USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 71
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SPACE FOR ADDITIONAL INFORMATION
M R-301 A
Suffolk
1
1
..
(City or Town)
No. 43
The Commontralth 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.
205
St. [ { If death occurred in a hospital or institution, · ¿ give its NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
mary E. Bohling
( If deceased is a marmed, widowed/nr divorced woman,give aho maiden name.) 43 Searge 220 St.
(a) Residence. No.
(Usual place of abode )
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
years
months days.
In this community
2 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
5 SINGLE
( write the word)
MARRIED
WIDOWED
Single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
yeers
IF STILLBORN. enter that fact here.
8 76 Years AGE
- Months
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Itnowwork
Industry
aux Home
11 Social Security No.
Est Boston
12 BIRTHPLACE (City)
( Siate or country )
mars.
13 NAME OF
FATHER
John Bahling
14 BIRTHPLACE OF
FATHER (City) ...
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER Julia Sheehan
16 BIRTHPLACE OF MOTHER (City) "(State nr country )
Chiland
» Informent (Addre ) 43 Slave S
Jesois munay nucci
I HEREBY CERTIFY that a satisfactory standard certificate of death wes filed with ma BEFORE the buriel or tranalt permit was issued : 24m. & childress
(Signature of Agent of Board of Ijealth or other y
4.0 Napl. 23/43-
.... (Omclai Designation) ( Tytte nf Issue of Permits
.....
18 DATE OF
DEATH
Lips
22
(Month)
(Day)
1943 (Year)
19 HEREBY CERTIFY, That I attended deosased from
Syet 1
1943
dept 22
1943
I lest saw h
er
allve on ..
Leet 21
, 1943, death Is sald to
have occurred on the date stated above, at 7 H m.
Duration
IMBORTANT
Immedlate couso of deeth. Cerebral Hemorrhage
sept14 ..... 1943
Due to ChromeHyperten
Due to
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
200
20 Was disease or injury in any way related to oooupetion of deceased ? If so, specify
( Signed)
(Address)
Jan 23 19 43
21 teresa
Plece of Burial, Cremation or Removal.
Dete ......... mulden ( City of Town )
DATE OF BURIAL
dypt
24
1943
22 NAME OF
FUNERAL DIRECTOR
Frederick
8 manucho
ADDRESS
East Boston
Received and Aled .19
( Registrar)
E
1
100M- 6 - 2-42-8855
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoital 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
should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain M
PARENTS
PLACE OF DEATH
(County) Winthrop
2 FULL NAME
(Was deceased a
U. S. Wer Veteren,
if so specify WAR)
4 COLOR OR RACE|
Female Write
MEDICAL CERTIFICATE OF DEATH
What test confirmed dlegnosis Clinical Signs
Major findings :
Of operations
Dete of
Of autopsy
Relation, If any
. M. D.
IO or Business :
( Give meiden name of wife in fully
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medical officer shall forthwith, after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other authorizeil person or of any member of the family of the deceased, furnisb for registration a standard certificate of death, stating to the best of his knowledge sud 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 aeen alive by the physician or officer and the date of hia death ... Gen. Laws, Chap. 16, 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 bundred and four- teen, shall, if the deceased, 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 a recital to that effect, speci- fying the war, sud shall also certify in such certificate both the primary and the secondary or iinmedliste cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, sucb physician or officer shall forfeit ten dollars. For the purposes of thla sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humired and fourteen, the word "war" shall incline the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he 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 sixtcen and nineteen bundred 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 burled, 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 one grave or tomb other thau tbe 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 boily is buried. No such permit shall be Issued until there shall 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 returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, aa required by law, o 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 ia a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death Is caused by violence, tbe medi- cal examluer 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 renioval shall constitute a permit for such removal; provided, that such body shall be returned to the town from wbich 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, aa 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 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 physiciau certifying the cause of death shall thereafter furnish for registration any other wece+ sary information which can be obtained as to the deceased. or wa to the manner or cause of the death, which the clerk or registrar way require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or otber person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a perinit so to do from 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 tbe care of the cemetery or burial ground in which the interment is made. ... Cbap. 114. Sec. 46. C. 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 lles aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calla for the observance of the following rules of practice :
(1) Attending phyalciana will certify to sucb deatha only aa 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 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 medical attendance or whose pbyat- clan is ahsent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all dcatba 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, aml deaths following abortion, but also deaths from disease rasulting from Injury or Infection related to occupation, the audden deatha of persona not disabled by recognized dlacase, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name tbe disease caualng death. Aa related causes, name earlier morbid conditions, If any, related to the principal cause and any important complication of the principal cause.
1
Statement of Oooupatlon .- Precise statement of occupation ia very im- portant, so that the relative bealthfulness of various pursuits can be known. Make some entry In this section for every person aged 10 yeara 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 boine. For a woman wbose only occupation waa that of bonie bousework, 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
P
RM R-301 A
Suffolk
(County)
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.
26
f ( If death occurred in a hospital or Institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
(If nonresident, give city or towu and State)
months
days.
In this community
25grs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
No.
136 Hermon St.
2 FULL NAME
Ruth Stacey Fall
(a) Residence. No.
136 Hermon St.
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
MARRIED
WIDOWED
or DIVORCED
(or) WIFE of
( Unshand's name in full)
6 Age of husband or wife if alive
31
7 IF STILLBORN. enter that fact here.
8
AGE
28 Years
10 Months
10 Days
At Home
11 Social Security No. .
none
12 BIRTHPLACE (City)
Sommerville
(State or conutry)
Mass.
13 NAME OF
FATHER
William Stacey
FATHER (City)
Halifax
15 MAIDEN NAME
OF MOTHER
Ilizabeth Bearner
16 BIRTHPLACE OF
MOTHER (City)
Halifax
(State or country)
Nova Scotia
17
Percy A. Mall
136 Termon St. Winthrop
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
(State or country)
Nova Scotia
100m (d)-1-41-4667
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 g
...
Signature of Agent of Board of llcelth or other)/
9/27/43
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept.
24
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Feb-20
...
1943
to 00ft23
1×3
I last saw her alive on 19 43, death is said to .. m. Duration have occurred on the date stated above, at 12:300 Immediate cause of death Clinic heart IMPORTANT disease-urile failure
4400
Due to ..
Playmates Lever with
Strep, infection
4 yrs
Due to.
Scatter 14-18 Sta
minidel - a.
Other conditions.
Edema y lega
(Include pregnancy within 3 months of deathy
(4 ch, tiro)
Major findings;
Of operations.
isis Dale Huid 14-1820
aspirated de Caldas
.Date
SBT 19-43
Ot autopsy
What test confirmed diagnosis ?
Clinical Cols
IMPORTANT
Physician
l'uderline the cause to which death should be charged sta- fistically.
20 Was disease or injury in any way related to oooupation of deceased ?.......
If so, specify.
Francis 9.5 laule
..
(Signed)
M. D.
(Address)
SeveryMan
Dato 2260 1943
21
Winthrop
l'lace of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Sept. 27,
1943
19
22 NAME OF
FUNERAL DIRECTOR.
Richard 76 White
ADDRESS
147 Winthrop St . Winthrop
Received and filed
SEP 2 7 1943
19
(Official Designation) (Date of Issue of Permit)
( Registrar). V
E
1
Winthrop
(City or Town)
3 SEX
4 COLOR OR RACE|
Female
White
Industry
10 or Business :
14 BIRTHPLACE OF
Informant
( Address)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that effect.
PARENTS
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
WIIn UNFAVING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information
Usual
9 Occupation :
Housewife
5 SINGLE
(write the word)
Married
Sa If married, widowed, or divorced
HUSBAND of
Peroyoke maiden game of wife in full)
years
If less than 1 day
Hours
Minutes
PLACE OF DEATH
(If deceased is a married, widowed or divorced woman, give also maiden name.)
......
years
24000
Winthrop
That I attended deceased from
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall 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 fanrily 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 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 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 helief, 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, 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 human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit 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, ageut 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 hoard of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence. the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained carly enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such reinoval, 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 heen 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 thereafter furnish for registration any other neces sary information which can be obtained as to the deceased, or as to the mamier 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 hoard, from the clerk of the town where the body is to be huried 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).
Medical 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, Scc. 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 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 deatha following abortion, but also deaths from disease resulting from injury or infection releted 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 iliness. 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 ouly 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
M R-301 A
PLACE OF DEATH
Suffolk (County)
(City or Town) 53 breach 2
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.
St. § ( If death occurred in a hospital or institution, { give its NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME
William & Gallagher
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
53 /Black
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
, months days. In this community 10 yrs. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE1
5 SINGLE
( write the word)
MARRIED
WIDOWED Wholoves
or DIVORCEO
5a If married, widowed, or divorced HUSBAND of ...
(Give maiden name of wife in full)
( Husband's name in full)
6 Age of >husband or wife if alive
years
IF STILLBORN. enter that fact here.
8
7.8 Years
Months
........ Oays
f less than 1 day
Hours
Minutes
Lumber Standen
11 Social Security No.
12 BIRTHPLACE (City)
( Siale or country )
13 NAME OF
FATHER
Willian Gallagher
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIOEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Relation, if any
I HEREBY CERTIFY that a satisfactory standard certificats of death was filed with me BEFORE the burlat or transit permit was Issued :
(Signature of Agent of Board of Health or other) Ma the Officer 9/21/43
(Omcial Designation) ( Date of Issue of Permit}
18 DATE OF
September.
27
19X3
(Year)
19 A HEREBY CERTIFY, July 1 - 19
X3
Vent. 23
ko.
19
I last saw h
.alive on
have occurred on the date stated ahova, at.
Immediate cause of death. Bulunan Educa (Acento)
Duration IMPORTANT
Que to.
Broncho - Premonia
3 days
Due to.
amputation of leg.
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findings :
Of operations
Oate of
Of autopsy
What test confirmed diagnosis ?
20 Was disease or injury in any way related to oooupation of deceased ?... ........
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