USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 64
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SPACE FOR ADDITIONAL INFORMATION
R-303-A
1
PLACE OF DEATH
Sullink (County) Winthrop (City or Town), No. 279 River Road
The Commonfocalth 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.
194
St. § ( If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
Kathryn
Ke- Tiernan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
279 River Road Withratp
St.
(Usual place of abode)
(If nonresident, give city or town and Statc)
. Length of stay: In hospital or Institution ....
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.2
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEDSingle
Temale White
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
ycars
7 IF STILLBORN, enter that fact here ..
8
AGE/O.
Years
.. Months.
Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Dressmaker
Retired
Industry
10 or Business :
Dressmaking
11 Soolal Security No ..
Port Henry
12 BIRTHPLACE (City)
(State or country)
N. Y.
13 NAME OF
FATHER
Martin Mc Tiernan
14 BIRTHPLACE OF
FATHER (City)
(State or country )
Ireland
15 MAIDEN NAME
OF MOTHER
Ann Lunney
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Elizabeth Lunney ( Relation, if any
( Address )
279
River Rd.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with mo BEFORE the buslal of transit permit was issued : Um. Dlchildress NO (Signature of the or Board of Health or other) Oct 20/40
(Official Designation) (Date of Issue of Pepinit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October 18 -1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that i 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 fully.) acute cardiac failure Certerio Salenstic Heart Procese Probably Cormany Sclerosis
20 Accident, suloide, or homlolde (specify)
Date of ocourrenoe.
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 ?
Manner of
Injury
(Specify type of place) Collapsed + died qmucche
Nature of Injury
While at work ?.
Was thore an autopsy?
21 Was diseaso or Injury In any way related to occupation of deceased ?......
if so, specify
The Brinkley Land
M. D.
(Signed)
(Address)
22
Calvary
New York N.Y.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL Pots 22/11945 19
23 NAME OF
FUNERAL DIRECTOR
The HCMalex
ADDRESS
Winthrop »
Recelvod and filed nCT ?? 19:15 19
(Registrar)
Cpa mr. J. mely extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to Insert a recital to that effeot 10/26
PARENTS
50m (g)-1-41-4667
C
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, If so specify WAR)
::
6 Age of husband or wife if alive
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 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 hy 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 belicf, 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 relief ex- pedition and the l'hilippine 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 Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury 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 perinit 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 from a town, froin oue cemetery to another, or from one grave or tomb 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 aforesald or froin the clerk of the town where the body is buried. 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 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 hoard of health, or employed by it or by the selectmien for the purpose. shall upon application make the certificate re- quired 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 an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session 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 re- moval, unless a permit in the usual form for the removal of such body has becu 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 Immited 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 lor regls- tration. The person to whom the permit is so given and the physician cer- tifying 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 re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has 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 fret- son appointed to have the care of the cemetery or burial ground In which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
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. G.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the hest of his knowledge and helief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physloians 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 physlolans will certify to such deaths only aa those of persons who, though disabled by recognized disease uurelated to any form of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably dus 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 dissass resulting from Injury or Infection related to oocupation, the sudden deaths of persons not disabled by recognized diseass, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Coin- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify : (1) Under cause it's known or presumable nature; and (2) under manner, indicate the circuin- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "lleart disease, presumably coronary sclerosis. (Sudden death. )"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
---
R-301 A
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.
PLACE OF DEATH
Suffolk Kanthuch
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. r
195
Registered No.
§ (If death occurred in a hospital or institution, give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place or ibode)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
he the word)
Grand
Sa If married, widowed, or divoroed HUSBAND of ...
(or) WIFE of
( Husband's name In )
6 Age of husband or wife if elive
years
7 IF STILLBORN, enter that fact here.
8 58 Years AGE
Months Daye
If less than 1 dey
Hours
Minutes
Usual
9 Occuostlon :
Дваметра
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (Cily)
( Siste or country)
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Greland
15 MAIDEN NAME OF MOTHER Katherine Luders
16 BIRTHPLACE OF
MDTHER (City)
(State or country )
...
17 Informar ( Address)
69 collage an Kach
I HEREBY CERTIFY that a asta factory standard certificate of deathy was Aled with me BEFORE the budal or transit permit was Issued : William D. Childuns (Signature of Agent of Board of Health or other)
Cegene- Det. 20/45 ( Date of Issue of Permits
(Omciel signation)
18 DATE OF
DEATH
(}fonth)
(Day)
8
(Year)
19 | HEREBY CERTIFY,
Thet I attended deosased from
abul
1943
Oct 18
1945
I last sawh RA
.. allve on.
have occurred on the date stated above, at.
9:00 pm
m.
Immediate oause of death
Cerebral Jeuneage
Duration
IMPORTANT
Due to
Hypertension Choune
nejenitis
Due to
Other conditions. ( Include pregnancy within 8 months of death)
Mejor findIngs: Of operations
Date of.
Of outopsy
What test confirmed diagnosle?
IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deoeesed ?
If so, spaolfy ... ( Signed) ... Marion @ ........
... A ....
. M. D.
( Address ) Syl Wennichs
Date Ma- 19 1945
21 Hoch Caros malden. or Removal. Place of Burial, Crematie
(City or Town)
1945
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECT
ADDRESS
1409 Washington & Bd
Regalved od Tled OCT 2 . 1940
19
( Registrar)
100m.(g)-1 15 15510
1
No.
Citor TowMY "89" Cottage Un Many & Snuthen (Cassidy) ( If deceased Is a maryfed, widowed Hvorced woman, give also maiden name.)
2 FULL NAME
1089@lottagraus
years
months days.
St.
(If nonresident, give clty or town and State)
In this community 58 yra.
mos.
dayı.
1945
tp.
Cet 18
1945, death Is said to
Rope Celaa Mass Julep Cassidy
PARENTS
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 persou 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 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 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 oi 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 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 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 forum 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
DATE OF ENTERING MILITARY SERVICE
29016 0.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-203-A
PLACE OF DEATH
1 No. + Suffolk (County) NunThrop (City or Town) Winthrop Community Hospital
The Commnoutealth 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.
196
St. { { If death occurred in a hospital or Institution, ( give its NAME instead of street and number)
2 FULL NAME
Victor E nelson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
41. Temple an Wanttoob
(Usual place of abode)
Hosp.
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
White
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
81
6 Age of husband or wife If allve years
7 IF. STILLBORN, enter that fact here.
8
AGE 31 Years
3 Month: 28
Days
if less than : 1 day
Hours ..
......
.. Minutes
Usual
Office Manager (Retired)
9 Occupation :
industry
Cotton Brookers
10 or Business :
11 Social Security No .....
029-12-3217
12 BIRTHPLACE (City)
Stockholm
(State or country)
Sweden
13 NAME OF
FATHER
Nils V Nelson
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Sweden
15 MAIDEN NAME
OF MOTHER
Caroline Larson
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
Sweden
12
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
October 29
2.45
Informant
17 Nils V Nelson ngayg, if any DATE OF BURIAL
( \ridireus) 8 Temple Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was files with me BEFORE the bar), or transit permit was Issued : Childress
marie of Agent of Tyand use wither).
Chealla Official Designation)
Officer 10/29/45 ( Date of issue of Permit) il
18 DATE OF
DEATH
October-26-1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I 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 fully.) Jamlaneous Cheval Hemorrhage General arterios clerosis quenocis to tec Leukemia "
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