USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 65
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17 Annat Care Station. It may (Address ) 93 Serversave with
I HEREBY CERTIFY that a satisfactory standard certificats of death was filed with me BEFORE the burjat or transit permit was issued : m. D. Children
-
(Signature of Agent gt Board of Health) or other)
Health Officer 10/14/42
'(Official Designation) (Date of Issue of Permit) (
18 DATE OF
October 14,1942
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deosased from
november 9/ 1946,
October 14.
1942
I last saw h.
„alive on.
October 14, 1942 death is said to
have occurred on the date stated above, at
€ 11:30 A.
Immediate oayse of death ...
acute Coronary Thrombosis
Due to.
Thematic Heart Prisene
Due to ..
Chronic Interstitial Heplinit
Other conditions
Conjective Failure
( Include pregnancy within 3 months of death)
Major findings:
Of operations
none
Date of.
Of autopsy
none
What test confirmed diagnosis@liucalx lab
20 Was disease or injury in any way related to occupation of deceased 20 If so, speolfy ......
(Signed)
Jacob
M. D.
(Address) 962 Squilly Y Date 10/14/292
Place of Burial, Cremache le Her dont le city of Townto
DATE OF BURIAL ...
Oct181942 19
22 NAME OF
FUNERAL DIRECTOR.
Boston, ass.
D.W.P
J.S .Waterman & Sons
ADDRESS
Received and Aled. 19
( Registrar)
100M-6 - 2-42-8855
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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
7 PLACE OF DEATH -
1
No. Clarence Orrin
Case
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so spoolfy WAR)
None
(Usual place of @bode)
(Specify whether)
ced I Besarich
(or) WIFE of
Duration
2 years .......
2 years
Iyear IMFØRTANT
Physician Underline the cause to which death should be charged sta- tisticallyc
11 Social Security 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 whoin he has attmuled during his last iffnesa, at the request of an undertaker or other authorized person or of any meniber 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.
A' physician or officer furnishing a certificate of death as required by the preceding section or by section forty-Ave of chapter one bundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, served in the ariny, navy or marine corps of the I'nited States in any war in which it has been engaged. insert in the certificate a recital to that elect, 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 saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bunelred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetween 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 buman 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 otber person shall exhume a human body and remove it froin a town, from one cemetery to another, or from oue 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 aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there aball have been delivered to sucb board, agent or clerk, as the case inay be, & satisfactory written statenrent containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original internrent, by a satisfactory certificate of the attending physician, if any. as required by law. o1 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient ressons, 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 niake 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, froin one town to another within the commonwealth cannot be obtained early enough for the purpose, tbe certificate of desth made as above provided and in the possession ot the undertaker desiring to make auch 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. sucb recital shall appear upon the permit. The board of health, or its agrut. upon receipt of such statement and certificate, shall forthwith countersign it and transmilt 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 urce+ sary information which can be obtained as to the deceased, or as to the manter or cause of the death, which the clerk or registrar may require .- Cbap. 114. Sec. 45. G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a hunian 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 hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person apointed to have the care of the cemetery or burial ground in which the interment is made .... Cbap. 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 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 calla for the observance of the following rules of practice :
(1) Attending phyalcians 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 phyalolana 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 pbyaf- cian is ahsent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all deatha sup- posably due to Injury. These include not only deaths caused directly or In- directly by traumatiam (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agruta, ami deaths following shortion, but also deaths from diseasa resulting from Injury or Infection related to occupation, the sudden deatha of persons not disablad by recognized dlacase, 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 ilying, e. g., heart fallure, asphyxia, astbenia, etc. As principai 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 Oooupatlon .- Precise statement of occupation la very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the dixcase causing death, report the usual occupation prior to illness. If the deceased bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at boine. For a woman whose only occupatiou waa that of hone housework, write bousework. For a person engaged in domestic service for wagen, however, designate the occupation by the appropriate terma, as housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
ORM R-301 1
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
PLACE OF DEATH
BOSTON NOTIFIED 11/9/42 Suffolk County) Winthrop (City or Down) Winthrop Community Hospital No .....
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME
Mary Sheridan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
2/ More tv
St.
.....
years
months /0
days.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX 4 COLOR OR RACE Female White
5 SINGLE
MARRIED
WIDOWED
Single
5a lí 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. 7 IF STILLBORN, onter that fact here.
.years
8
AGE SP
Years
Months.
.Days
If less than 1 day
Hours
Minutes
Usual 9 Occupation:
none
Industry 10 or Business:
Mone
11 Social Security No. Mene
12 BIRTHPLACE (City) ...
(State or country)
East Boston Mass
13 NAME OF
FATHER
Patrick Sheridan
14 BIRTHPLACE OF
FATHER (City)
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Bridget Oully
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Thomas thesedan (Brother
Relation if any
Informant.
(Address)
29320 23 1l fo Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Childrens
(Signature of Agent of Board of Health or other)
Health Office 10/19/47 (Official Designation) (Date of Issue of Permit} / {
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct
17
1542 (Year)
19 | HEREBY CERTIFY . That I attended deceased from 10-9
19.42
to
10-17
19 42
I last saw h ........... alive on.
10-
17
19.Y ..... , death is said
to have occurred on the date stated above, a
5 20 Pm
Immediate cause of death ....
Dubacute Intestinal Obstructi
Duration 10
Due to
Denandra Pratonetes
Palmarã Ocelema.
Due to
...
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or lojory In any way related to occupation of deceased ?
If so, specify
(Signed)
Q . B. Cataldo
M. D.
48 Byron ST Date Cet 17 1912
(Address)
malden
(Cify or Town)
.......
Place of Burial, Cremation or Removal.
DATE OF BURIAL.
Oct 20
1942
22 NAME OF
FUNERAL DIRECTOR
Charles H. Treanor
ADDRESS
Est Paston
.
Received and filed ..
19
A TRUE COPY ATTEST: (Registra:)
... 8 days 1/2 day
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
...
Date of Oct 14th 1642
Of autopsy
What test confirmed diagnosis ?
Operation
1000
PARENTS
200m-10-'39. No. 8427-d
1
(a) Residence. No .. (Usual place of abode) ength of stay : In hospital or institution (Specify whether)
40days"
(write the word)
(Month)
(Day)
(u U. S. War Veteran. apecity WAR) East Boston 1.1.
21
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 deccased, 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 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 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 thercfrom 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 hoard 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 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 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 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 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 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 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 eaused 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 disease resulting from injury or infection related to occupa- tion, the sudden deallis 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 be returned as at school or at home. For a woinan 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
ORM R-301
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
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No .... Winthrop Community Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No
1 (If death occurred in a hospital or institution, St. t give its NAME instead of street and number)
2 FULL NAME.Roy Francis Melanson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
25 Belmont
St.
.Everett Mass
(If nonresident, give city or town and state)
length of stay: In hospital or institution 2days, 5hrs., 30minsears
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
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
7 IF STILLBORN, enter that fact here.
8
AGE
Years.
.. Months.
......
Dayc
.. Hours
... Minutos
Usual
9 Occupation:
Industry
10 or Business:
Il Social Security No.
12 BIRTHPLACE (City)
Winthrop
(State or country)
Massachusetts.
13 NAME OF
FATHER
Raymond Melanson
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Nova Scotia.
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
Angele Comeau
16 BIRTHPLACE OF
MOTHER (City)
Digby, Nova Scotia
(State or country)
Canada
17
Informant.
Raymond Melanson
Relation, if any
father
....
(Address)25 Belmont St.Everett
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Children
(Signature of Agent of Board of Health or other)
Health Officer
(Official Designation) (Date of Issue of Dermit) 10/11/42
MEDICAL CERTIFICATE OF DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
Oct 15
1942, to.
Oct- 17
19 42
I last saw him alive on
Get
17 1942 death is said
to have occurred on the date stated above, at
4 104 m.
Duration
Immediate cause of death .......
Intracranal hearlage
Traumatic Cerebral anastasia
traumatic 1
Due to
Protracted haben and
Due to
prolapsed Couch
...
.......
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was discase or Injury In any way related to occupatina of deceased ? no
If so, specify.
..........
D. Doused Patito
M. D.
(Signed)
7 Central 2%. 2. 15 Date 10-18 1942
(Address) ..
2) Stelligand Forest Hilles
Place of Burial, Cremation or Removal.
(City_or Town)
22 NAME OF
FUNERAL DIRECTOR
DATE OF BURIAL
......
oct.21
Anthony Sement
ADDRESS
215 eforth sto roston
Received and filed 19
A TRUE COPY ATTEST:
(Registrar)
2days.
40 hours
Other conditions
none
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of ....
Of autopsy
What test confirmed diagnosis ?
-0
200m-10-'39. No. 8427-d
2° 5 hrsy less than 1 day
years
(write the word)
18 DATE OF
DEATH
Oct
18
1942
(I U. S. War Veteran. specity WAR)
place of a
Everett notified "/9/42
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwith, 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 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 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 carly 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 sball 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 been engaged, such recital shall appcar upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be
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