Niu. S. Childrens 8
(Signature of Agent of Board of Health or other) Health officie 7/30/42
... (Official Designation) (Date of Issue of Permit)
20 Was disease or injury in any way related to oooupation of deceased If so, specify.,
(Signed)
Charles Liberman
M. D.
(Address) 21 Have Wal foot Date uly 50 1942
EI Dorchester Helping Hand
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
July 30
19.42
22 NAME OF
FUNERAL DIRECTORA
ADDRESS
Estabanhel Stanetiky
Received and filed
siva 3
1940
19
( Registrar)
10 yrs
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Of autopsy
What test confirmed diagnosis ?
Duration IMPORTANT
Immediate cause of death. Celbral Hemorrhage
Due to
Centerio-sclerosis
Due to ...
IMPORTANT
Physician Underilne the cause to which death should be charged sta- tistically.
PARENTS
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10. requires physicians to insert a recital to that effect. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
100m (d)-1-41-4667
18 DATE OF
DEATH
July
(Month)
30
1942
(Day)
(Year)
19 HEREBY CERTIFY,
July 23
1942
to ..
That i attended deceased from July 30, 1942
Ilast saw h.n ...... allve on July 30, 1942 death Is said to
have occurred on the date stated above, at. 7:40 p.m.
....
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so spędify WAR) ..:
St.
(If nonresident, give city or town and State)
12 yrs.
St.
.....
2 FULL NAME
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan 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 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 nanie of the deceased. his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, 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 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 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, 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 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 may 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 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 body, not previously interred, from one town to another within 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 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-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has beco engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chsp. 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 lias notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physlolans 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 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) 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 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. 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 Oocupatlon .- 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
-
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH
State File No.
Registrar's No.
State of
1. PLACE OF DEATH:
2. USUAL RESIDENCE OF DECEASED:
(a) County
middlesex
(a) State
mars
(b) County
(b) City or town
Clinton
(c) City or town
Winthrop
(c) Name of hospital or institution:
59 High St.
() Street No. 229 Washington. Que
(If rural, fre location)
(d) Length of stay: In hospital or institution
In this community
1 no. 12 days
(Specify whether
years, months or daye)
Somere Walton
MEDICAL CERTIFICATION 5
3. (b) If veteran,
name war
3. (c) Social Security
No. 022-03-3784
21
year
1942 hour
11
minute
50
n
4. Sex
7
5. Color or
w
race
6.(a)Single, widowed, married,
divorced
that I last saw h.2 Valive on
June 5
and that death occurred on the date and hour stated above.
Duration
7. Birth date of deceased
(Month)
(Day)
(Year)
Mitral Susufficiency
8. AGE:
Years 67
Months
Days 20
hr.
mm.
9. Birthplace Revere
mars. (State or foreign country)
Due to
13/A
A
10. Usual occupation
1I. Industry or business
office
Other conditions.
PHYSICIAN
(Include pregnancy within 3 months of death)
13. Birthplace nova Scolei
14. Maiden name
7 relerick
Major findings: Of operations
15. Birthplace nova Scotia
(City, town, or county)
(State or foreign country)
16. (a) Informant's own signature Verum Walton
(b) Address.
Clinton, Com.l
22. If death was due to external causes, fill in the following:
(a) Accident, suicide, or homicide (specify)
(Burial, cremation, or removal)
(Month) (Day) (Year)
(c) Place; burial or cremation
(b) Date of occurrence
Where did injury occur?
(City or town) (County)
(State)
(d) Did injury occur in or about home, on farm, in industrial place, in public place?
(Specify type of place)
While at work? (e) Means of injury
23. Signature
Stine
(M. D. or other)
Address Clistli
Date signed
6/6/4
8-6917
U. S. GOVERNMENT PRINTING OFFICE 16-13493
Underline the cause to which death should be charged sta- tistically.
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