USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 41
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Statement of Cause of Death .- Canse 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 discase causing death. As related causes, name earlier nrorbid 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 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 occupatiou whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A X
Suffolk
(County)
Winthrop
(City or Town)
No. 17 Bartlett Parkway
.......
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be tiled 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 aud number)
2 FULL NAME
Ida May (Faust ) Miller
( If deceesed Is a married, widowed or divorced women, give also maiden name.)
(a) Residence. No.
17 Bartlett Parkway
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution (Before death)
years
months days.
in this community
18
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widow.
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
years
> IF STILLBORN. enter that fact hera.
Years 8 AGE 80. .1. Months2.7 ...... Days
If less than 1 day
Hours
Minutes
Usuat
9 Occupation :
Housewife
Industry
10 or Business :
At Home
11 Social Security No.
None
12 BIRTHPLACE (City)
(Siste or country)
Mass
13 NAME OF
FATHER
Unable to obtain
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Unable to obtain
PARENTS
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF MOTHER (City) (State or country)
Unable to obtain
17 Informant ( Address)
Albert Dodson Bartlett Parkway
RSUM, If any
Place of Burial, Cremation or Removal.
DATE OF BURIAL
June
3
(City or Town)
1543
22 NAME OF FUNERAL DIRECTOR ..... Howard S Hunolds
ADDRESS Winthrop
Signature of Agent of Board of Health or other) Health Officer
6/1/45
.... (Official Designation)
( Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
may
31 1943
(Monthy
(Day)
(Year)
19 | HEREBY CERTIFY, That I attendad dacaased from May 30,, 1943, to mar 31 1943
i last saw h.e ............ alive on ..
.....
310
, 1943 death is said to
hava oocurred on the date stated above, at ....
4 TOP
m.
Duration
Immediate cause of death Caronom Thrombosis
Due to Arteriosclerosis
5 years
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findings :
Of operations
22
Dete of
Of autopsy.
220-20
What test confirmed diagnosis ?. Clinical Sigas
20 Was disease or injury in any way related to cooupation of decaasad? 200 If so, specify.
(Signad)
M. D.
(Address) Winthrop mass Date May 31
.19K
21
Winthrop
Winthrop
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
100M-6 - 2-42-8855
1
=
------
,
1
PLACE OF DEATH
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physlolans to insert a recital to that offsot.
I HEREBY CERTIFY that a satisfactory standard oartifioste of death wes fited with me BEFORE the burfar or transit barmit was Issued : Man:D. (Vildrest
Raoeived and fled. 19
JUN-1 ------ 1849
( Registrar)
Registered No. ............
WWPHYSICIAN - IMPORTANT
U. S. War Vateran,
if so spoolfy WAR)
Female
(Specify whether)
"IMPORTANT Sudden
East Boston
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail forthwith, after the death of a person whoin he has attended during his iast 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 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 iliness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the decessed, to the best of his knowledge and belief, 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 s recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediste 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 shsil forfeit ten dollars. For the purposes of thia aec- tion and of sections forty-Ave, forty-six and forty-seven of said chapter one bundred and fourteen, the word "war" shall inchide the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety- eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chisp. 46, Sec. 10.
No undertaker or other person shali 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 ita agent appointed to lague such permits, or if there is no such board, from the clerk of the town where the person died; aud no undertsker or otber person shall exhume a human body and remove it fromn a town, from one cenietery to another, or from one grave or tomb other thau 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 cierk of the town where the body is buried. No such permit shail be Issued until there aball have been delivered to sucb board, agent or clerk, as the case inay 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, o1 in lieu thereof a certificate as ilereinafter 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 meniber 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, froin one town to another within the commonwealth cannot be obtained esrly enough for the purpose, the certificate of desth made as above provided and in the possession of tbe undertaker desiring to make such renovsi 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 removai, uniess a permit in the usuai form for the removal of such hody 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. sucb recital shali appear upon the permit. The board of health, or its agent. upon receipt of such stateoient and certificate, shali 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 shail thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner of canse 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 froni the hoard of health or its agent appointed to issue such permits, 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 appointed 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 shail make examination upon the view of the dead bodies of ouly such persons as sre 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 shali forthwith go to the place where the idy lles aud take charge of the same; ... - Generai 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 deatha only as those of persons to whom they have given bedside care during a last iliness from disease unrelated to any form of injury.
(2) Board of Health phyalolans will certify to such deaths only aa those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medicai attendance or whose phyaf- cian is ahsent from home when the certificate of death is needed.
(3) Medloai Examiners will Investigate and certify to all dicatbs sup- posably due to Injury. These include not only deaths cansed directly or in- directiy 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 diseasa resulting from injury or infeotion related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Canse of death meana the disease, or coniplication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenla, etc. Aa principal cause name tbe disease caualng death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of tbe principai cause.
Statement of Occupation .- Precise statement of occupation ia very im- portant, so that the relative healthfuiness 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 fitness. If the deceased bsd retired from business, report the usuai occupation prior to retirement. Children not gainfuliy employed may he returned aa at school or at boine. For a woman wbose oniy occupatiou waa that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, aa housekeeper-private family, cook- hotei, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
-301 A
1
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No. Station Hospital Fc t Banks Mass
The Commontoralth 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.
116
f (If death occurred in a hospital or institution,
........... St. [ give its NAME instead of street and number)
2 FULL NAME
JOHN TIMOTHY SCULLY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
17 Virgil Road
(Usual place of abode)
St. West Roxbury .... Mass ..
(If nonresident, give city or towu and State)
Length of stay: In hospital or Institution
( Before death)
years
- months
2
days.
In this community
0
yrs.
O mos.
O
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE!
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Ilushand's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here.
8
AGE 33
. Years
1 .. Months
.. 20 .. Days
If less than 1 day ..... Hours Minutes
Usual
9 Occupation :
Soldier
10 or Business :
Industry
U. S. Army
11 Social Security No.
Unknow
12 BIRTHPLACE (City)
(State or country)
Boston, Massachusetts
13 NAME OF
FATHER
Michael F. Scully
14 BIRTHPLACE OF
FATHER (City)
Boston, Massachusetts
(State or country)
15 MAIDEN NAME
OF MOTHER
Grace Rockwood
16 BIRTHPLACE OF
MOTHER (City)
Boston ,Massachusetts
(State or country)
17 Informant Helen Mullaney.
Relation, If any ... sister.,
( Address) 15 Virgil Rd. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial ør transit permit was Issued : Www. D. Childrens
( Signature of Agent of Board of Health of other)
The atthe office 6/1/43
('Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
MAY
31,
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
May 29,
19 43, to May 31,
1943
I last saw !
him
alive on
May 31,
19 43 death Is sald to
have occurred on the date stated above, at.
7:58
Pm.
Immediate cause of death .. Bilateral ... lobar ... and ....
broncho pneumonia
Duration
IMPORTANT
2 ... days
Due to.
Due to ..
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
1.Bilateral lobar and broncho
Of autopsy.pnemonia. 2Edema of brain.
What test confirmed diagnosis ?
IMPORTANT
Physician
U'nderline he cause to which death should be charged sta- listically.
20 Was disease or injury in any way related to occupation of deceased? NO. If so, specify ..........................
M. D.
(Signed) ... George R ..... Alpert,.Med ..... Corps"."
(Address) Fort .... Banks, .... Ma'ss ...
Date.May ... 31.1943.
Baton
21
new Calvan
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
June
4
19.413
22 NAME OF
FUNERAL DIRECTORY
ADDRESS
254
Beach st Renne
Received and filed
JUN 1 1949
19
( Registrar) X
100m (d)-1-41-4667
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
BOSTON NOTIFIED 6/9/43
(Specify whether)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
1943
X
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered bospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an mulertaker 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 deceaseil, bis supposed age, the disease of which he chod, defined as re- quired by section one, where same was contracted. the duration of bis last illness, wben last seen alive by the physician or officer and the date of bis death ... tien. 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 t'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 all the secondary or immediate canse of death as nearly as be 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 humulred and fourteen, the word "war" shall inchide the China relief ex- pedition and the Philippine insurrection, which sball, for saint purposes. be decmed to have taken place between February fourteenth, eighteen bundred and ninety-eight and July fourtb, nineteen hundred and two, and the Mexi- can border service of ninetecu hundred and sixteen and nineteen bundred 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 buman body and remove it froin a town, from one cemetery to another, or from one grave or tomb other than the receiving tontb to another in the same cemetery, until he bas 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 sball have been delivered to sucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be retururd 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. ot 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 pbysi- cian who is a member of the board of health, or employed hy it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attemling physician. If deatb 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 withun 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 bas been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ton of chapter forty-six. that the deceased aerved in the army, navy or marine corps of the I'nited States in any war in which it has been engaged. sueb recital shall appear upon the permit. The board of health, or its agent. njom receipt of such statement wil certificate, shall forthwith counter-ign It aml transmit it to the clerk of the town for registration. The person to whom the perunt 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 hury 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 bealth or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the hoily is to be buried or the funeral is to be hell, or from a piersou apointed 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 snob 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 liea 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 illness from disease unrelated to any form of injury.
(2) Board of Health pbysiclans 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 trauuratism ( including reaulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aml deatbs following abortion, hut 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 nieans the disease, or complication which causes death, not the mode of dying. e. g., beart failure, asphyxia, asthenia, etc. As principal cause name the discase cansing 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 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 inay be returned as at school or at home. For a woman whose only occupation was that of home 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 persou wbo had uo occupatiou whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
1
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
117
Registered No.
4713
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
2 FULL NAME
Patrick J. O'Hara
(If deceased is a married, widowed or divorced woman, give also maiden name.)
34 Brookfield Road
St.
Winthrop, Mass.
(a) Residenoe. No.
(Usual place of abode)
Hospital
years
months
1
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorcedFlorence M. Monahan
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
40
years
7 IF STILLBORN, enter that fact here.
8
AGE
5.7
Years
Months.
.Days
If less than 1 day Hours. .Minutes
Usual
9 Ocoupation :
Merchant
Industry
10 or Business :
Fish
11 Soolal Seourlty No ... 01307.3755
Dublin
12 BIRTHPLACE (City)
(State or country)
Ireland
13 NAME OF
FATHER
William O'Hara
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Ellen Smart
16 BIRTHPLACE OF
MOTHER (City)
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