USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 13
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STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will 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: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained 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 its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
39
St. [give its NAME instead of street and number) No. Winthrop Community Hospital
2 FULL NAME Henry Irving Furlong Sr
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
30 Almont
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
1
10
months
days. In place of residence
years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March 9,1959,
(Day)
(Month) (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
January
19.
59.
to.
March 9,
59
I last saw himalive on
March 8,, 19 59,
death is said to
have occurred on the date stated above, at
3:25 am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Rheumatic Heart disease
Due To Calcified aortic stenosis (b)
1950
Due To (c)
OTHER
SIGNIFICANCoronary thrombosis
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
clinical and lab
5 Was disease or injury in any way related to occupation of deceased ? no If so, specify.
(Signed
Pasquale Contango
M. D.
(Address) 238 Maverick Street
3/9/59
6
Place & Enithromation
(City or Town)
DATE OF BURIAL
March 11
19.59
7 NAME OF
FUNERAL DIRECTOR.
Ernest P Caggiano
ADDRESS
147 Winthrop St. Winthrop.
Received and filed MAR 10 1959 19
(Registrar)
8 SEX
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED
Married
10a If married, widowed
AHMAor MvGeorge
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
62%
Months
Days
If under 24 hours
Hours_
_Minutes
Mechanic
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
Typewriters Supply
15 Social Security No.
013-05-4753
16 BIRTHPLACE (City)
Boston
(State or country)
17 NAME OF
FATHER
Henry Furlong
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Margaret Cavanaugh
6x9m- 211.6)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia Distort
21
Informant
Mrs Anna M Furlong
(Address)
20 Almont St. Winthrop
I HEREBY CERTIFY that a satisfactory. standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Talker & Terlauniy. (Signature of Agent of Board of Healthyor other)
Health Officer
3/10/59
(Official Designation)
(Date of Issue of Permit)
UBV
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
oes not mean of dying, heart failure, tc. It means 2. or compli- which caused
as, if any, ave rise to cause the ause
(a). under- last.
ons contrib -- > leath but not the terminal ndition given
Chapter 137, 54, requires to print or cause or death ificates.
50M-11-56-918978
[ R-301A 1
Registered No.
f(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
PERSONAL AND STATISTICAL PARTICULARS
INTERVAL
BETWEEN
ONSET AND
DEATH
1945
Jan. 1959.
PARENTS
East Boston, Mass. Winthrop
or Business:
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 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, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate 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 section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be decmed to have taken place between February fourteenth, cighteen hundred and ninety-eight and July fourth, nincteen hundred and two, and the Mexican 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 onc 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 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 inter- ment, 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 physician 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 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 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 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 registra- tion. 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).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. . - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons 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 derk 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 intermentils made.
Chap. 114. Sec. 46, G. L., (Tarcentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these Laws calls for the observance of the follow- ing 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 needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
X
Sublack
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
Registered No. 40
[(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
Mrs Sarah (Davis) Halward
(If deceased is a married, widowed or divorced woman give also maiden name.)
9 VINE AVE
Winthrop.
(If nonresident, give city or town and State)
8 - years.
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
Nov.14
19
58
to.
MAR 10
1959
I last saw h.ELalive on
MAR. 9
1937, death is said to
have occurred on the date stated above, at
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CEREBRAL VASCULAR
ACCIDENT
Due To
HYPERTENSIVE AND
(b)
ARTERIO-SCIEROTIC HEART DIS
(c)
Due To
WITH CONGESTIVE FAILURE
4Mo
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Boston, Mass
17 NAME OF
FATHER
neph Davis
18 BIRTHPLACE OF FATHER (City) (State or country)
England
19 MAIDEN NAME
OF MOTHER
Elizabeth Saunders
England
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mary Elizabeth Stocks
21
Informant
(Address)
85 Ode tt. natick
Thay & Williamsn CLHEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me" BEFORE the burial or transit permit was issued :
(Signature of Agent of Board of Health or other)
5/11/57
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
WHITE
10 SINGLE
(write the word)
WIDOWED
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full) William David Aalward (Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
81x
Months Days
If under 24 hours
Hours ....... Minutes
Occupation :
13 Usual
Pausewife
(Kind of work done during most of working life)
14 Industry
or Business:
at Home
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed ?_
No
What test confirmed diagnosis ?-
CLINICAL
5 Was disease or injury in any way related to occupation of deceased/16 If so, specify
(Signed) M. D. (Address) 222 Pleasantst WINTHERORD
6 Forest Niels
Place of Burial or Cremation March 13
59 19
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
173 Brighton are aleston
ADDRESS
Received and filed
MAR 11 1959
19
(Official Designation)
(Date of Issue of Permit)'
1
PLACE OF DEATH
(County) Winthrop (City or Towny
q VINE AVE
No.
2 FULL NAME
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death
8 ... years months days. In place of residence
CERTIFICATE OF DEATH WINTHROP
-THIS IS A NENT RECORD. se only APPROVED ink or black writer ribbon.
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH
not enter : than one le for each (b) and (c)
does not mean le of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal ondition given
Chapter 137, 1954, requires ens to print or e cause or of death on rtificates. CAP. 46, 55 9 & AP. 114 ยงยง 45, HAP. 38 $ 6.)
S
211
A O-58-923886
PARENTS
10.2059
Date. Basta maso
City or Town)
INTERVAL
BETWEEN
ONSET AND
DEATH
5DAY
2 YRS
MAR
10
1959
(Year)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
no
if so specify WAR)
MR-301A
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING.
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RECETTE
KAR 11.1939 "":
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing 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 deathsonly 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 needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business. report the kind of work done during most of working life even if retired. 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.
R-301A
X 1 -
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
94 Locust Street, Winthrop No.
2 FULL NAME
James Tauchen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
94 Locust
St
(If nonresident, give city or town and State)
Length of stay: In place of death
3.7years
months. days. In place of residence years. _months. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY, That I attended deceased from
2-3
19
07, to 3-11
1959
I last saw h& malive on
3-09 -.
, 19 57, death is said to
have occurred on the date stated above, at 5:099 m.
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE78
grs
Years
10Months2
Days
If under 24 hours
.. Hours ..... Minutes
13 Usual
Occupation :
Cutter
(Kind of work done during most of working life)
14 Industry
or Business:
Clothing
15 Social Security No ..
013-03-4798
16 BIRTHPLACE (City)
Czechoslovakia
(State or country)
Austria
OTHER
Bronchial asthma
CONDITIONS
Emphysema
Was autopsy performed?
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? 20.
If so, specify ..
(Address).
(Signed).
1194Washington.we De 3-11-
1909
Winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March 13th
19.59
7 NAME OF
L DIRECTO
Richard C. Kirby
ADDRESS 917 Bennington St. ,E.Boston
Received and filed
MAR 11 1959
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
CBL
(State or country)
Austria
19 MAIDEN NAME
OF MOTHER
CBL
CBL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Austria
21
Informant
Mrs. Anna M. Tauchen-wife
94 Locust St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Falls (. Pekcanng) (Signature of Agent of Board of Health of other)
( Heatbele Office
3/11/59
(Official Designation)
(Date of Issue of Permit)
V.I. V
UCTIONS FOR CERTIFICATE
giving OF DEATH at enter than one for each b) and (c)
es not mean of dying, heart failure, c. It means or compli- hich caused
s, if any, ve rise to ause (a), the under- ause last.
ons contrib -- eath but not the terminal Idition given
Chapter 137, 54, requires Is to print or cause or death on ificates.
50M-11-56-918978
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March
11
195-9
(Year)
(Month)
(Day)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
hugocardial Heart
Disease
arteriosclerosis
(b)
generalized
Due To
(c)
10a If married, widowed, or divorced.
HUSBAND of
Anna M. Liska
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
WW 1
(a) Residence.
No.
(Usual place of abode)
[(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
To be filed for burial permit with Board of Health or its Agent.
17 NAME OF
FATHER
(CBL) Tauchen
Legame, M. D.
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 de eased. furnish for registration a standard certificate of death. stating to the best of his knowledge and hchef 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 deccased, 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 cffcct, specifying the war, and shall also certify in such certificate both the primary and the secondary of imme diate cause of death as ncarly as he can state the same. For neglect to comeit. i V E Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourtecn, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purpose's, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexicay border. service of nineteen hundred and sixteen and nincteen hundred and seventeen" G. L. Chap. 46, Sec. 10.
death certificate contains a recital, as required by section ten of chapter forty-six, that the deccased 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 registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thercafter furnish for registration any other necessary information which can he obtained as to the deccased, 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 persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - Gencral Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons 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 issuc 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 held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing 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.
(?) "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 needed.
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