USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 36
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(Signature of Agent// Board of Health or other)
1 health Office 5/15/46
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
May
14,
1946
( sfonte)
(Day)
(Year)
19 1 HEREBY CERTIFY,
Thet I attended deocasad from
June 5,
19.45, to
may 13,
1946
I last saw her
allva on
May 13,, 1946, death Is said to
have occurred on the date stated above, at
SA.
m.
Immediate oause of death.
Cerebral Hemorrhage
Due to
arterioscleratic Heart Bueno
- Chowiec Meskaitis
Due to.
Chronic arthritis
Other conditions.
( Include pregnancy within 3 months of death)
Mejor findIngs :
Of operations
Date of
Of eutopsy
What test confirmed dlegnosis?
Phypress & amuster
IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was diseese or injury in any way related to occupation of deocesed ?
if so, spaoify ..
Samuel B, Haldbury, NU.D.
. M. D.
(Signed)
(Address) 270 Shirley St Withany Date May 14, 1946
21
Winthrop
Winthrop
(City or Town)'
17
1946
6. Kelly
ADDRESS
....
Received and fled
MAY20 1946
19
( Registrar)
Duration
IMPORTANT 10 days
5yrs. 5 yrs. 18 yrs.
13 NAME OF
FATHER
George Whiteley
14 BIRTHPLACE OF
Boston
FATHER (Clty)
(State or country)
wass.
15 MAIDEN NAME
OF MOTHER
Catherine Kelleher
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Boston
Catherine & Kelly daughter
)
17 Informant (Address) /12 Version Stl win.
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Way
22 NAME OF
FUNERAL DIRECTOR.
11 Meridian St., E.J 13
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physloians to insert a rooitai to that effeot.
(Was deceased 2
U. S. War Veteran,
ff so specify WAR).
no
( If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
4 COLOR OR RACE
Female White
2
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 tbe 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 be 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 in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate hoth the primary and the secondary or immediate cause of death as nearly as be can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder service of nineteen hundred and sixteen and nine- teen bundred and seventeen. G. L. Chap. 46, Sec. 10.
ST. Win No undertaker or other person shall bury 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 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 Jomh 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 sball he issued until there sball 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 bealth, or employed by 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, tbe medi- cal examiner shall make such certificate. If such a permit for the removal fof a human body, not previously interred, from one town to another within the commonwealth cannot he ohtained early enough for the purpose, the certificate of deatb 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 he returned to the town from which it was removed within thirty-six bours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained bereunder. If the death certificate contains a recital, as required
by section ien of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The hoard of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given aud the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to bave 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 bury a human body or the asbes thereof which bave heen brought into the commonwealth until he bas 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 he buried or the funeral is to be beld, 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 deatbs 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 pby- sician is absent from home wben 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 by 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 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., beart 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 tbat 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 wbose only occupation was that of home bousework, 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 bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
Dr. Goldberg 270 Shuley
IR-301 A
See instructions and 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
100m-9-44-14955
PLACE OF DEATH
Suffolk (County)
winthrop (City or Town) No. Winthrop Community Hospital
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.
Registered No.
St. { (If death occurred in a hospital or institution, I 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 of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
3
months
2 ] days.
In this community
30TS.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4
COLOR OR RACE
White
5 SINGLE (write the word)
MARRIED
WIDOWED
1
or DIVORCED
Marrued
5a If married, widowed or divorced HUSBAND of ...
(or) WIFE of
(Give maiden name of wife in full)
Morton Scott.
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE 57
Years
Months
26
Days
If less than 1 day
Hours
Minutes
Usual
Housewife
9 Occupation:
Industry
10 or Business:
Own Home
11 Social Security No.
None
worcester
12 BIRTHPLACE (City).
(State or Country)
Mass .
13 NAME OF
FATHER
Raymond Smith
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Norway
15 MAIDEN NAME
OF MOTHER
Lena Hanson
16 BIRTHPLACE OF
MOTHER (City).
(State or Country)
Norway
17 Norton Smith Hus parRalation, if any )
Informant
(Address
15 Townsend St
vinthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed withy me BEFORE the burial otransit ner it was issued: Walter . Baker Stature of Agent itoarea Health or other)
Health Officer
(Official Designation)
(Date of Issue of Permit)
5/15/46
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
may
Month)
14 (Day)
)
1946 (Ycar)
19
I HEREBY CERTIFY.
That I attended deceased from
March 23, 1945, to
May 14
, 19 46
I last saw h
et alive on
may
have occurred on the date stated above. at
6 5 A . m.
Immediate cause of death Rheumatic Heart Disease
with congestive failure
Due to
Chronic glomerulo-nephritis 4 months
asthmatic Bronchitis
none
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
none
Of operations
Date of
Of autopsy
nonE
What test confirmed diagnosis? Clinical+ Laboratory
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed
maurice Traunstein
, M. D.
(Addr
ess 562 Shirley St. Winthe Date May 14, 1946
21
Winthrop
winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
OR Howard & hypolito
ADDRESS
Winthrop. Thues.
Received and Filed 19
(Registrar)
Duration IMPORTANT 1 year
2 years
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
no
May, 16
46
1
2 FULL NAME
{Mrs.) Mabel Scott
(If deceased is a married, widowed or divorced woman, give also maiden name.)
15 Townsend Street, Winthrop, Mass.
13
19 46, death is said to
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 othcer 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 in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate hoth the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one 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 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 be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot 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 hereunder. If the death certificate contains a recital, as required
by section teu or chapter ivily -six, tual 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 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 bury 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 suchi hoard, from the clerk of the town where the body is to be buried 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 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 deathis 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 by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may 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 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
101 A
Suffolk
(County)
Winthrop
(City or Town)
No. 24 Winthrop St
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.
Registered No. { (If death occurred in a hospital or institution, I give its NAME instead of street and number)
2 FULL NAME
Samuel J. Devlin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
24 Winthrop St
( Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
Sa If married,
HUSBAND of
wider chefand A Kelley
(Give maiden name of wife In full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8 AGE .. 7.1 Years Monthe Days
If less than 1 day
Hours
Minutos
Usual
9 Ocoupetion :
Retired .... Customs ..... Officer
Industry
10 or Business :
U. S. Customs
11 Social Security No.
12 BIRTHPLACE (City)
( Siate or country)
Treland
Londonderry
13 NAME OF
FATHER
John Devlin
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Charity McCafferty
16 BIRTHPLACE OF
MOTHER (City)
( State or country )
Scotland
17 Informant Catherine A. Devlin( daugite (Address) 24 Winthrop St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was Aled with me BEFORE the burist or transit permit was Issued : Waller 4. Bakero
..... (Signature of scent of/Board of Health or other)
1 health Office 5/21/46
(Oficial Designation) (Date of Taque of Pofmit)-
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deosased from
1VI
19
to ..
19
I last saw h ... z.f ... ) .... allve on ...
21-/1976, death Is said to
have occurred on the date stated sbova at ..
1 4 m.
Duration
Immedlate cause of death
IMPORTANT
Due to
Due to.
Other conditions.
( Include pregnancy within 8 monthe of death)
IMPORTANT
Physicien Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related .to occupation of deceased ?
If so, speolfy
( Signed)
1
1
M. D.
(Address) , imiei), Date
11/
Winthrop
(City /or Town)
1946
19
21
Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL
May
24.
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Winthrop, Mass
Received and Ated
19 ........
MAY 22 1943 ( Registrer )
1
..
100m. (g)- 1-45-15510
PLACE OF DEATH
1
-
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that offoot. PARENTS
.........
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
( If nonresident, give S
35
or town and State)
1:41
-
Of autopsy
What test confirmed diagnosis?
Major findings :
Of operatione
Data of
John F. Omaler
19
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 tbe same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of tbis 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.
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