USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 49
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12 BIRTHPLACE (City)
(State or country)
Boston
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 oooupation of deceased ? If so, specify
(Signed)
(Address) + Washington for Data 8-16
M. D
204/2
21Holy Cross Maider! Place of Burial, Cremation or Removal. 1 (Citv or Town)
DATE OF BURIAL
And IS I 42
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
n Fro )
....
(Signature of Agent of Board of Health or other)
/ health Spiele 8/18/45
Received and filed ..
19
18 ( Registrar)
1/ Modus V. OVào O sert a recital to that effect.
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires/physiata
PARENTS
14 BIRTHPLACE OF
Charlestown
FATHER (City)
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Nora Welsh
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
17 Joseph F Halay 5 Husband ..
Relation, if any
Informant
( Address) Tindenhi77
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial/or transit dermit was issued : in.D. Childrensig.
/ (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august 16
1 last saw h .........
alive on.
Cung 16 99% Rdeath Is said to
have occurred on the date stated above, at
2.30 Pm
Duration
Immediate cause of death
IMPORTANT
2 dny
Due to ...
recurrent cousins
Due to. section
IMPORTANT
Physician
13 NAME OF
FATHER John H. Quinlan
100m (d)-1-41-4667
PLACE OF DEATH
1
Registered No.
146
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
(a) Residence. No.
(Usual place of abode)
2
Female
Thito
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medloal offioer shall forthwith, after the death of a person whom he has sttended 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 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, 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, sha!l, 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 sectinns 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-cight 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 front the board 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 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 altending 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 aection ten of chapter forty-aix, that the deceased served in the army, uavy 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 ia 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, or aa 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 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 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., (Terccuteuary Edition).
Medical examiners shall make examination upon the view of the dead bodiea 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 laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whom they have given bedside care during & last illneas from disease unrelated to any form of injury.
(2) Board of Health physiolans will certify to such deaths only aa 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 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 diaeasc, 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 .- Precise 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, aa housekeeper-private family, cook-hotel, etc. For a person who had uo occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
-
1
PLACE OF DEATH
Suffolk (County)
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.
. " (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Pary M. Mcauley (Partimer)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
11 Prospect Ave
........
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution
( Before death)
(Specify whether)
years
months
days.
In this community
2 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWEO
or DIVORCED
HiCON
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Al FUNIE(Husband's name in full)
have occurred on the date stated above, at. m.
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8 AGE 71 Years 5 Months. Days
If less than 1 day .Hours Minutes
Usual 9 Occupation : house wife
Industry 10 or Business :
11 Social Security No.
one
12 BIRTHPLACE (City)
(State or country )
Ireland
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Catherine Cauden
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Helen E. McAuley
Relation, if any
Informant
prospect ave Winthro:
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
huldelik
(Signature of Agent of Board of Health or other)
Office
............ 8/17/42
(Date of/ Issue of Permit)
18 DATE OF
DEATH
(Month )
(Day)
(Year)
HEREBY CERTIFY,
June 1941
to
That + attended deceased from
aug 16.
1942
I Jast saw h
.alive on
........ death Is sald to
Duration IMPORTANT
Immediate oause of death. Acute Cardiac Conducente 2 hs
ARRAYthmia
Que to
Due to ..
ب
Den. Artimi Schvalenfant
Quesi
5.
Other conditions. (Include pregnancy within 3 months of death)
Major findings :
Of operations
Oate of.
Of autopsy
What test confirmed diagnosis ?.
Physician Underline the cause to which death should be charged sta- tistically.
20 Was discase or injury in any way related to occupation of deceased ?..........
If so, specify.
(Signed) Edward & Regard
(Address)
272 Jsoudown 1
Date/16
M. D. 1942
21 Oak Grove Telford
(City or Town)
Place of Burial, Cremation or Removal.
OATE OF BURIAL
.Aug ........ 1.9
22 NAME OF FUNERAL DIRECTOR on Scorge 2
1912. Doliet
ADDRESS 163 Cischington St. hoverville
Received and filed
19
( Registrar)
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.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoltal to that effect.
100m (d)-1-41-4667
Thealite
7 (Official Designation)
Winthrop
(City or Town)
-
No. 11Trosvect .... Ave
Registered No.
(Was deceased a U. S. War Veteran, If so specify WAR)
16
42
Female white
10 day
IMPORTANT
13 NAME OF
FATHER
Jemes Fortimer
......
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 laat 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 aud 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 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 inimediate 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 horder 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 ita 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 exhumne 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 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 he issued until there shall have been delivered to such board, agent or clerk, as the case inay be, & satisfactory written statement containg 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 board of health, or employed by it or by the aelectmen 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, 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 auch 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 aection ten of chapter forty-aix, that the deceased aerved 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. ahall 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 ia 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 ... . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examinera shall make examination upon the view of the dead bodies of only sucb 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 Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deaths only as those of persona to whom they have given bedside care during a laat illneas from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deatha 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 csused 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 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 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 honie housework. write bousework. 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-301 A
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
100m (d)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit permit was issued : Www. D. Childrens 8 (Signature of Ageut of Board of (leaith or other) ( Health Officer (Official Designation) (Date of Issue of Dermit) 8/21/42
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
20,
1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
August 18,
1,2
19
to
August 20.
19
/12
(or) WIFE of
(Husband's name in full)
LO
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
AGE
8 17 Years
Months
1
Days
If less than 1 day
Hours.
......... Minutes
Usual
9 Decupation :
Soldier
Industry
10 or Business :
U. S. Army
11 Social Security No.
None
12 BIRTHPLACE (City)
( State or country )
Danvers, Massachusetts
2 yrs.
(Include pregnancy within 3 months of death)
IMPORTANT
Physician
Underilne the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to ocoupation of deceased ? If so, specify ...
(Signed).
Dianay Claro, Capt. me
(Address) Station Hospital
Fort Banks, Mass
Date Alle. 2019 42.
21
Camp Deven
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
Com 22
1942
22 NAME OF
FUNERAL DIRECTOR Themex
ADDRESS
254 Beard Se Réve
Received and filed.
19
( Registrar)
1
Winthrop
(City or Town) Station Hospital . Fort Banks. Mass.
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.
Registered No.
148.
( If death occurred in a hospital or institution, St. ( give its NAME instead of street and nuniber )
PHYSICIAN - IMPORTANT
2 FULL NAME
JOHN FRANCIS NIMBLETT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
Fort Banks, Mass.
(Usual place of abode)
( If nonresident, give city or town and State)
Length of stay: In hospital or Institution .... hospital ....
-years
"" months
2 days.
( Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
Ruth Elizabeth .Abbott
(Give maiden name of wife in full)
I last saw him
alive on
August 20.
19
death is sald to
have occurred on the date stated above, at.
8:23
a
m.
Duration
IMPORTANT
E ... hr ...
Due to.
Arterial hypertension, cause
undetermined.
2 yrs.
Due to ....
13 NAME OF
FATHER
Unknown
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Unknown
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
Unknown
(State or country )
17
Jchn Nimblett
(
Relation, if any
.... Son
Major findings:
Of operations.
Date of ..
--
Of autopsy
Cerebral hemorrhage. Cardi
ac enlargement.
What test confirmed diagnosis ?.
Autopsy
Informant.
( Address)
PLACE OF DEATH
Suffolk (County)
No.
(Was deceased a
World
U. S. War Veteran,
If so speolfy WAR)
Tar IT
St.
In this community
6yrs.
2 mos.
- days.
42
Immediate cause of death Apoplexy, cerebral
Other conditions.
Retinitis, albuminuric
That I attended deoeased
from
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, 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, furnisb 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 his last illness, when last seen alive by the physician or officer and the date of bis death .. . Gen. Laws, Chap. 46, Sec. 9.
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