USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 59
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Health
aplicar
8/26 /46
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
(Month
23 (Day)
1946 (Ycar)
5a If married, widowed or divorced
HUSBAND ot .
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age ot husband or wife if alive
7 IF STILLBORN, enter that fact here.
Stillborn
years
8
AGE
.Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Industry 10 or Business:
11 Social Security No.
Winthunter
mass
12 BIRTHPLACE (City)
(State or Country)
13 NAME OF
FATHER
John J. Kirby
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
East Boston
masa
15 MAIDEN NAME
OF MOTHER
ME Mary mcmullen
16 BIRTHPLACE OF
MOTHER (City)
(State of Country)
East Bostono
musa
20 Was disease or injury In any way related to occupation of deceased?
It so, specify
(Signed)
M. D.
(Address) 670 S anatomy 19 Date
8/20 19 46
Botox
St michaels Place of Burial, Cremation or Removal. (City or Town) 26 19
46
22 NAME OF
FUNERAL DIRECTOR
ADDRESS East Bothfo. 7.
Received and Filed
SEP 3 1946 (Registrar)
19
X
Duration IMPORTANT
Immediate cause of death Still Bom
Due to
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis?
That I attended deceased from
. 19
, to
, 19
1 last saw h
alive on
, 19
, death is said to
have occurred on the date stated above. at
m.
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
PLACE OF DEATH
Suffolk (County?
1
No. .
(City or Town) Winthrop
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Community Hospitals
To be filed for burial permit with Board of Health or its Agent.
Registered No. 159
(If death occurred in a hospital or institution, § give its NAME instead of street and number)
Kirby
2 FULL NAME
divorced woman .
(a) Residence.
No.
4
d. Woodside luk
St.
(If nonresident, give city or town and State)
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Female
4
COLOR OR RACE
Mute
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(Usual place of abode)
Length ot stay: In hospital or institution
(Before death)
years
DATE OF BURIAL CTOR frederick magnat
19 I HEREBY CERTIFY.
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 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 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 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, 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 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 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 hody is buried. No such permit shall be 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 be 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 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 removal of such hody has heen sooner obtained hereunder. If the death certificate contains a recital, as required
by mecliun teu vi chapier 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 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 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 body 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 such board, from the clerk of the town where the hody is to he huried 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 hy traumatism (including resulting septicemia), and hy 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 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 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 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
03-A
35
1
PLACE OF DEATH
Suffolk (County) Winthrop (City-or Town) Winthrop Community Hospital
: The Commonwealth 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.
160
§ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced weman, give also maiden name.) 60 Bates are Winthrops
(a) Residence. No.
(Usual place 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
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACEJ
Matz
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(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.
e. Still Born
8
AGE
Years
Months.
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Cant be leamed
14 BIRTHPLACE OF
Dont Je leamed
(State or country)
15 MAIDEN NAME
OF MOTHER
Grace & Smith
16 BIRTHPLACE OF
MOTHER (City)
(State og country )
Stuthigh Pass
17 Sarah South Governo then
Informane
600 atta Qua Tantra bara
. I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bytial cor transit permit was Issued : Walter, A. Jaksex. (Signature of Agent of Board of Health or other)
8/26/46
(Official Designation) (Date of Issue of Permith
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Cerequest
23
84-1946
(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.)
Prematurin
Stillborni
20 Accident, suicide, or homicide (specify)
Date of occurrence.
19
Where did
Injury occur?
(City or town and State)
Did injury ocour in or about home, on farm, In Industrial place, or In publlo
place?
(Specify type of place)
Manner
hus corsiagi due to maternal
Injury
Nature of
Sblenia anderela.
Injury
While at work ?
.Was there an autopsy?
421
21 Was disease or Injury In any way related to ocoupatlon of deceased?
If so, specify.
(Signed)
M. D.
(Address) Matin
Cody -24 1946
22
Place of Burial, Cremation yr Remo (City or Town)
DATE OF BURIAL
aug 27, 1946
19
23 NAME OF
FUNERAL DIRECTOR
ADDRESS
14/0 9 Washington at Esto
Received and filed
AUG 271946
19
(Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a reoltal to that effect. PARENTS
50m (g)-1-41-4667
No. Baby girl Smith
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
of
....
-
COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physiclan or registered hospital medloal officer shail 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 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 secondsry 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 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 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 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 cierk 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 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 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
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 regla- tration. The person to whom the permit is so given and the physiclan cer- tifying the cause of death shall thereafter furnish for registration any Other necessary information which can be obtained as to the deceased, of as ". 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 per- 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 shali 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 hls county the body of such a person, he shall forthwith go to the place where the body iles and take charge of the same; ...- General Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town cierk or registrar in the place where the deceased died ilis name and residence, If known; otherwise a description as fuli 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 best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calis for the observance of the following rules of practice :
(1) Attending physiclans will certify to such deaths only as those of persons to whom they have given bedside care during a iast illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons who, though 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) Medioal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the actlon of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deatlis from disease resulting from injury or Infection related to oocupation, the sudden deaths of persons not disabled by recognized disease, 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 wili 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: "Com- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- clated hemorrhage, homicidal." "Asphyxiation by suspension, sulcidal." "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 known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal Inquiry. For example : "Ilemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart 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
03-A
1
PLACE OF DEATH
SulloCk (County) Winthrop (City or Town) Winthrop Community Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or its Agent.
Registered No.
161
[ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
No. 60 Rates are Northrop
(a) Residence. No.
(Usual place of abode)
Abobital
' Length of stay : In hospital or Institution ..... ........
(Before death)
(Specify thether)
years
months
1. days.
(If nonresident, give city or town and State)
In this community-22 .
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( wri
the wor
5a If marrled, widowed, or divorced HUSBAND of
(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
22
AGE
Years
Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
at Home
Industry 10 or Business :
11 Social Security No ..
une
12 BIRTHPLACE (City) Withinup news (State or country)
13 NAME OF
FATHER
Lewis Suite
n.l.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Dachmuch, N.J.
15 MAIDEN NAME
OF MOTHER
auch man tadden
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Seland
17 Informant piccole trucco ( Address)
I HEREBY CERTIFY that a satisfactory standard certifigitte of death was filed with me BEFORE the butial or/transit permit was issued : N altte.
(Signature'or agent/of Board of Health or gther)
Health thick 8/26/46
Official Designation)
(Date of Issue of Fermlt),
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august -24-1946
(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.) Post Partum Hemorrhage; Splenic anaemia Surgical Shock
20 Accident, suicide, or homicide (specify)
Date of occurrenoa
19
Where did
Injury occur?
(City or town and State)
Did injury ocour in or about home, on farm, In industrial place, or In publio
place ?
(Specify type of place)
.
Manner of
Died quickly following a
Injury
Nature of
precipitate deliver
Injury
While at work? Was there an autopsy ?.
21 Was disease or injury In any way related to ocoupation of deceased?
If so, specify
M. D.
(Signed)
(Address)
Blotuma Parte 24
1946
22
Place of Burial, Cremation or Reploval.
(City of Town)
Relationng any
DATE OF BURIAL ..
aug 27
2016
23 NAME OF
FUNERAL DIRECTOR lice JEquially
....
ADDRESS
19404 Washington , Both
Received and filed
AUG 27 1946
19 ....
..
(Registrar)
50m (g)-1-41-4667
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physlolans to Insert a reoltal to that effect. PARENTS
No. grace W. Smith
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
1
GATRAVIS 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 naine 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.
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