USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 49
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(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is ahsent 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 abortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the 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 he 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
ar
C C
RM R-302
of the city or town in which the deceased resided. (See Chap. 16, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased ..
PLACE OF DEATH
7 Hampshire (County)
The Connuontovalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Northampton
(City or town making return)
1
Northampton
(City or Town)
No. Veterans Administration
give its NAME instead of street and number)
2 FULL NAME
Walter C. Osgood
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
Winthrop, Massachusetts
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ..
(Before death)
(Specify whether)
17
years
4
months
1.
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Sa If married, widowed, or divoroed HUSBAND of
(or) WIFE of
--
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
About .53Y . Day's
If less than 1 day
.Hours .....
Minutes
Usual
9 Ocoupation :
Cook
Industry 10 or Business :
11 Social Security No.
Lowell
-
13 NAME OF
FATHER
William B. Osgood
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Margaret Clinton
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Informant. ( Address)
Hospital Records ( Relation, if any
A TRUE COPY.
ATTEST :
(Reglatrer of city or town where death occurred)
DATE FILED
July.24.
19
45
18 DATE OF
DEATH
July
.2.3
1945
( Month)
(Day)
(Year)
12.I HEREBY CERTIFY,
That I attended deceased from
March 22
19.28 ... ,
to
July .... 23., .......
19 .... 45
last saw him alive on July 23,
1945., death Is sald to
have occurred on the date stated above, at.
8:20 P.m.
Duration
Immediate cause of death
Bronchogenic ..... car.
cinoma
6.mos.
Due to.
Due to
Other conditions.
D
ntiaPraecox
(Include pregnancy within 3 months of death)
Paranoid
Major findings :
Of operations.
None
Date of
Bronchogenic Carcinoma
th. Metastasis
What test confirmed diagnosis ?..
Autopsy.
20 Was disease or Injury In any way related to occupation of deceased i.Q
If so, specify.
(Signed) R. T. O Neil, Lt. Col. M.C. ClingPair
(Address)Northampton., Mass. . Date.7 ..... 2.4 ... 19 45
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ... I.National , Pinelawn
(Cemetery )
DATE OF BURIAL S.u.l.y .......... ,
(Cilt or Town) 19
22 NAME OF
FUNERAL DIRECTOR
James H. Quinn
ADDRESS
71 King St. Northampton, Mass
Received and filed
AUG 8 -1945
19
(Registrar of City or Town where deceased resided)
20YRS ·
Underline the cause to which death should be charged sta- tistically.
PARENTS
12 BIRTHPLACE (City)
(State or country )
Massachusetts
50m (e)-1-41-4667
(If death occurred in a hospital or institution,
St.
(If U. S.
war Veteran,
specify WAR) War 1
World
Registered No.
138
1
AUG-SWUNG M
01 A Sifelt Which Kenauto 1 (City or Town) U Shane Dri No.
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 Agenn 130 1
Registered No.
A { {If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME ( If deceased is a married, wid usd
or divorced woman, give also maiden name.)
I'dhave drive
St.
(If nonresident, give city or town and State)
Length of stay: In Ansoltet or Institution
( Before death)
( Specify whether)
years
months
days.
In this community 50 yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name in fuli)
6 Age of husband or wife if elive years
7 IF STILLBORN, enter that fect here.
AGE
8 5 grears - Months Days
If less than 1 dey
Hours
Minutes
Usual
9 Occupation :
at home
Industry
10 or Business :
11 Social Security No.
Name
12 BIRTHPLACE (City)
( State of country)
Bostan 3
13 NAME OF
FATHER
Frank La Gente
14 BIRTHPLACE OF
FATHER (City)
(State or country)
France
15 MAIDEN NAME
OF MOTH
Galerie De Larey
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
N.S.
17 Victor Nelson ( Relation, If any
Informant ( Address)
i HEREBY CERTIFY that a satisfactory standard certificata of death was filled with me BEFORE the burial or transit/ permit was Issued: Wie-S- Childress x (signature of great of Board of Health of other )
Health ruce
7/31/45
7(Ömcial Designation) ( Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
28 1945
(Day)
1
(Year)
19 | HEREBY CERTIFY,
July 21,, 1945.
to
attended deosased from
Viast saw h .___ / ....... ailve on
July 28, 1945, death Is said to
have occurred on tha date stated above,
1105 P.m.
Immediate oeuse of death
Bronchopneumonia
Due to
Carcinomatosia
Due
Carcinoma of Vagina
6 months
Other conditiona ..
Itiona.
( Include pregnancy within 8 months of death)
IMPORTANT
Mejor findings :
Of operations
none
Date of.
Of eutopsy
hour
What test confirmed dlegnosls ?
Clinical + Laborator
Underline the cause to which death should be charged sta- tistically. no
20 Was disease or injury in ony way related to occupation of deceesed ? if so, spacify ... (Signed) Maurice Traunstein dress) 562 shulgift days
.¿ M. D. Lagos 1945
21 Wenthrap Tem
(City or Town)
Place of Burial, Crentiof or Remyml. DATE OF BURIAL. a
19.525
22 NAME OF
FUNERAL DIRECTOR
Tingly Bron
ADDRESS
Winthrop, Mais
Received and Alad.
19.
JUL 31 1945
( Registrar)
100m(1)-1.44-13634
If deceased was a U. S. War Vateran, Q. L. Chap. 46. Section 10, requires physicians to Insert a recital to that offact. PARENTS
PLACE OF DEATH
..... 1 w rac mal D Nelson
PHYSICIAN · IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) HOZ
(a) Residence. No.
(Usual place of abode)
maiden nafty die in full
Thet
July 28
19
45
Duration
IMPORTANT 6 days. 2 months
Physicien
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 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 hundred 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 that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relicf 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 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 body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall 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 hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the 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 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 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 statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the 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 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 bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such 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
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- 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 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 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
RM R-301
PLACE OF DEATH
(County)
(City or Town)
Thr Commaumralth af Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
140 ......
-
{ (If death occurred in a hospital or institution, St, { give its NAME instead of street and number) PHYSICIAN-IMPORTANT (Was doroaged a
2 FULL NAME
PANTMEN OF NFAITH JORI GH OF MANHATTAN 'Sf
Certificate of Death
1 15
65
1. NAME OF DECEASED (Print or Typewrite) First Name
Middle Name
PERSONAL PARTICULARS (To be filled in by Funeral Director)
MEDICAL CERTIFICATE OF DEATH (To be filled in by the Physician)
2 USUAL RESIDENCE: (a) State .. MASS
16 PLACE OF DEATHI
(a) NEW YORK CITY: (b) Borough
MANHATTAN
(b) c. WINTHROP (c) Pont Ofice and Zone ...
(d) NO ..... 20 LEWIS AVE.
Ave. or Institution Man (If not in hospital or institution, give street and number.) Ste
(If in rural area, give location) (e) Length of residence or stay in City of New York immediately prior to dealb NON RES
(d) Length of stay at place of death immediately prior to death 5 DAYS
17 DATE AND HOUR OF
(Month) (Day) (Year) (Hour) AM
18 SEX 19 COLOR OR RACE
20 Approximate Age 66 YEARS
5 DATE OF BIRTH OF
(Month)
(Day)
(Year)
DECEDENT
JANUARY
23-1879
6 AGI 66 3
Nativ. Mother
A Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
IRON WORKER
# Industry or business in which work was done, as slik mill, sawmill, bank, own business, etc. CONSTRUCTION
B BIRTHPLACE OF DECEDENT: (a) State UNITED STATES
(b) County PHILA (e) City Town or Village PHILA, PA
080-
9 OF WHAT COUNTRY WAS DECEDENT A CITIZEN AT TIME OF DEATH?
u. S. .
10 WAS DECEASED WAR VETERAN? IF SO, NAMS WAR
No
Type Accid.
12 BIRTHPLACE
OF FATHER
(State or country) UNITED STATES
Witness my hand this 13 day of MAY 19 4-5.
Sign
re Mansiones filhaMD
Address metropolitan toque
M. D.
15 SIGNATURE OF INFORMANT MATTIE
HALL
WIFE
CAMDEN, N.J.
22 PLACE OF BURIAL OR CREMATION
NORTH WOOD CEM, PHILA, PA
DATE OFBURIAL OR CREMATION MAY 16TH 1945
23 FUNERAL DIRECTOR New York Funeral Service ADDRESS BUREAU OF RECORDS AND STATISTICS DEPARTMENT OF HEALTH
148 East 745 Att
PERMIT NUMBER 2383
CITY OF NEW YORK
eteran?
R)
or town and State)
mos.
days.
CATH
(Year)
attended deceased from 19
9 . . , death is said to
m.
Duration Important
Important
PHYSICIAN
Underline the cause to which death should be charged sta- tlstically.
used
14 BIRTHPLACE
OF MOTHER RELAND (State of country)
RELATIONSHIP TO DECEASED
ADDRESS 817 FEDERAL ST.
ate
19
or Town)
19
(Signature of Agent of Board of Health or other)
Received and filed.
AUG 2 1 1945
19
..... (Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
(Registrar)
100m(h)-1-41-4695
1 17FI-1 Bors-Death lastitution Boro Reskl. Y Arca-Dist. Occupation Nativ. Dec. 01 Citiz. Dec. Cause 1 Cause 2 Operation THIS CERTIFICATE NOT VALID UNLESS FILED IN THE HEALTH DEPARTMENT DO NOT WRITE IN THIS SPACE, MARGIN RESERVED FOR CODING AND BINDING AM-Autop. / Com. 7 mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF 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. If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. .... N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- O. T. Accid.
197- MAY 14 AM 11 04
SAMUEL
HALL
Last Name Social Security Number
WINTHROP (c) Name of Hospital METROPOLITAN
3 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word) MARRIED
4 WIFE HUSBAND
of MATTIE
MALE WHITE
21 I HEREBY CERTIFY that (+ attended the deceased)* (a staff physician of this institution attended the deceased)*
If LESS than 1 day.
yrs. 20 mos. days
bra. or min. from. MAY 8- 19 45, to MAY 13, 1045, 50
and last saw h. M alive at 8 AM on MAY 13,1945
I further certify that deaveids no caused, directly or indirectly by accident, homicide, suicide, acute or chronic poisoning, or in any suspicious or unusual manner, and that it was due to NATURAL CAUSES more fully described in the confi- dential medical report filed with the Department of Health.
I further certify that deals no due to communi- cable disease listed in Section 103 of the Sanitary Code, (see over), which requires that the casket must be permanently scaled before removal from the place of death.
* Cross out words that do nto apply.
t See first instruction on reverse of certificate.
I PARENTS OF DECEASED |
11 NAME OF FATHER OF DECEDENT
ISAAC
13 MAIDEN NAME
OF MOTHER OF DECEDENT MARY BURNS
BUILDING
@ |7 Occupation!
DEATH MAY 13 1945
8.50
Certificate No ...
No.
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 bls last Illness, at the request of an undertaker or other authorized person or of any member of the famlly 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 age, the disease of which he dled, defined as required by sectlon one, wbere same was contracted, the duration of his last illness, when last seen allve by tbe physiclan or officer and the date of bis deatb . . . 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 fourteen, 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 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 sball 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 tbe 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 bundred 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 bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the 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 wbere 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 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 by the selectmen for the purpose, shall upon application make the certificate required of the 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 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 re- inoval of such body has been sooner obtained hereunder. If the deatb certificate contains a recital, as required by section ten of chapter forty-
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