USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 37
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(3) Medical Examiners will investigate and certify to all deaths sup- posably 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 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 .- 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 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 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, how- ever, 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 Wintherole (City or Town) Hermon No. James Kelly 42
The Commonwealth 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.
Registared No.
369
§ (If death occurred in a hospital or institution,
{ give its NAME instead of street and numher)
2 FULL NAME ..
«Il deceased is a married, widoyed or divorced woman, giye also maiden name.)
(a) Residence. No.
1/2
Hermon
(Usual place of abode)
no.
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
months days.
In this community
18 yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male White
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word) Married
Sa If married, widowed, or divorced Mary G. Whiteley, HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if oliva
62 years
7 IF STILLBORN, enter that fact hera.
AGE
8 72 Years Months Days
If lass than 1 day Hours Minutas
Usual
9 Occupation :
Master Mariner
Industry
10 or Businass :
PW. D. Ferry Dir. G. g. B.
11 Social Security No.
none
12 BIRTHPLACE (City)
( Sinte or country)
Easy 130stor
ricass.
13 NAME OF
FATHER
John Kelly
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Ann Brobbey Brojday
16 BIRTHPLACE OF
MOTHER (City)
St. John
(State or country) New Brunswick
17 Mary G. Kelly Relation Af any Informant (Address) 412 / Htermon Stry Writh
I HEREBY CERTIFY that a satisfactory standard oartifloats of death was fled With me BEFORE the burial of transit permit was Issued : Han S. Children &
Signature of Afent of Board of Health or other)
Health Officer 5/29/44
(Official Designation) (Date of Issue of Permity
18 DATE OF
DEATH
may
28,
1944
(Month)
(Day)
(Year)
19 HEREBY CERTIFY, That I attendad dacaasad from
San. 16,
19 1944 10
May 28,
19 44
um
may 28
19 ...... daath is sald to
have occurred on the data stated above, at
7: 4PM.
.m.
Immediate cause of death.
Coronary Thambases
Duration 10 days IMPORTANT
1 year
....
5 years
Other conditions.
( Include pregnancy within 3 months of death)
Major findinga:
Of operations
Data of.
Of autopsy.
What test confirmed diagnosis?
IMPORTANT
Physician Underline the cause to which death should be charged sta- 1istically.
20 Was disease or injury in any way related to occupation of daceased ?
( Sig
If so, spaoify ..
Samme B. Hallen,
M. D.
(Address) 270
Stanley st.
..... Data .....
0199 1944
21
Winthrop
Place of Burial, Cremation or Removal. (City or Town) 44
DATE OF BURIAL.
May
31
19.
22 NAME OF
FUNERAL DIRECTOR.
Totu
C. Kelly
ADDRESS
11 Meridian St . E. J13
19 ....
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requiree physicians to insert a recital to that effect. PARENTS
100m(i)-1-44-13634
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
no
so specify WAR)
St.
Winther of
(If nonresident, give city or town and State)
(Give maiden name of wife in full)
allve on.
Due to ..
Hipertening antonio Saluto
КакТолинь
MEDICAL CERTIFICATE OF DEATH
Due to
Winthrop
Received and Alad MAY 3-1-1944" ( Registrar )
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 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 hoth 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 expedition 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 Mexican horder service of nineteen hundred and sixteen and nine- teen 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 hody 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 hoard, 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 tomh other than the receiving tomh 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 huried. No such permit shall be issued until there shall have heen delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall he accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian wbo is a member of the hoard of health, or employed by it or hy the selectmen for the purpose, shall upon application make the certificate re- quired of the attending 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 within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker desiring to make such removal sball constitute a permit for such removal; provided, that such hody shall he returned to the town from which it was removed within thirty-six hours after sucb removal, unless a permit in the usual form for the removal of such body has heen sooner obtained bereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The hoard 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 aud the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies 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 sball forthwith go to the place where the hody lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
No undertaker or other person sball bury a buman hody 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 hody is to be huried 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. . .. Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
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 hedside 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 witbout recent medical attendance or whose pby- sician 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 indirectly hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, 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 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 im- portant, so that the relative healthfulness of various pursuits can he 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, how- ever, designate the occupation hy 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
DEATH
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
110
(City or town making return)
State Board of Healt Bureau of Vital Stabg
FLORIDA
Registrar's No.
1. PLACE OF DEATH:
Pinellas
3901
Precinct No.
(Write name, not number)
(c) City or
St. Petersburg
City or Town NOS
39-511-
(d) Name of hospital or institution enRoute To Dound BER Hose 6 (If not in hospital or institution, write street number or location)
(e) Length of stay: In hospital or institution
4 months
At place of death (Specify whether years, months or days)
2. USUAL RESIDENCE OF DECEASED:
(a) State
Massachusetts
(b) County.
(c) City or Town
Winthrop
(If outside city or town limits, write RURAL)
Street No. .
(If rural, give location)
Citizen of Foreign country? No
yes or no
If yes, name country
Howard Augustus Gilson
3. FULL NAME OF DECEASED
3 (b) Social Security
3 (a) If veteran,
Spanish Amer. No. 025-05-7956
name war
4. Sex Male
5. Color or race
6. Single, married, widowed or divorced Widowed
21. I hereby certify that I attended the deceased from 10 44 To. Jan /3 1944:
Hat I Inst saw h im
alive on
and that death occurred on the date and hour stated above. Immediate cause of death
Como Exclusion
Due to
tant
...
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings: of operations
(Give date of operation)
Underline the cause to which death should be charged sta- thetically.
22. If death was due to externai causes, fiil in the following:
(a) (Probably) Accident, micide, homicide (specify)
(b) Date of occurrence
(c) Where did injury occur?
(City or town) (County) (State)
(d) Did injury occur in or about home, on farm, in industrial place, in pobile piace?
(Specify type of place)
94 15 While at work? (e) Means of injury
23. Signature
M. D.
(a) Address Find TheendBl Date Signed
4/19/44
9
(Official Designation)
(Date of Issue of Permit)
À TRUE COPY ATTEST:
(Registrar)
100m (h)-1-41-4695
17. Burial, cremation or removai?
17 (a) Date Jan. 15, 1944 17 [op) Plad Cambridge, Mass.
18. Funeral Director's Signature
18 (a Address St. Petersburg, Florida
19. Filed 1-13 1944
ocai Registrar
.......
ation, mber) T
......
days.
......
from
id to tion tant
6 (a) If married, widowed or divorced, husband of (or)
Bertha Letourneau
gilson
6 (b) Age of husband or wife, if alive
7. Birth date of deceased
Sept. 23. 1873 (month)
(day)
(year)
8. Age: Yeare 70
Months
If less than one day
3
Dayı
21
hrs.
min.
9. Birthpiace Radfield Lowa
(City, town of county)
(State or foreign country)
10. Usuai occupation Gen. Mgr. F.S. Payne Elevator Co
11. Industry or business
12. Name Henry E. Gilson
13. Birthplace
14. Maiden name
15. Birthplace unknown.
16. Informant's Signature Mala Nay
MEDICAL CERTIFICATION
January
Day
13
20. Date of Death: Month
hour 3
Minote 30 a. M.
Duration
CIAN erline use to death d be d sta-
ly.
of antopsy
D.
P
16 (a) Address
Removal
....... (a) County (b) Precinct Town AMOUND MOTH Mother Father If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF wife of
NON- RESIDENT
OF DEATH
State File No.
24
Retired
years
White
Year
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 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 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, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or hy section forty-five of chapter one hundred and fourteen, 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, specifying 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 pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section 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 expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not heen buried, until he has received a permit from the hoard of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiv. ing tomh to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the hody ls huried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may he, 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, hy 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 in- sufficient, a physician who is a member of the board of health, or em- ployed by it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall make such certificate. if such a permit for the removal of a human hody, 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 hody 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 heen sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-
six, that the deceased served In the army, navy or marine corps of the United States in any war In which It has been engaged, such recital shall appear upon the permit. The board of health, or Its agent, upon receipt of such statement and certificate, shall forthwith countersign It and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifylng the cause of death shall thereafter furnish for registration any other necessary Information which can he 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).
Medical examiners shall make examination upon the vlew 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, Sec. 6.
No undertaker or other person shall hury a human body or the ashes thereof which have heen hrought into the commonwealth until he has received a permit so to do from the hoard of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the hody is to he buried or the funeral Is to he held, or from a person appointed to have the care of the cemetery or burlal ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the 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 hedside 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 home when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), 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 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, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid 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 he 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
M R-301 |
1 Nc PLACE OF DEATH 3 SEX (or) WIFE of 7 IF STILLBORN, 8 AGE Ye Usual 9 Occupation: Industry 10 or Business: 13 NAME OF FATHER (State or cou PARENTS 16 BIRTHPLA MOTHER (State or c 17 Informant (Address) 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. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 1I Social Securi 200m-10-'39. No. 8427-d
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
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