USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 52
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4 COLOR OR RACE
"write the word)
5 SINGLE MARRIED WIDOWED or DIVORCE Parneed
ed Libanes / Myles (Give maiden name of wife mann)
(Husband's name in full)
6 Age of husband or wife if alive.
59
years
7 IF STILLBORN, enter that fact here.
If less than 1 day
Hours .
Minutes
ficher fit. Se
11 Social Security No. 013-03-1256
Boston
masa
Leyland"
15 MAIDEN NAME OF MOTHER arie Burroughs
16 BIRTHPLACE OF MOTHER (City) (State or Country)
Quetre mon
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial ør transit permit was issued: Walter & Bakes
(Signature of Agent of Board of Health or other) Health Officer 8/1/48
(Official Designation), (Date of Issue of Permit)
48
last saw alive on
Carcinoma of Signoria
Due to
Due to
Other conditions (Include pregnancy within 3 months of death)
·Physician Underline the cause to which death should be charged sta- tistically.
bon if any ). 21 taly Cole
100M-7-46-19068
Kung James les. (If deceased is a married, widowed - diforged woman, give also maiden pame 39 Pleasant It busser, marc
Length of stay: In hospital or institution_ (Before death)
(Specify whether)
years
21 days.
IMPORTANT
Months Days
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 hy section one, where same was contracted, the duration of bis 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 tbe 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 iu the certificate a recital to that effect, speci- fying tbe 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 tomh 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, tbe 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 witbin the commonwealth cannot be obtained early enough for the purpose, tbe 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 vi chapier forty-six, tuat the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the asbes 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 tbe 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 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 "ause 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 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
7
PLACE OF DEATH
Suffolk (County) Winthorpe (City or Town) 211 Pleasant No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent
Registered No.
148
St. f (If death occurred in a hospital or institution, ! give its NAME instead of street and nun.ber) )
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR) . na
211
(a) Residence.
No.
Pleasant
St.
(Usual place of abode)
na
years
months days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
WIDOWED
MARRIED
WIDOWED-
or DIVORCED
5a If married, widowed or divorced HUSBAND of ..
(or) WIFE of
Timothy &
(Human's name in full)
(Give marden none of wife input)
o Sullivan
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
AGE
69
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
at home
Industry
10 or Business:
own
11 Social Security No.
12 BIRTHPLACE (City)
(State or Country)
Limerick neland
13 NAME OF
FATHER
John Ahearn
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Ireland
15 MAIDEN NAME
OF MOTHER
margaret Can
16 BIRTHPLACE OF
MOTHER (City)
Incland
BRYAN
Sullivan ( Relation, if any ) 2110 Pleasant ST Winthorpe
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burialof transit permit was issued: Waller f. Baker (Signature of Agent of Board of Healthor other) Health Officer Official Designation
7/30/48 (Date of Issue ( Pernat)
18 DATE OF
DEATH
July
(Month)
(Day)
30
1948
(Year)
19
I HEREBY CERTIFY,
That I attended deceased from
July
1948.to
12
July 30
. 19 ×8
er
I last saw h
alive on
July 36
. 194 9, death is said to
have occurred on the date stated above, at 10:50 A.m.
Duration IMPORTANT
Immediate cause of death
Carcinoma
the Colon with metartare
to the liver
meta In 200/ mar.
Due to
Due to
Other conditions
Generalived arteriosclerosis
(Include pregnancy within 3 months of death)
with arterinelerdir Heart berline
Diabetes mellitus
Major findings:
Of operations
not performed
Date of
Of autopsy is? Clinical.
year . IMPORTANT 10 46. Physician
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, specify Sacchi a. Samighetti , M. D.
(Signed)
de Paration. G. Bro Date July 30 19 48.
(Address
21 Holy 6 ross Cemetery malden (City or Town)
Place of Buffal, Cremation or Removal.
DATE OF BURIAL
aug 2
19 448
22 NAME OF
Paul
. Nelly
FUNERAL DIRECTOR
ADDRESS
11 meridian Ist 6. 3.
Received and Filed
19
AUG 2 1948
(Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
See instructions and extracts from the laws on back of certificate.
PARENTS
17 Informant (Address)
100M-7-46-19068
1
2 FULL NAME
mary & Sullivan (If deceased is a married, widowed or divorced woman, give also maiden name.)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
(If nonresident, give city or town and State)
15
e
A R-301 A
Limerick
Limerick
What test confirmed diagnosis?
MEDICAL CERTIFICATE OF DEATH
years
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 hy 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, See. 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 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 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 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 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 he 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 he 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 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 body has heen sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten vi chapter forty-six, tuat the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the hody 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 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 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, 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 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 domestie 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
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RM R-302
deceased the clerk
PLACE OF DEATH
(County)
1
(C'ity or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
5 (It deal give its NAME instead of street and number) (If death occurred in a hospital or institution,
S (If U. S. War Veteran,
Bureau of Vital Statistics
CONNECTICUT STATE DEPARTMENT OF HEALTH
Feste of
Hartford, Ceunesticat, U. S. A.
Death
MEDICAL CERTIFICATION
1. Place of Death
a. County
19. I hereby certify that I attend the deceased from
4-10-48
19
to
19
Note: If ontalde eity or towa Emita, write rural
c. Nama of Hospital or Institution
Grace .... 10sp ..... Note: If not In bolp. er inst., give street No, or Woontlos
d. Length of stay : In hosp. or inat.
in this community
2 Usual residence of deçe sed
curred on .4-19748 at 9: 05. 8 ... . m.
Duration
Immediato cause of death ...
from
Goronery thrombosis. Pulmonary thrombosis
aid to
Lion
....
Due to: Generalized arteriosclerosis
Other morbid conditions (including ...
any pregnancy within 8 months of death)
Major findings of operations
the one cause above, to which death should be charged statistically.
Of autopsy
20. 1f death was due to external causes, fill in the following:
a. Accident, suicide, or homicide (specify) b. Date of occurrence
c. Where did injury occur? . .......
-
City or towa stata
d. Did injury occur in or about homo, on farm, in industrial place, in public place?
15. Maiden name
Mar y G. Walsh
16. Birthplace
England
City or town
Stete or foreign country
17a, Informant
John O'laley
17b. Address ......
Winthrop, Mass ..
18. Burial, Cremation, or Removal, Date Cemetery
Winthrop 4-19-18
Place
Winthrop, Mass.
Address
Received for record this ...
19th ..... ...... day of
19
Company . .... .... Regiment
I. D.
The foregoing is a true copy.
John J. Coleman Ragistver
MAY ... 1.0. 1948
Form V. 8. 18 (11-47) 30M
Copier reside of th
25M-(f)-11-4:
Informant (Address)
DATE OF BURIAL
QISTUL 10Wn) 19
A TRUE COPY. ATTEST :
(Registrar of city or town where death occurred)
DATE FILED 19
Received and filed AUG 26 1948 19
(Registrar of City or Town where deceased resided)
ician erline ise to death I be d sta- Ily.
Specify type ut place
e. While at work?
f. Means of injury
M.J.Carpinella,MD
21. Signature of physician Branford, Ct. Date signed -19-48
....
Was Deceased a Veteran? ....... n.Q ..
... If so, give War
Wes Body Embalmed? License No. .......... 200
If so, Name of Embalmer denna Signature of Licensed Embalmer or Licensed Undertaker
Hugh A .Keenan Son
dow Haven, Com
Received for filing in the State Office
Physicians: Underline
8. Date of birth of deceased
.. Dec ... . 23., ... 1885
nontÌ
day
62
3
26
month days ............ If less than one day
10. Birthplace
Boston Lass.
11. Usual occupation
housewife
12. Industry or business
18. Name 14. Birthplace
Robert A . Neilson
MOTHER FATHER |
Apr. 19, 1948
Jb. Social Security Number fema fe PERSONAL AND STATISTICAL PARTICULARS white 4. Sex . 5. Race ce wa 6. Single, widowed, married, divorced Ga. If married, widowed, or divorced, give name of husband or wifa Robert wilson
d. Street No.
linthrop
Note : If rural, give location
e. If foreign-born, how long in U. S. A .?
8a. Full name Edith N. Wilson
b. County
a. City or town
.. Winthrop Highlands
Notes Lf outride ety or towa Amita, write rural
...
I last saw h T slive on 4-19-48 ., 19. ...; death is said to have oo-
.. State .. Mass. 05/8
.........
NEW HAVEN 613T
b. City or town
4-19-48
...
Registered No.
149
No.
St.
EDITH M. WILSON
2 FULL NAME ...
days.
Duo to: . Chronic mrocorditis
?.
6b. Age of husband or wife, if aliva T. Date of death
9. Age. .. years
City er towy State or foreign country
City or town State or forilga country
..........
22 NAME OF FUNERAL DIRECTOR ADDRESS
RM R-302
Middlesex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Wal tham
(City or town making return)
Registered No.
354.50
S (If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
Thomas Borelli
2 FULL NAME
(If deceased Qtparted, ISWe ,or fece Bomgive also maiden name.)
(a) Residence. No.
(Usual place of abode)
st
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
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