USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 70
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1
Boston
(City or Town)
Mass.General Hospital
The Commonbralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
8698 96
- (If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Phillip J McKenna
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
64 Somerset Ave.
(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
montha
2
days.
In this community
yr8.
mos.
2
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
Sa If married, widowed, or dlvoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at.
3:35AM
m.
Duration
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
8
AGE
17 Years
Months ..
Days
If less than 1 day
Hours.
Minutes
Usual
9 Oooupation :
Studen.t.
Industry
10 or Business :
High School
11 Sooial Security No.
-
12 BIRTHPLACE (City)
(State or country)
Boston Mass
Major findings :
Of operations
None
Date of
charged sta-
tistically.
What test confirmed diagnosis?
20 Was disease or injury in any way related to oocupation of deceased?
15 MAIDEN NAME
OF MOTHER
Mary A Buckley
16 BIRTHPLACE OF
Winthrop Mass.
(Address)
Holy Cross-Malden Mass.
(City or Town)
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
F M Donahue
ADDRESS
Charlestown Mass
A TRUE COPY.
Dificul & Honning
ATTEST :
DATE FILED
(Registrar of city of town where death occurred)
Oct.8
48
19
Received and filed
OCT 16 1948
19
(Registrar of City or Town where deceased resided)
25M-(f)-11-42 10746
17
Informant.
(Address)
Mother
(
Relation, if any
If so, specify
C L Clay
(Signed)
Mass. General Hospt
Date
10-4 19
M.
MOTHER (City)
(State or country)
Other conditions
(Include pregnancy within 3 months of death)
Physician
13 NAME OF
FATHER
Arthur J McKenna
PARENTS
14 BIRTHPLACE OF
Everett Mass.
FATHER (City)
(State or country)
Due to.
Ac.lymphatic leukemia
1 Week
Due to ..
Immedlate oause of death
Intracranial hemorrhage
6 Hrs
18 DATE OF
DEATH
(Month)
Oct. 4/48
(Day)
(Year)
19 | HEREBY CERTIFY,
O.c.t ... 2
19
48.
to
That I attended deoeased
Oct. 46
19
...
i last saw
im
.. alive on
Oct. 4/
19
...
death Is said to
PLACE OF DEATH
Suffolk (County)
No.
-
(If U. S.
War Veteran,
speolfy WAR)
Winthrop
Mass.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Oct. 7/48
Underline the cause to which death should be
Of autopsy
Clinical
M R-301 A
Winthrop (County)
Revere 1/5/48
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.
197
Registered No.
§ (If death occurred in a hospital or institution,
St.
¿ give its NAME instead of street and number)
-
2 FULL NAME
Baby ... Boy ... Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
128 Walnut Ave ...
Revere, Massst
.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ... Hospital. O
(Specify whether)
years
O months
0
days.
In this community O
yrs. O
mos. O
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
...... years
-7 IF STILLBORN, enter that fact here.
Still BORN
8
AGE ..... O
Years
O .... Months.
O .... Days
If less than I day Hours Minutes
12 BIRTHPLACE (City)
winthrop
(State or country) Moss.
13 NAME OF
FATHER
Seymour Poul Smith
FATHER (City)
Portsmouth
(State or country)
New Hampshire
IS MAIDEN NAME
OF MOTHER
Celia Blistein
16 BIRTHPLACE OF
MOTHER (City).
Chelsea
(State or country)
Mass.
Relation, if any
Mr. S.P.Smith ( Father )
Informant
(Address)
128 Walnut Ave Revere, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Wallers. (Signature of Agent of Board of Health or other)
Thealite affiche 10/5/48
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
Oct
4.1948
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,
That I attended deceased from
19 ......
.. , to.
19
I last saw h .............
alive on.
19 ..
death is said to
have occurred on the date stated above, at. Immediate cause of death, Unom 6 Congenital
.m.
Duration IMPORTANT
Due to ...
Spina
Depida
Hydrocephaller
Due to.
Vidrace ah Les
Other conditions. (Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations
Underline the cause to .Date of which death Of autopsy should be charged sta- What test confirmed diagnosis? Chuicant findways stically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed).
Po Xeles
Date.
10/4
M. D.
21 Winthron Cemetery Winthrop Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL.
October 5, 1948
19
22 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS
174 Winthrop St, Winthrop
Received and filed OCT 5 1948
19
(Registrar) X
100m-2-'40-D-729-a
I
Suffolk
(City or Town)
(a) Residence. No ..
.....
(Usual place of abode)
3 SEX
การกลาย
6 Age of husband or wife if alive ..
Usual
9 Occupation :
none
Il Social Security No ...
14 BIRTHPLACE OF
PARENTS
IZ
CAUSE OF 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.
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Industry
10 or Business :
none.
PLACE OF DEATH
No. Winthron ... Community .... Hospital
(If U. S.
War Veteran,
specify WAR) ....
NO
MEDICAL CERTIFICATE OF DEATH
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 deccased, 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, definded 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.
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 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 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 hercinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required 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 another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual forin for the re- moval 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 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 necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- 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 received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body Is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . .. Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is nccded.
(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 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 important, 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, 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
PLACE OF DEATH
+ Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registrar's No.
198
St. S (If death occurred in a hospital or institution, { give ita NAME instead of street and number)
2 FULL NAME
Catherine Louise Conant
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20 Bowdoin Street
(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
months
days.
In this community 6 yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widow
5a If married, widowed, or divorced
HUSBAND of
Fred(Giconintame of wife in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
8
82
7
12
AGE
Years
Months.
Dayı
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
House Wife
Industry
10 or Business:
At Home
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
Missouri
13 NAME OF
FATHER
Unable to obtain
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Unable to obtain
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF
MOTHER (City) -
(State or country)
Unable to obtain
17 Gladys Johnson
Informant
(Address)
20 Bowdoin St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death way/filed with me BEFORE the burial or transit permit was issued:
,
(Signature of Agent of Board of Health or other) Haltle Visible 10/8/48
7(Oficial Designation)
(Date of Issne of Permit).
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
4/25/47, 19
to_
10/7/48
19
I last saw ben alive on
9/28/65, 19, death is said to
have occurred on the date stated above, at 2-30AM.
Immediate cause of death lecebul arteria-
sclerosis nita DeConvulsive seizure
6/22/47
sclerosis
1937
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?: Clinical
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 deceased?
If so, specify.
(Signed) 2 av decorte
(Address) 32 Mang Ous Date 1017 1948
M. D.
21
Woodlawn
Everett
Place of Burial, Cremation or Removebct .
(City or Towa)
48
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed OCT & 1948 19
A TRUE COPY ATTIST:
(Registrar)
from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect PARENTS
100m-(f)-1-45-15510
1
Winthrop
(City or Town)
No.
20 Bowdoin Street
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
2
1948
(or) WIFE of
(Husband's name in full)
Duration IMPORTANT
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer sball forthwitb, 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 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 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 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 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.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not been buried, until be 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 exbume a buman body 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 bas 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 aball be 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, bis certificate cannot be obtained early enough for the purpose, or is insufficient, a physt- cian who is a member of the board of bealth, 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 witbin the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal sball 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 berennder. 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 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 regista ir 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 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 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 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 sucb deaths only as those of persons wbo, though disabled by 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 by 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., 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 bealtbfulness 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 bad 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 wbose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate tbe 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 4
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
M R-302
2 FULL NAME
3 SEX
M
(or) WIFE of
AGE.
10 or Business :
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
FATHER (City)
15 MAIDEN NAME
OF MOTHER
PARENTS
MOTHER (City)
(State or country)
Informant.
(Address)
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
Copies of returns of deaths recorded during the previous month which occurred in your city of town in case the deceased
(State or country)
4 COLOR OR RACE|
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
Eleanor M Hall
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive .m.m.m .... years
7 IF STILLBORN, enter that fact here.
8
73
Years
10
Months.
Days
19
If less than 1 day
.. Hours .......
Minutes
Usual
9 Oooupation:
Manager
Industry
Retail Mdse.
11 Social Security No ...
Cannot be learned
Hampstead N. H.
Alfred Foote
14 BIRTHPLACE OF
New Hampshire
Frances Randall
16 BIRTHPLACE OF
New Hampshire
17 C R Foote
Relation,gbpny
..
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
Oct. 9/48 (Day)
(Year)
19
19 I HEREBY CER
Sept./30
to
Oct. 9
6FY .
That
bet
ttended deceased from
48
J last saw h
im alive on.
19.
Li8
.. ,
death Is said to
have occurred on the date stated above, at
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