USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 78
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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 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 homc. 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
R-301 A Suffolk County) Winthrop 1 (City or Tegn) 127 Bowdoin No. Martha M. Killilea PLACE OF DEATH
The Commontoralth of Massarinisetts 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.
231
( If death occurred in a hospital or institution,
give its NAME Instead of street aud nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME
( If deceased Is a married, widowed or diyorced woman, give also maiden name.)
(a) Residence. No.
127 Bowdoin
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
yeara
months
days.
In this community
15 yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
Female White
5 SINGLE
( write the word)
Widowed
MARRIED
WIDOWEO
or DIVORCER
Sa If married. widowed, or divorced
HUSBANO of
(or) WIFE
Welive maiden name of fire in bleu
( Husband's name in full)
6 Age of husband or wife if ative
years
> IF STILLBORN. enter that fact here.
8 62 years AGE Months Oays
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housework
Industry
10 or Business :
Own Home
11 Social Security No.
more
12 BIRTHPLACE (City) ......
( State or country)
East Boston Mass
13 NAME OF
FATHER
John Sullivan
14 BIRTHPLACE OF
FATHER (Cit)
Boston
(State or country)
mass
15 MAIDEN NAME
OF MOTHER
Ellen Clancy
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
mass
17
Informant
( Address )
alice Killilea duringher)
127 Botadoin
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : Van. D. Children
Il atthe
(Signature of Agent of Bord Of Health or other) 11/27/44
(Official Designation) ( Date of Issue of Permft)
18 DATE OF
DEATH
IV- VEMber
23
( Jfonth)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deosased from
SENT- 11, 1939, to Nov-23
19
44
I last saw h.
alive on
Nov. 28, 19 44 death is said to
have occurred on the date stated above, at.
11.30 P.
.. m.
Immediate cause of death.
Cerebral
Hemorrhage
Duration IMPORTANT 3 days
...
Que to
arteriosclerosis 8
HYPERTENSION
Due to
Other conditions
( Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
IMPORTANT Physician Underline the cause to which death shoul .! charged sta. tistically.
20 Was disease or injury in any way related to onoupation of deceased ? If so, specify.
('Signed)
Edwa
rand
......
-
ramp 21 M. D. Date NayHp 44.
(Address) 200 was Ghin Dying
21
Winthrop
Winonaje
l'lace of Burial, Cremation of Removal.
(City or Town)
OATE OF BURIAL
nov
27
1944
22 NAME OF
FUNERAL
Charles H. Treanor
ADDRESS
East Boston
Received and Aled. NOV Z"7"1944 .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
St.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(Usual place of abode)
1944
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or regiatered hospital medioal offioer shall forthwith, after the death of a person whoin he has attended during his last illness. at the request of an undertaker or other authorized person or of ans meniber of tbe faniily of the deceased, furniab for registration a standard certifcate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. where same was contracted. the duration of his last fllnesa, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Cilap. 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 hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, aerved in the army. usvy or marine corps of the I'nited States in aus war in which it has been engaged. insert in the certificate a recital to that effect, speci- fylug 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 saine. For neglect to comply with sny 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 and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place between February fourteenth, eigliteen hundred and ninety. eight and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen bundred and seventeen. G. L. Clisp. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a buman body in a town, or remove tlierefrom a human budy which has not been buried, until he has received a permit from the board of health, or ita agent appointed to issue such permits, or if there is uo such board, from the clerk of the town where the person dled; and no undertaker or otber person shail exhume a buman body and remove it froin a town. from one cemetery to another, or from one grave or tomb other than the receiving tomb to another In the same cemetery, until be has received a permit from the board of health or ita 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 sucb board, agent or clerk, as the case tnay be, a satisfactory written statement containing the facta required by law to be returned aud 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. 01 in lieu thereof a certificate as liereinafter provided. If there is no attending physician, or if, for sufficient ressons, hla certificate cannot be obtained early enough for the purpose, or ia insufficient, a physi- 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- cai examiner ahall 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, tbe certificate of death made as above provided and in the possession ot tbe undertaker desiring to make such removal shall constitute a permit for much 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, 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 statentent and certificate, shall forthwith countersign it and transmilt 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 wa to the manner of cause of the death, which the clerk or registrar may require .- Cbap. 114. Sec. 46, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a hunian body or the ashes thereof which have been brought lino the commonwealth until he has re- ceived a jærmit so to do from the hoard of health or its agent appointed to issue such permits, or if there is no such hoard, front the clerk of the town where the body is to be buried or the funeral is to he held, or from a person apiminted to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Btedical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died hiy violence. If a medical examiner has notice that there is within lils county the hody of such a person, he shall forthwith go to the place where the body iies aud take charge of the same; ... - General Laws, Chap. 38, Suc. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deatha only aa 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 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 pbysi- cian ia ahsent from home when the certificate of death Is needed.
(3) Medlos! Examiners will investigate and certify to all deatba sup- posably due to Injury. These Include not only deaths caused directly or in- directly by traumatiam (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agenta, all deaths following abortion, but also deaths from diseaas resulting from Injury or Infection ralated to occupation, the sudden deaths of persons not disablad by recognized disease, 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 fallure, asphyxia, astbenla, etc. Aa principal cause name tbe disease caualng death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statemant of Oooupation .- Precise statement of occupation ia very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the disease causing death, report the usual occupation prior to illness. If the deceased bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at boine. For a woman wbose only occupatiou waa that of bonie bousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa bousekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
......
(City of Town) 53 Just One
The Commontoralile of Massarinisetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or ite Agent.
Registered No.
232
St.
@Mary a. Kershaw
( If decessed is a/married, widowed or divorced woman, give also maiden name.) 33 Sust Line St.
Length of stay: In hospital or Institution
(Before desth)
(Specify whether)
years
months days.
In this community/D
yrs.
mon.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
( write the word)
MARRIED
WIDOWED
Classid
-
( Husband's name in full)
years
f less than 1 day
Hours
Minutas
a Name
Hansemais
12 BIRTHPLACE (City)
( State of country )
Guland
13 NAME OF
FATHER
Michael Ring
Tuland
15 MAIDEN NAME
OF MOTHER
Margaux Calmar
Fuland
James Kershaw Vicentau .
Section At any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Mm. S. Children
(Signature of Agent of Board of Health or other)
Health Office 11/28/44
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Mar
26
1900
( Month)
(Year) (Day) That i attended deosased from
19 | HEREBY CERTIFY,
nov 20
...
19 44
no 26
19.
44
I last sawhen alive on non
2.6. 19 4, death Is said to
have oocurred on the date stated above, at.
6-10P
.m.
Duration
Immediate oeuse of death.
Cerebral Hemorrhage
IMPORTANT
Aur 194
Due to
Cerchial arteriosclerosis
1940
..... ....
IMPORTANT
Major findings:
Of operations
none
Date of.
Of autopsy
none
What test confirmed diagnosis?
20 Was disease or injury, in any way related to oooupation of deceased ? no
If so, speolfy
(Signed)
acBenjamin
M. D.
( Address)
816 Broadway Date
11/27 1944
21
Woodlawn
Place of Burial, Creniation or Removal.
DATE OF BURIAL.
(City or Town)
11/29
19.4x
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Rentre
R. A. AT Null
Received and flied.
******----- 4944-
19
( Registrar)
100M-4 -2-42-8855
PLACE OF DEATH
1 No. 2 FULL NAME (a) Residence. No. (Usual place of abode) 3. SEX 4 COLOR OR RACE Sa If married, widowed, or divorced HUSBAND of (or) WIFE of 6 Age of husband or wife if alive > IF STILLBORN. enter that fact here. Usual 9 Occupation : Industry 10 or Business : 11 Social Security No. 14 BIRTHPLACE OR FATHER (City) (State or country) 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) 17 informant. ( Address if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effeot. 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 60 Years Months Days
§ ( If death occurred in a hospital or institution, give its NAME instead of street and nuniber)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, If so spoolfy WAR)
(If nonresident, give city or town and State)
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Physician
L'aderline the cause to which death should be charged sta- tisticaily.
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 stteiled during his last illness, at the request of an undertaker or other authorizeil per-on or of sus member of the family of the deceased, furnisb for registration a standard certifcate of desth, stating to the best of his knowledge and belief the kaine of the deceased. his supposed age, the disease of which he ilied. deflued as re- quired by section ore, wliere same was contracted. the duration of his last illness, when last seen slive 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 desth as required by the preceiling section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased. to the best of his knowledge and belief, served in the ariny, 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 elect, 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 saine. For neglect to comply with suy 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 bundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea. he deencd to have taken place hetwcen February fourteenth, eigliteen hundred and ninety-eiglit and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen bundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or ita 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 froin a towu, from one cenietery 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 abali have been delivered to such board, agent or clerk, as the case inay be, @ satisfactory written statement containing the facts required by law to be 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, o1 in lieu thereof a certificate as liereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a meniber of the board of health. or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence. the 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 conunouwealth cannot be obtained early enough for the purpose, the certificate of death made as 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 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 hren engaged. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement aud certificate. shall forthwith counter-ign it and transmiit 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 niece+ sary information which can be obtained as to the deceased, or as to the mancher of 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 hunian body or the ashes thereof which have been brought Into the commonwealth until he lias re- ceived a permit so to do from the board of health or its agent appointed to issue such perinits, or if there is no such hoard, front the clerk of the town where the body is to be buried or the funeral is to he held, or fromn a person appointed to have the care of the cemetery or burial grommul in which tbe interment is made. ... Chap. 114. Sec. 46. C. L., (Tercentenary Editiou).
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 conuty the hody of such a person, he shall forthwith go to the place where the body lies aud take charge of the same; ... - General Lsws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha 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 physlolans will certify to such deaths 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 is ahsent from home when the certificate of death is needeil.
(3) Medloal 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 deaths following abortion, but also deaths from diseasa 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 moile of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principai cause nsme the disease caualng 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 Oooupatlon .- Precise statement of occupation la very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. if the occupation had been given up or changed on account of the discase causing death. report the usual occupation prior to illness. if the deceased had retired from business, report the usual occupation prior to retireinent. Children not gainfully employed may be returned aa at school or at home. For a woman whose only occupatiou was that of honie bousework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
(County)
Winthrop
(City or Town)
No. 135 .... Cliff .... Ave ...
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 Agen 2233
Registered No.
( If death occurred in a hospital or institution, give ita NAME instead of street and number)
2 FULL NAME ......... Anni ...... Sms .. ].1 ...
Gibbs
( If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
U. S. War Veteran,
if so specify WAR)
...
(a) Residence. No.
125 cliff Ave.,
(Usual place of abode)
........
St.
(If nonresident, give clty or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community 20 yrs.
- mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE| 5 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If marrled, widowed, or divorced HUSBAND of
(or) WIFE of
Albert (Fire 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
77
AGE
Years
2
Months
28
Days
-
if less than 1 day Hours Minutes
Usual
9 Occuoation :
Housewife
Industry
10 or Business :
At Home
11 Social Security No.
none
Huntington
12 BIRTHPLACE (City)
( State or conutry)
N. Y.
13 NAME OF
FATHER
James B. Small
14 BIRTHPLACE OF )0
1
. -
FATHER (City)
not known
(State or country)
15 MAIDEN NAME
OF MOTHER
not know
16 BIRTHPLACE OF
20
MOTHER (City)
not ... known
(State or country)
17 Informent ( Address)
Town Winthrop Welfare DeBiatlonaduray
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