USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 75
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HUSBAND of
Figura E nolan
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive years
IF STILLBORN. enter that fact here.
AGE
8
63
Years
Months
Days
If less than 1 day
Hours
Minutos
Usual
9 Occupation :
Watchman
Industry
10 or Business :
Retired
11 Social Security No.
'2 BIRTHPLACE (City)
(Siate or conutry)
East Boston masa
13 NAME OK
FATHER
Patruk Haces
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Chiland
15 MAIDEN NAME
OF MOTHER Annie Lungley
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
chilund
17 Thomas I Havez Informant (Address) 366 Plusant d
Reletion, If any
I HEREBY CERTIFY thet a satisfactory standard oortiffoste of death was filed with ma BEFORE the burjat or Vangt permit wes lequed :
(Signature of Agent of Board of Health or other) Healthe Girleer 10/2/43
(omclal Designation) (Date of Issue of Permit)
18 OATE OF
DEATH
Clit
1
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
1943
to.
That I attended deosased from
Oct1
19
43
I last saw h .... k.km ... allve on
oct
1977 death is said to
have occurred on the date stated above, at ..
4 am
Duration
Immediate oause of death.
IMPORTANT ....
care
Que to.
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findings :
Of operations
Oate of
Of autopsy.
What test confirmed diagnosis?
operation
Underline the cause to which death should ba charged sta. tistically.
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify
('Signed)
(Address)
0105 mendiants
Date
............. M. D.
Haly texas
1Place of Burial, Cremation or Removal, DATE OF BURIAL.
mulden (City or Town) 4
1943
22 NAME OF
FUNERAL DIRECTOR
OF Mayderick manado
ADORESS
East Bortno 6
Reoeivad and Aled
0 1943
......
19
( Registrar)
100M-G - 2-42-8855
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 offoot. PARENTS
PLACE OF DEATH
1
No. ...
St.
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so speolfy WAR)
1943
1 year 1 ...
IMPORTANT Physician
21
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physioien or registered hospital medioal officer shall forthwith. after the death of a person whoin he has attended during his last illnesa, at the request of sn undertaker or other authorized 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 and belief the name of the deceased, his supposed sge, the disease of which he died. defined as re- quired by section one. where same was contracted. the duration of his last illnega, when last seen slive by the physician or officer and the date of bia death ... Cen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa 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 ariny. navy or marine corps of the I'nited States in eny 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 immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, auch 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 bundred and fourteen, the word "war" shall include the China relief ex- pedition sud the Philippine insurrection, which shall, for said purposes, he deencd to have taken place hetwcen February fourteenth, eigliteen 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. Chiap. 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, untii he haa received a permit from the board of health, or ita agent appointed to lesue such permita, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shali exhume a human body and remove it froin a town. from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he haa received a permit from the board of irealth or ita 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, a satisfactory written atatement containing the facta 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. 01 in lieu thereof a certificate aa liereinafter provided. If there is no attending physician, or if, for sufficient reasona, hia certificate cannot be obtained early enough for the purpose, or ia insufficient, a physl- 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 by violence, the medi- cal examlier 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 es above provided and in the possession ot 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 haa been sooner obtained hereunder. If the death certificate containa a recital. aa 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 heen engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such stelement and certificate, shall forthwith counter-ign 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 nece+ sary information which can be obtained as to the deceased. or as to the manner of 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 s human body or the ashes thereof which have been brought Into the commonwealth until lie has re- ceived a permis so to do from the hosrd 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 appointed to have tbe care of the cemetery or burial ground in which the interment ia made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examinera 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 body lies aud take charge of the same; ... - General Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deaths only as those of persona to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deatha 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 ia ahsent from home when the certificate of death ia needed.
(3) Medloal Exeminers will investigate and certify to all decatbe sup- posebly due to Injury. These include not only desihs 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 deatha from diseass 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 .- Cause of death means the dlaease, or complication which causea death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name tbe disease causing death. Aa related causes, name earlier morbid conditiona, if any, related to the principal cause and any important complication of the principal cause.
Statement of Oooupatlon .- Precise statement of occupation is very im- portant, so that the relative healthfulnesa of various pursuits can be known. Make some entry in thia aection 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 businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned an at school or at bomne. For a woman wbose only occupatiou was that of home bousework, write bouxework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as housekeeper-private family, cook- hotel, etc. For a peraon wbo had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 |
1
PLACE OF DEATH
2 FULL NAME
Annie Leeson Mis
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
F.
cinace
4 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
AGE 80
If less than 1 day
Hours.
Years
Months ....
Days
Usual
9 Occupation:
Industry
10 or Business:
11 Social Security No.
none
12 BIRTHPLACE (City)
Russia
(State or country)
13 NAME OF
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
unknown.
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
-
Russia
(State or country)
Www. S. Childressx
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
Signature of Agent of Board of /Health or other)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
FATHER
Javor LEERoy
LEERM
200m-10-'39. No. 8427-d
5 SINGLE
single write the word)
Minutes
17
Informant
(Address)
34 BEECK Rd. Brooklinin mm
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial br transit permit was issued;
Healthe Office 10/3/43
(Official Designations
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
3
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
219
1943, to Cad
3.
19.4.3.
I last saw b ... In alive on.
2
19 .. 5.3., death is said
to have occurred on the date stated above, at ....
a.m.
Immediate cause of death.
.....
.............
Broncho- parcumana
Due to Canedoal Hemon Tonga - Page
Due to Chromic Hypertenen Haut
...........
Other conditions
Samlite
(Include pregnancy within 3 months of death)
...
PHYSICIAN
Major findings :
Of operations
Date of ..........
Of autopsy
What test confirmed diagnosis? Chmal
20 Was disease or Injury is any way related to sccopatico ol deceased 7 ........
If so, specify ...
(Signed).
(Address) 148 WillofSt
Date 10/
19.9.3
21
Terveth 35cm
..... Place of Burial, Cremationm DATE OF BURIAL
22 NAME OF
HEury Y-
FUNERAL DIRECTORA
ADDRESS
470
tartaist. Buonkleine
Received and filed
1943
19
....
(City or town making return)
Registered No.
202
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
(If U. S.
3.
War Veteran.
specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
48 Cutler St. .... Winthrop Mass ....... St.
years
months / days.
(If nonresident, give city or town and state)
In this community 3 0
yrs.
mos.
days.
6 Age of husband or wife if alive .years
Suffolk (County) Wullcos (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
· Muchasleon. Hospitalar No.
Relation, if any,
Underline the cause to which death should be charged sta- tistically.
20
M. D.
A TRUE COPY ATTEST:
(Registrar)
Duration
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for 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 hury 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 Issuc such permits, or if there is no such board, from the clerk of the town where the person dicd ; 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 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 sooncr 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 of 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 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, Sco. 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) Atlending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ncss from disease unrelated to any form of injury.
(2) Board of Ilealth 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 lo injury. These include not only deaths caused directly or indirectly hy 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 infeclion related lo occupa- tion, the sudden deaths of persons nol disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which eauses death, not the mode of dying, e. g., heart fallure, 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 woman whosc 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
RHODE ISLAND STATE DEPARTMENT OF HEALTH
City or Town No. 223
i of Vital Statistics
CE OF DEATH
COPY OF RECORD OF DEATH
City or Town
Providence
St. and No.
1137 Broad St
(If death occurred in a hospital or institution, give ita NAME instead of street and number)
igth of residence in city or town where death occurred .......... yra ........... mos ...
....... ds. How long in U. S. if of foreign birth?
.yTB ............. mos ....... .
de.
L NAME
William J Cady
War Record.
(Name of War)
(a) Residence:
St. and No
(If nonresident give city or town and State)
24 Wilshire
City or Town
Winthrop
Mass
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
M
4. COLOR OR RACE |
W
5. Single, Married, Widowed,
or Divorced (write the word)
M
rried, widowed, or divorced (if wife, FULL MAIDEN name)
SBAND
) WIFE
Florence C Bradshaw
] OF BIRTH (month, day and year)
ILLBORN enter that fact here.
-
Months of
gestation
Years
54
Months
Days
Equipment Man
ustry or business in which work was done, as silk mill, saw mill, bank, etc.
ito deceased last worked at
this occupation (month and
year)
11. Total Time (years)
spent in this
occupation ..
UAIIPLACE (city or town)
(E te or country)
Boston .... Mass
I.ME William J Cady
4 JRTHPLACE (city or town).
New ..... Brunswick
State or country)
5 JAIDEN NAME (Full name) Mary Gibbons
MEDICAL CERTIFICATE OF DEATH
21. DATE OF DEATH
Oct 4 1943
19
(month, day, and year)
22.
I HEREBY CERTIFY, That I attended deceased from
19
to.
19
I last saw h ...
... alive on
19.
deato is said
to have occurred on the date stated above at ....
m.
The principal cause of death and related causes of importance
were as follows:
1 (See below)
Date
of onset
de, profession, or particular
kind of work done, as spinner
sawyer, bookkeeper, etc ..
If LESS than
1 day ........ hrs.
or .......... min.
Coronary Occlusion
Other contributory causes of importance:
Name of operation t
.Date of
Was there an autopsy?
What testa confirmed diagnosis? !
STATEMENT OF CAUSE OF DEATH
Cause of death means the disease, injury, or complication which causes death, not the mode of dying, e. g., hear asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier mo ditions, if any, related to the principal cause and any important complication of the principal cause. Under other contributo of importance, name other important diseases or injuries. Examples :
Example I
Example II
The principal cause of death and related causesj of importance were as follows:
Date of onset
The principal cause of death and related causes of importance were as follows:
Dat
Arteriosclerosis
1915
Attack of Epilepsy
1 u
Chronic interstitial nephritis
1921
Run over by street car
1t
Cerebral hemorrhage
July 5, 1927
Peritonitis
3 d
Other contributory causes of importance : Gallstones
May 1, 1923
Other contributory causes of importance : Gastroenteritis
...
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN Duplicate certificate received 5/2/44 ( sue dupliente file)
R-301 A
PLACE OF DEATH
Suffolk. (County) Minthus It ...... (City or Town) 3 6 2
Pleasant St. Wenthing
No. Man Niniful Sawyer (Cashman).
( If deceased is /a married, widowed or divorced woman, give alao maiden name.)
(a) Residence. No.
362 Pleasant $1: 0
St.
(If nonresident, give city or town and State)
/
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
1
2 FULL NAME
(Usual place of abode)
3 SEX
4 COLOR, OR RACE
White
temale.
5a If married, widowed, or divorced
HUSBAND of
IF STILLBORN. enter that fact here.
Usual
9 Occupation :
at home
Industry
10 or Business :
none
11 Social Security No.
none -
PARENTS
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect.
extracts from the laws on back of certificate.
Terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See Instructions and
8
AGE +9 Years
Months
Days
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
(or) WIFE of
Colis
(Give maiden name of wife ip full)
Francis troye
( Husband's name In full)
6 Age of husband or wife if alive 52
years
If less than 1 day
Hours ..
Minutes
12 BIRTHPLACE (City)
East Boston
(Siste or country)
mass.
13 NAME OF
FATHER
Cornelius Cashman.
14 BIRTHPLACE OF
FATHER (Clty)
Ireland
(State or country)
County boch.
15 MAIDEN NAME
OF MOTHER
Mary Mcauliffe
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
County Cork.
17
Informant
( Address)
362
Pleasant It stayed thishand .
I HEREBY CERTIFY that a satisfactory standard oertinoate of death was filed with ma BEFORE the burial or transit permit was issued:
3 ... (Signature of Agent of Board of Health other) Health Officer 10/6/43 (Omclal Designation) ( Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
10
1
4/4/3
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
1943
Ło.
That I
attended deceased from
(ase
I last saw him alive on
02+ 12 3)
.199
death Is said to
have occurred on the date stated above, at
11.05 H
m.
11:15 a
Duration
IMPORTANT
Immadiate cause of death
Carcinomator
Great
Due to uterus
Due to
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
aderco- cartesio 0
Major findings:
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