USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 67
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HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
S Age of husband or wils if alive. years
7 IF STILLBORN, onter that fact here.
8 AGE Years
Months3 Days
Hours ..........
Minutes
Usual 9 Occupation:
Industry 10 or Business:
11 Social Security No.
Winthrop
Masg.
13 NAME OF
FATHER
William Rusell
14 BIRTHPLACE OF
1
Revere
FATHER (City)
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Doris Schwart?
16 BIRTHPLACE OF
Revere
MOTHER (City)
(State or country)
Mass.
17
Informant. William Russell Sr. Father
(Address)
48 Pearl Ave. Revere
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D. Chil dress
bature of Agent of Board & Hcanh or other) 10/26/42
seattle trick (Oficial Designation) (Date of Issue of Permit) /
19 I HEREBY CERTIFY. That I attended deceased from
/ .....
19 ... 2 10
19.
I last saw h.
IM alive on ....
00/24
19 42 death is said
to have occurred on the date stated above, at ) 0
.m.
Immediate cause of death. ..... Intracranial Non I Hemorrhage
Due to
Nisstoria-presulive
Due to
deluray
Other conditions
(Include pregnancy within 3 months of death)
....
PHYSICIAN
Major findings : Of operations
Date of ....
..........
Of autopsy
What test confirmed diagnosis ? (1.
Shines tab
11+
20 Was disease or Injury In any way related to occupation of deceased ? Tut
If so, specify ....
John T.Williams
(Signed)
... M. D.
(Address).
,429 Beacon St. Barts . Och 24042
21
Holy Cross
Malden
Place of Burial, Cremation or Removal (City or Town)
DATE OF BURIAL.
October26 1942
19
22 NAME OF
FUNERAL DIRECTOR
Michael C. Marcella
ADDRESS
10 No. Benett St. , Boston
Received and filed. 19
A TRUE COPY ATTEST: (Registrar)
1
PLACE OF DEATH
Suffolk (County)
winthrop (City or Tewn)
No .... Winthrop Community Hospital William Russell Je. Baby
...........
(write the word)
DEATH
(Oct
18 DATE OF
24
1442
(Month)
(Day)
( Year)
24
42
Duration 3 tür
lf less than 1 dey
12 BIRTHPLACE (City)
(State or country)
PARENTS
Underline the cause to which death should be charged sta- tistically.
Relation, if any
MEDICAL CERTIFICATE OF DEATH
(U U. S. War Veteran. specity WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer sball forthwith, after the death of a person whom he bas 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 disease of which bc 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 bas received a permit from the board of hcaltb 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 be 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, bis 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 appcar upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall fortlıwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be
obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Scc. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or tbc 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 llealth physicians will certify to such deatbs only as those of persons who, though disabled by recognized disease un- related to any form of injury, bave died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting scptice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disoaso resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disablod by recognized disease, and those of persons found dead.
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, namc 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 bealthfulness 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 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 bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
1
PLACE OF DEATH
Suff .. o.l.k. (County)
Winthrop. (City or Town)
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.
( { If death occurred In a hospital or institution,
St. ¿ give its NAME instead of street aud number)
2 FULL NAME
Robert Anderson
(If deceased is a married, widowed or divorced woman, give also maiden nanie.)
(a) Residence. No.
2.09 Somerset Avenue
St.
Winthrop
(Usual place of abode)
(It nouresident, give city or town and State)
Length of stay: In hospital or Institution.
( Before death)
( Specify schoolhas)
years
1
months
days.
In this community 30
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
Sa If married, widowed, or divorced
HUSBAND of
...
Margaret.
(or) WIFE of
( iInshand's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact .here.
8 AGE 87 Years 3 Months . Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Grocer- retired
10 or Business :
Industry
Own business
11 Social Security No.
None.
12 BIRTHPLACE (City)
G.l.a.s.c.o.w ........ S.c.o.t.land
(State or country)
13 NAME OF
FATHER
William Anderson
14 BIRTHPLACE OF
FATHER (City)
Glascow, Scotland
( State or country)
15 MAIDEN NAME
OF MOTHER
?
Carmichial
16 BIRTHPLACE OF
MOTHER (City)
Glas.co.w., ..... Scot.lanh
( State or country)
(Signed)
( Address)
10/20042
17 Informant. Mrs. James Gillis Relation if any in (Address) SI Birch Road- Winter &W
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlar or transit permit was issued:
(Signature of Ageut of Board of Ifearth or other)
Health Officer 16/26/42
Received and filled
.19
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
October 26
1942
( Months)
(Day)
(Year)
19 HEREBY CERTIFY,
Left 28
42
That 1 attended deceased from
to
1943
1 last saw h.
alive on
Leaf LA, 1942
have occurred on the date stated above, at
1-3 A
m.
Immediate cause of death ..
trucca Preciosa
11:03
Duration
7
IMPORTANT
3 days 2 pi
Due to.
Due to.
Other conditions
(luclude pregnancy within 3 months of death)
IMPORTANT Physician
Major findings : Of operations.
Date of.
Of autopsy.
What test confirmed dlagnosis ?.
l'underline the cause to which death shuuhl be charged sta- listically.
20 was disease or injury in any way related to occupation of deceased ? if so, specify
no
21
Cedar Grove
Dorchester
l'lace of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL ..
O.c.t.o.be.r.
29 .. , ..... 1.942.
19
22 NAME OF
FUNERAL DIRECTOR Forcarol S. Reynaldo
ADDRESS
(Registrar)
100m (d)-1-41-4667
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
No.
12.5 ..... Cliff ..... Avenue ........ Winthrop.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
d to
(Cive inaiden name of wife in full)
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 auv menther 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. lis supposed age, the disease of which he ched. defined as re- quired by section one. where same was contracied, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Cen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or hy 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 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 inunediate 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 incinde the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes. he deemed to have taken place between Fehruary 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 uineteen 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 rrmove 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 perinits, 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 tomh other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall 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 he 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 selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused hy violence. the medi- cal examiner shall make such certificate. If such a permit for the removal of a Imman 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 been engaged. such recital shall appear upon the perinit. 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 perniit is so given aud 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 hrought into the commonwealth until he has re- ceived a permit so to do from the hoard 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 he huried or the funeral is to be hekl, or from a person appointeil 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 hody of such a person, he shall forthwith go to the place where the boily 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 physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illucss from disease unrelated to any form of injury.
( 2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent nicdical attendance or whose phyal- 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 reaulting septicemia), and by the action of chemical ( drugs or poisons), thermal, or electrical agents, amt deaths following abortion, 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 coniplication 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, relateit 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 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 terins, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write uone.
SPACE FOR ADDITIONAL INFORMATION
RM R-301
1 PLACE OF DEATH HUSBAND of Usual 9 Occupation: PARENTS 17 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 Industry 10 or Business: 200m-10-'39. No. 8427-d
Suf 17 (County)
Tinthrop
(City or Town) No inthron Community
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,
give its NAME instead of street and number)
William Francis Dacey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
57 Buch wind "
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution
.......
years
months
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Mile Th
4 COLOR OR RACE
(write the word) DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, That I attended deceased from October 23 1942 to to. October 27 19 4/2
I last saw him
alive on
October 27, 1942, death is said
to have occurred on the date stated above, at.
Immediate cause of death ......
Brondio pneumonia
.....
2 days.
Due to
Placenta Previa
with Caravan Rechon
Due to .
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
Of autopsy
Bundeo prenuncia
....
What test confirmed diagnosis? @means
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury in any way related to occupation of deceased ? no
If so, specify ......
(Signed).
fault
M. D.
(Address)62 Hurley 0
Date.
Hace of Burial, Cremation or Removal.
(City .or Town)
DATE OF BURIAL ) Of/29/1542
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Form HOMales
Received and filed .........
19
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
October
27
1942
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
S:
5a If married, widowed, or divorced
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8 AGE Years Months
4
Days
If less than 1 day Hours.
.. Minutes
II Social Security No.
/Inthron
12 BIRTHPLACE (City)
(State or country)
Mass
3 NAME
F Hacer st.
FATHER
Ili EDicev
14 BIRTHPLACE OF
FATHER (City)
รำทรัศกาล
(State or country)
15 MAIDEN NAME
OF MOTHER
Helen Mclaughlin
16 BIRTHPLACE OF
MOTHER (City)
Tinthron
(State or country) Hatier 2.
Relation, if any
Informant. .. ... non cần mìn hại
(Address)
57 Buchenmust
....
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. S. Children
(Signature of Agent of Board of Health or other)
I healthe Office 10/28/42
Hospital
St. l
CH U. S. war Veteran. specify WAR).
St. (If nonresident, give city or town and state)
days.
In this community
yrs.
mos.
days.
A TRUE COPY ATTEST:
(Registrar)
58:
... m.
Duration
3 days
.. Date of ..
10/28 /4.
Dicay
ther
2 FULL NAME
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physleian or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... Gen. Laws, Chap. 46. Sec. 9.
No undertaker or other person shall hury or otherwise dispose of & 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 died ; and no undertaker or other person shall exhune a human hody and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if. for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the hoard of health, or employed hy it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy 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 & 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 hody has heen 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 clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thercafter fur- nish for registration any other necessary information which can be
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