USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 51
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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 hedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Bnard 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 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 by 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 diseaso 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, 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 busi- ness, 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 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
1
PLACE OF DEATH
Suffolk (County)
./inthrop (City or Town) Winthrop Community Hospital No.
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
151
{ { If death occurred in a hospital or institution,
St.
( give its NAMIE instead of street and number)
2 FULL NAME
Ada Maria .(Winn) Lamb
(If deccased is a married, widowed or divorced woman, give also maiden name.)
72 Main
St.
(If nonresident, give city or town and State)
Length of stay: in hospital or Institution
( Before death )
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACEJ
White
5 SINGLE
(write the word)
Widowed
18 DATE OF
DEATH
august
23.
1942
(Month )
(Day)
(Year)
5a if married, widowed, or divoroed
HUSBAND of
(or) WIFE of
Cha rfGive maiden name of wife im full)
(TTushand's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN. enter that fact here.
8
AGE
86 Years
6
Months.
18 Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
At home
Industry 10 or Business :
11 Social Security No ...
Portland
12 BIRTHPLACE (City)
(State or country)
Maine
13 NAME OF
FATHER
William B. Winn
Major findings :
Of operations.
none
Physician
14 BIRTHPLACE OF
FATHER (City)
Portland
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Mary Colby
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Vermont
Farley
17 Trs Mabel Deroo
Informant
( Address)
82 main St
Relation, difeany
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjai or transit permit was Issued : Nm. D. Children
(Signature of Agent of Board of Health or other)
Health office 8/45/42
/(Official Designation) (Date of Issue of Permity
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify ..
(Signed)
(Address)
Mithing Muss Date aug 24
...
M. D.
1942
..........
21
Winthrop Cemetery
winthep
l'lace of Burial, Cremation or Removal.
August 25, 142º
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
inthrop ... Lass
Received and filed. 19
(Registrar)
Duration
IMPORTANT
30 hrs
Due to.
Due to.
Other conditions.
arterio Achimis .
(Include pregnancy within 3 months of death)
10 years IMPORTANT
Underline the cause to which death should be charged sta- tistically.
Date of
Of autopsy
What test confirmed diagnosis ?.
clinical
....
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
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
Hospital
years - months
1 days.
In this community
80yrs. - mos. ~
days.
MARRIED
WIDOWED
or DIVORCED
19 | HEREBY CERTIFY,
That I attended deceased from
aug 22
19 42, to Ona 23
I last saw her
alive on
aug 23-0
19.41, death Is said to
have occurred on the date stated above, at
10.15
a
.m.
1942
immediate oause of death.
Lobar.
Registered 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 fortliwith. 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 ans meniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and behet the name of the deceased. his supposed age, the disease of which he died. defined as re- quired 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.
A physician or officer furnishing a certificate of death aa required by the preceding seetion or by section forty-five of chapter one hundred and four- teen, shall. if the deceased, to the best of his knowledge and helief, aerved in the army. 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 canse of death as nearly as he can state the same. For neglect to compdy with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen. the word "war" shall inelude 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 froin 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 huried. No such permit shall be issued until there ahall 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 internient, 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 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 linman body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unlesa a permit in the usual form for the removal of such body has been aooner obtained hereunder. If the death certificate contains a recital, as required
by aection 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 hoard of health, or its agent. upon receipt of such statement and certificate, shall forthwith countersign it and transinit 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 apprinted 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 person apjointed 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 hy violence. If a medical examiner has notice that there is within his county the lrody of such a person, he shall forthwith go to the place where the Irady lies aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such 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 ia absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deatha sup- posably due to injury. These include not only deaths caused directly of in- directly by traumatism (including resulting aepticemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, 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 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 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 aa at school or at home. For a woman whose only occupation was that of honie housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
(County)
Vinthron
(City or Town)
No.
I30 Broni-frala Ra
The Commonmoralth 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.
152
{ ( If death occurred in a hospital or Institution, St. [ give ita NAME instead of street and number)
2 FULL NAME
Elizabeth M. Mullen
Monarch
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so speolfy WAR)
(a) Residence. No.
+3 Brookfield Rd
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution ..
(Before death)
(Specify whether)
years
months
davs.
In this community
yrs. " mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
White
MARRIED
WIDOWED
or DIVORCED idoWed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
71 1 ] (.Give maiden name of wife in full)
(Husband's name in full)
have occurred on the date stated above, at
9:15
Pm.
6 Age of husband or wife if alive
years!
7 IF STILLBORN, enter that fact here.
8
AGE
75
Years .
Months
Days
If less than 1 day Hours. .Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
Own Home
11 Social Security No.
12 BIRTHPLACE (City)
Chelsea
(State or country)
13 NAME OF
FATHER Jeremiah Mullen
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Marv Cassidy
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Mrs. Frank A. Farrell
Relation, if any
Informant ... ( Address) 130 Brookfield Rd
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
22 NAME OF
John F. Omaley
19
FUNERAL DIRECTOR
ADDRESS
winthrop
19
/(Official Designation) (Date of Issue of Permit>
18 DATE OF
DEATH
August 25, 1942
()fonth)
(Day)
(Year)
19 | HEREBY CERTIFY,
19
Lupust 9,
42
to August 25 ,
42
I last saw h
er
allve on
Aurust 25.
42
19.
death Is sald to
Immediate cause of death
Carcinoma of Sigmoid
Duration IMPORTANT
Due to.
Due to.
Other conditions.
Arteriosclerosis
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
No operation
Date of
Of autopsy
No autopsy
What test confirmed diagnosis ?
Clinical progress
Underline 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)
(Address) 28 ash. Av. Anthrop Aug. 26
19
42
21
St. Joseph S
£
Pepperell
Place of Burial, Cremation or Removal.
DATE OF BURIALAUX 28 TO42
(City or Town)
(Signature, of/Agent of Board of Health or other) Health Of beer 8/24/42
Received and filed
( Registrar)
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
4 COLOR OR RACE
-
5 SINGLE
(write the word)
That I attended deocased from
19
IMPORTANT Physician
PARENTS
1
PLACE OF DEATH
(Usual place of abode)
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 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, Scc. 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 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 tonib to another in the same cemetery, until he has received a permit from the board of health or its agent aforcsaid 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 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 hy 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 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 ageut, upon receipt of sucb statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other ueces- sary information which can be obtained aa 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 centetery or burial ground in which the interment is made. ... Chap. 114. Sec. 46. G. L., (Terccuteuary Edition).
Jfedical 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, 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 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 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 ahortion, 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 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 tbe 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 on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
SEVERE NOTIFIED SEP 0 15-12
Sulfalk
(County)
HenTherap (City or Town), Winthrop
CERTIFICATE OF DEATH
Registered No.
153
Community Nosplus (If death occurred in a hospital or institution, ly Nosplust. give its NAME Instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Baby Boy Cantillo
( If deceased is a married, widowed-of divorced woman, give also maiden name.)
21
(Bayswater )
St.
EBita
(If nonresident, give city or town and State)
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