USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 13
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While
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) manuel
Sa If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive ... 32
.. years
7 IF STILLBORN, enter that fact here.
8
AGE ...
x
.. Months.
8
Days
If less than 1 day
Hours.
.Minutes
Usual
Salesman
9 Occupation :
Industry
Shows (Relaite) Business
10 or Business:
11 Social Security No .... East Boothbay
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Peter Mc Jungle
PARENTS
14 BIRTHPLACE OF
East Boothbay
FATHER (City)
(State or country)
Mande
15 MAIDEN NAME
OF MOTHER
unable to blum
BIRTHP
MOTHER (City)
(State or country)
OF mathe to obtain
17
Albert Shark ME Jungle Son
... )
Relation, if any
Informant
(Address) 40 Sagamore are Whacked Marca
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wine. D. Childelig (Signature of Agent of Board of Health or other) He atthe offerer 2/11/44
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ...
Fer
8
1944
(Month)
(Day)
(Year)
I HEREBY CERTIFY, That I attended deceased from
1942, to Jet- 8
19.4 cl
I last saw ham alive on Feb 8 .. 19 44 death is said to have occurred on the date stated above, at ........... 11.30 p.m.
Immediate cause of death. ......
Duration IMPORTANT
Chronic myocardeto mich left 3 years Ventricular failure Due to.
Due to.
Other conditions. (Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings:
Of operations
none
Date of
Of autopsy.
e
What test confirmed diagnosis ?.
Clinical
20 Was disease or injury in any way related to occupation of deceased? 220
If so, specify adres arbinger
M. D.
(Signed)
Waythey mes Date/.
2/10
1944
(Address) ....
21 Wantlinh Vendeand Winterty Mass Place of Burial, Cremation or Removal. / (City or Town)
DATE OF BURIAL.
19458
22 NAME OF
FUNERAL DIRECTOR Leur. R. Dension
ADDRESS.
Received and filed FEB 19 TC11 19
(Registrar)
1
(City or Town)
40 Sagamore avr Winthurts No ...
archibald Rupert Mc Jungle
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 40 Sagamore avenue Wusthof
.......
(If nonresident, give city or town and state)
*
years
months
days.
In this community 26 yrs.
mos.
days.
1
100m-2-'40-D-729-a
CAUSE OF DEATH In piam 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.
Underline the cause to which death should be charged sta- tistically.
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 bis last illness, at the request of an undertaker 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 deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, tbe 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 buman body in a town, or remove therefroin a buman 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 from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing 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 delivered to such 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, as required by law, or in lieu thereof a certificate as bereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of tbe attending physician. If death is caused by violence, the medical 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 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 sball constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval 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 sball 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 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 bave 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
Tbe 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 physician is absent from bome 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 septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from dlsease 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 complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, astbenia, 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 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 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 occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. 94 Lincoln St .Winthrop
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
38
Registered No.
f ( If death occurred in a hospital or institution,
St.
give its NAME instead of street aud nuniber)
2 FULL NAME
JohnA. Visconte
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
94 Lincoln St.
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
none
years
months
days.
In this community
25
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX male
4 COLOR OR RACE
white
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED married
Sa If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Anne(Cire medByme of wife in full)
( Husband's name in full)
6 Age of husband or wife if alive 33
years
> IF STILLBORN. enter that fact here.
8
AGE ... 52 Years
Months
Days
If less than 1 day Hours Minutes
Usual
Salesman
9 Occupation :
Industry
Alcoholic beverages
10 or Business :
11 Social Security No. .
028-09-7473
'2 BIRTHPLACE (City)
(State or country)
Mass.
Boston
13 NAME OF
FATHER
Vito Visconte
Major findIngs:
Of operations
Date of
Of autopsy ..
What test confirmed diagnosis?
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
, M. D.
If so, specify .........
(Signed) ...
(Address) YWashoping on Date 2-9- 1944
21
Winthrop C. Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL. February 11 1944
19
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : MMS- Cluldrefix .
(Signature of Agent of Board of Health or other) Health Officer 2/10/44
Pomcial Designationy (Date of Issue of Dermit)
18 DATE OF
DEATH
tel.
( Month)
8
(Day)
(Year)
19 | HEREBY CERTIFY,
Thet I attended deceased from
19.
to
19
I last saw h ....
alive on
19 .. .... , death is said to
have occurred on the date stated above, at.
2:30 A
m.
Duration
Immediate cause of death
h. C. Ward Auna IMPORTANT
Due to
Due to.
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Mary Cornetta
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17 Informant ( Address)
Anne T .Visconto Belation, if any
94 Lincoln St. Winthrop
22 NAME OF
FUNERAL DIRECTOR
R. C. Kirby Click
ADDRESS
Boston
Received and flied
19
( Registrar)
100M-€ - 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 effect. PARENTS
PHYSICIAN - IMPORTANT
(Was deosesed a
no
U. S. Wer Veteren,
if so specify WAR)
(Usual place of abode)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
1944
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith. after the death of a person whoin he has 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 certifcate of death, stating to the best of his knowledge and behef the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one, where same was contracteil. the duration of his last illneaa, when last seen alive by the physician or officer and the date of bia 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- teeu, shall, if the deceased, to the best of his knowledge and helief, aerved in the army, navy or marine corps of the I'nited States in any war in which it has been engaged, iusert in the certificate a recital to that elect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or iinmediate cause of death as nearly as he can state the saine. 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 bumired and fourteen, the word "war" shall include 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 sixteen and nineteen hundred and seventeen. C. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a buman body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or ita agent appointed to issue sucb permits, or if there is no such board, from tbe clerk of the town where the person died; and no undertaker or other person shall exhume a buman body and remove it from a town, from one cenietery 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 ita agent aforesaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there aball bave been delivered to such board, agent or cierk, as the case inay be, a satisfactory written atatement 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. ot in lieu thereof a certificate aa hereinafter provided. If there ia no attending physician, or if, for sufficient reasons. hia certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who ia a member of the board of health, or employed by it or by tbe aelectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence. the medl- 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 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 body haa been sooner obtained hereunder. If the death certificate containa a recital, ae 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 ageut. 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 giveu and the physician certifying the cause of death shall thereafter furnish for registration any other since+ 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 uray require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a hunian body or the ashea thereof which have been brought luto the coninicuwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permita, or if there is no such hoard, from the clerk of the town where the boily 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 ibe interment ia made .... Cbap. 114. Sec. 46. C. L., (Tercentenary Edition).
Medical examinera shail 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 liea aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawe calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha 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 physiolans will certify to such deatha 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 pbsal- cian ia ahsent from home when the certificate of death ie needed.
( 3) Medioal 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 cheniical (drugs or poisons), theriual, or electrical agents, ami deaths following abortion, but also deatha from diseasa resulting from injury or Infootion 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 meana the disease, or complication which causea death. not the moile of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease causing death. As related causes, name earlier morbid conditiona, if auy, related to the principal cause and any important complication of the principal cause.
Statement of Oooupation .- Precise statement of occupation ia very im- portaut, so that the relative healthfulnesa of various pursuits can be known. Make aome entry in thia aection for every person aged 10 yeara 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 had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at hoine. For a woman whose only occupatiou waa that of honie housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-303-A
1
PLACE OF DEATH
No.
Sullak (County) Wuttrop (City or Toyn) Bellevue Cerc. #
The Countantwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agent.
Registered No.
20
St. [ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME. alfred w. Kershaw
(If deceased is a married, widowed or divorced woman, give also maiden name.) 55 Bellevue Lave Winthrop 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 4 8 yrs. ~ mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mile
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) muriel
Sa If married, wltowed, or dienst Ingalls
HUSBAND of
(Give anaiden nance of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband os wife If allve ....
50
years
7 IF STILLBORN, enter that fact here.
AGE.
Years 7 Months ... X .Days
If less than 1 day Hours. ...... .Minutes
Usual
9 Occupation :
Guard
Industry
american air Lines Ecet Sosten
10 or Business :
11 Social Security
032-05-3213
12 BIRTHPLACE (City)
(State or country)
Chicago
13 NAME OF
FATHER
William . J. Kershaw
PARENTS
14 BIRTHPLACE OF
FATHER (City)
London
(State or country)
England
15 MAIDEN NAME
OF MOTHER
alma, Evalina Noxon
16 BIRTHPLACE OF
MOTHER (City)
Pación
(State
(Canada)
Ontario
17 Inny Dorothy AKershaw. (Address) 10 Wendree & cambridge miss
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bunal or transit permit was Issued : 1 2/17/44 Signature of Agents of Board of Health or other) Health Officer (Official Designation) (Date of Issue of Vermit>
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February - 14 - 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that 1 have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fullf.) ʻ acute cardiac Dilata Ture Hypertensie Heart Disease
20 Accident, sulolde, or homlolde (specify)
Date of ocourrenoo.
.19
Where did Injury ocour ?
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In publlo
place ?
(Specify type of place)
Injury
Found dead in his head
Manner of
Nature of Injury
While at work?
.Was there an autopsy ?.
200
21 Was disease or Injury in any way related to ocoupation of deceased ?. -
If so, specify
.
M. D.
(Signed)
Button HerDate-14-1944
(Address)
22
Place of Burial, Cremation or Removal.
(City or Town)
1944
23 NAME OF
FUNERAL DIRECTOR.
Choo. R Bennon
ADDRESS
Nurellent suaso
Received and filed
FER 19 1944
19
(Registrar)
..
extracts from the laws relative to the return of certificates of death. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a reoltal to that effeot
50m (g)-1-41-4667
Relation, if any DATE OF BURIAL
wie
8
52
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
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 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 registration a standard certificate of deatlı, 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.
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, 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 tbat 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, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-cight 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.
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