USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 15
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Received and filed. 19
A TRUE COPY ATTEST: FEB-&-" (ofBistrar)
100m(h)-1-41-4695
1 3 SEX Male (or) WIFE of. Industry 10 or Business: PARENTS 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. macion snouia De carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF Usual 9 Occupation :
2 FULL NAME
(If deceased'is a married, widowed or divorced woman, give also maiden name.)
1) Pleasanton
S&
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution .: (Before death)
(Specify whether)
years
2 hrs. 3 min.
....
2torp.
.......
(City or Town) Martheop Comm. No .. BABY Jou
Relation, if any Talter)
NOR-WWIIK VIAINI W
PHYSICIAN
Underline the cause to which death should be charged sta- tistIcally.
21 .
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 hla last Illness. at the request of an undertaker or other authorized person or of any member of the famlly of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and bellef the name of the deceased, hla supposed age, the disease of which he dled, defined as required by section one, where same was contracted, the duration of his last illness, when last seeu alive by the phyalclan or officer and the date of hla death . .. Gen. Lows, 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 fourteen, shall, if the deceased, to the best of hls 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 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, 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 slxteen 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 hody which has not heen 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 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 receiv- Ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body la 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, 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 la in- sufficient, a physician who is a member of the board of health, or em- ployed hy It or by 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 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 shall constitute a permit for such removal; provided, that such body shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body has been sooner obtained hereunder. If the death certificate contains a recltal, 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 counteralgn It and transmit It to the clerk of the town for registration. The person to whom the permit Is ao given and the physiclan certifying the cause of death shall thereafter furnish for registration any other necessary Information which can be ohtalned 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 examinera shall make examination upon the view of the dead bodles of only auch 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 received a permit so to do from the board of health or Its agent appointed to issue such permita, or If there la no auch 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 la 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 auch 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 la 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 polsons), thermal, or electrical agents, and deaths following abortion, but also deaths from dlsease resulting from Injury or infection related to occupation, the sudden deaths of persons not disabled by recognized dlsease. 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 la 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 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, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
·
-301 A Auffach ... County
1
No.
(City of Town 212 Novaride Que Guard I Lane
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.
38
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN · IMPORTANT
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual plece of abode)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
years
months days.
( If nonresident, give city or town and State)
In this community 26 yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE 11 frite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word) Marcel
5a If married, HUSBAND of
Ownerand M Webster
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
52
years
7 IF STILLBORN, enter that fact here.
8 AGE 21 Years - Months ... Days
If less than 1 day
Hours
Minutes
Usual 9 Occupation :
Startes
Industry
10 or Business :
Boston Clivated
11 Social Security No. .
12 BIRTHPLACE (City)
( Siste or country)
Cast Bretonh
13 NAME OF FATHER Cornelis Lane
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Cast Boston
15 MAIDEN NAME
OF MOTHER
Jamie bothwell
16 BIRTHPLACE OF
MOTHER (City)
( State or country),
South Boston.
17 Mir Quand J Lane
Relation, If any
Informant ( Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death waa filled with me BEFORE the burial or trangit permit was Issued ; William D. Children
(Signature of Agent of Board of Health or other)
agent Hleb, 25/46
(Official Designation) (Date of Issue of Peumit)
18 DATE OF
DEATH
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deosased from
19 ........... , 40
19
I last sew h ...
.. aliva on.
, 19
death Is said to
have occurred on the dato stated above, at
m.
Duration
Immedlate peuse of death.
IMPORTANT
Due to.
Due to
Other conditions
( Include pregnancy within 8 months of death)
Mejor findings :
Of operations.
Date of
Of eutopsy
Whet test confirmed dlegnosis ?.
IMPORTANT Physician
Underline the cause to which death should be charged sta. tistically.
20 Was disease or injury in any way related to occupation of decaesed ?.
If so, spoolfy/.
(Signed ) ....
Vred hecho 2-21-19
M. D.
21
Manches
Place of Burial, Crehfation of Remoral.
(City or Town)
DATE OF BURIAL He/25
1976
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
210 Hundelufty prote
19
Received and Alled FEB 2% 100G
( Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. PARENTS
100m-(g)-1-45-15510
PLACE OF DEATH
2 FULL NAME
( If deceased Is a married, widowed or divorced woman, give algo maiden name.)
212 Honderde Que
St.
22
1946
W 1 C - C C t f t
F S F n
C h n 0 f1 0 0 11 fı t t. n 0 1f P 5 D n h P 0 e a h h C -
..
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 helief 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 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 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 iu 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 hetwecn 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 hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not heen huried, 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 hoard of health or its agent aforesaid or from the clerk of the town where the hody is buried. No such permit shall he issued until there shall have been delivered to such hoard, 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, 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 he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed hy it or hy the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused hy violence, the medi- cal 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 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 shall 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 such removal, unless a permit in the usual form for the removal of such hody has heen sooner obtained herennder. If the death certificate contains a recital, as required
hy 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 aud the physician certifylng the cause of death shall thereafter furnish for registration any other neces- sary 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 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 shall 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 shall hury a human 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 he 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 hy 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 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 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 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 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 heen 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 hoine. 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RM R-302
Suffolk
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cholooa
(City or town making return)
Registered No.
104
39
Charles P. Slinoy
2 FULL NAME
(If deceased is a married,, widowed or divorced woman, give also maiden name. )Winthrop
OG LOS1
St.
(a) Residence. No.
(Usual place of abode)
hosp.
8
8
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE|
5 SINGLE
MARRIED
WIDOWED
DIVORCED
(write the word)
Marriod
Holen OINer
19 |HEBERS CERTIFY,
[That I attended deceased
19
I last saw h
alive on
19.
... , death is said to
have occurred on the date stated above, at
2 : 10A
m.
Duration
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE
YearStatMonthant.Puf | Pub. HDocumNingtes
If less than 1 day
Usual
9 Occupation :
Com. of Mass
Industry
10 or Business :
Il Social Security No. Boston Mass
12 BIRTHPLACE (City)
(State or country)
James
13 NAME OF
FATHER
PARENTS
14 BIRTHPLACE OF
Ireland
FATHER (City)
(State or country)
Hry Given.
15 MAIDEN NAME
OF MOTHER
Ireland
16 BIRTHPLACE OF
MOTHER , (City)
(State or country Records
vodieng Lome Hogy, Chelsea
Relation, if any
17 Informant (Address)
A TRUE COPY.
Joseph G. Tyrrell
ATTEST :
DATE FILED
(Registrar of city or town where death occurred) 2/23/46
19
18 DATE OF
DEATH
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's namein full)
Immediate cause of death. Hypertonsivo heart disease
few yr
Auricular fibrillation
Due to.
Chronic nephritis
Due
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be charged sta- Listically.
Of autopsy
Clinical
What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
A. Roubley
(Signed)
Soltera
2.23
M.46
(Address) na throp ver .. 7
theDate, 8599
21 PLACE OF BURIAL,
Feb. 26.1946
CREMATION OR REMOVAL
(Cemetery)
DIOS
(City or Town)
DATE OF BURIAL
Kirby
Wirth
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed
MAR 1 1 1946
19
( Registrar of City or Town where deceased resid
50m (e)-1-41-4667
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE_DICAINI V
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Ch8138a
1
'St Iffers' Home Hospital
No.
S
(If death occurred in a hospital or institution,
St.
( give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
SA"ar
Fob. 25, 1048
im
19
705.23
C
19
Underline the cause to which death
Enlisted S.W. 5/4/98 W.W.I 8/13/17 Discharged S.W. 11/25/98 WW.I 7/12/20
Rank S.W. Cpl.
Organization Co.A. 9th Regt. Vols. Mass.
11
Q.M.C.
WWI Ist Lt.
M R-301
PLACE OF DEATH
Suffolk. (County) WinthropM 3
ratified istys
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
40.
§ (If death occurred in a hospital or institution, St. ¿ give ita NAME Instead of street and number) PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran? If so, (specify WAR)
Que St.
St ...
....
levere
222
(If nonresident, give city or town and State)
years
months
3
daya.
In this community
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIPY. That I attended deceased from
02x 7
1
191 to 1/ 19 7-10 I last saw h --- alive on 201-27 194- 6 death is said to have occurred on the date stated above, at 10.2347. Immediate cause of death.
Duration Important
Due to Cerebral tessere
Due to. 6
Other conditions. (Include pregnancy within 3 months of death)
Major findings: Of operations.
Date of
Of autopsy.
What test confirmed diagnosis? weratt
PHYSICIAN Underline the cause to which death should be charged ata- ftistically.
20 Was disease or injury in any way related to occupation ef deccased?
If so, specify .....
(Signed)
(Address) Mandag Kreis Date Hvit
M. D.
10.76
21
Knollwood Cemetery Canton Mass
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
March
2
. 19 46
22 NAME OF
FUNERAL DIRECTOR
J. S. WatermanaJons
ADDRESS
Boston Mass
Received and filed.
WAR + 1948
19
À TRUE COPY ATTEST:
(Registrar)
NOR_WDITE DI LINTV WITHTHEINT
100m (h)-1-41-4695
I HEREBY CERTIFY that gsatisfactory standard certificate of death was filled with my BEFORE the purfel or transit permit was issued: Was Childrens
(Signature of Agedt of Board of Heather other) Thealite Officer 2/28/46
(Official Designation) (Date of Issue of Permit)
(write the word)
Married
€ Age of husband or wife if alive. years
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