USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 46
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U. S. War Veteran,
if so specify WAR)
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 authorizeil person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest of his knowteilge and behef 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 bia 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 bumtred 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 I'nited 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 immeiliate 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 inchile the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetween February fourteenth. eighteen hundred and ninety-eight and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen bundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of s 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 tourb 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 shall he 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 internient, by a satisfactory certificate of the attending physician, if any, as required by law. o1 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 hoard 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 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 rentoval 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 reinoval of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-aix, 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 ami certificate. shall forthwith counter-ign 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 canse 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 re- ceived a permit so to do from the boarit 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 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).
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.
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 deatha 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 ouly ss those of persons who, though disabled by recognized disease unrelated 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) Medical 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 septicemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, amt deaths following ahortion, 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 moile of dying, e. g., heart failure, asphyxia. asthenia, etc. Aa principal cause name the disease causing death. As related causes, tame earlier morbid conditions, if any, related to tbe 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 discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retiremeut. Children not gainfully employed may be returned as at school or at bome. For a woman whose only occupation was that of honie bousework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa bousekeeper-private family, cook-botel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffolk (County)
inthron
(City or Town)
106 Circuit Road
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.
141
{ { If death occurred in a hospital or Institution, St. (give its NAME instead of strect and number)
2 FULL NAME
Jane Gertrude (Hall) Rogers
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
106 Circuit Road
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
4 1yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
2
(Month )
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
Mi] Cumaidea name of wife in full)
(Tlusband's name in full)
6 Age of husband or wife if alive 68
years
7 IF STILLBORN, enter that fact here.
8
68 Years
4
Months
2
Days
If less than 1 day
Hours
Minutes
Due
presumably coronan
réclusion
hours
Due to.
11 Social Security No.
Clinton
12 BIRTHPLACE (City)
(State or country)
Massachusetts
13 NAME OF
FATHER
Augustus M. Hall
14 BIRTHPLACE OF
FATHER (City)
(State or country)
New York
15 MAIDEN NAME
OF MOTHER
Agnes Douglas
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
17 Milton. C. Rogers mustafany 106 Circuit Ra. Winthrop Mass
Place of Burial, Cremation or Removal.
DATE OF BURIAL
August 5
.
1941
19
22 NAME OF
FUNERAL .DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed
19
( Official Designation ) (Date of Issue of Permit)
19 | HEREBY CERTIFY,
That I attended deceased from
.
19
1
I last saw halive on
19 ....... , death is said to
have occurred on the date stated above, at ...
year
9 Am.
Duration IMPORTANT
Immediate cause of death ... Faturas cannes
U
Usual
9 Occupation :
At home
........
100m (d)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Win. D. Children
...
(Signature of Agent of Board of Health or other) Health appear 8/5/41
20 Was disease or injury in any way related to occupation of deceased ?....... no
If so, specify ................
(Signed) Arthur
ress) Minttrol Source, M. D.
Date ...................
.. 19 .. 5
IMPORTANT
Physician
Major findings :
Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- listically.
1 No. 3 SEX Female (or) WIFE of AGE PARENTS Informant .. (Address) If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physiolans to Insert a recital to that effect. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH In plain Industry 10 or Business :
-
1941
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(Usual place of abode)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Registered No.
(Registrar)
21Woodlawn Cemetery Clinton Mass (City, or Town)
Other conditions.
(Include pregnancy within 3 months of death)
Diabetes mellitus
81
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 whoin he has attended during his last illness, at the request of an undertaker or other authorized person or of suy member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and behef 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 hia death ... Cen. 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 snd four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army. navy or marine corps of the I'nited States in sny war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, sud shall slso certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the satne. 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, he deemed to have taken place hetween 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 fromn 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 body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case inay 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. 01 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be ohtsined early enough for the purpose, or is insufficient, a physi- cian who is a member of the hoard 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 lmaman 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 counter-ign 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 nece+ sary information which can be obtained as to the deceased, or as to the mauber 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 coolmonwealth 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 hoard, 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., (Tercentensry Edition).
Medical examiners shall make examination upon the view of the dead bodies of ouly 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 aud take charge of the same; ...- General Laws, Chap. 38, Sec. 6.
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 phyai- cian is absent from home when the certificate of death is needed.
(3) Medioal Examiners will investigate and certify to all desths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to ocoupation, 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, natne 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 bousework. 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
RM R-301 A
PLACE OF DEATH
Saf.f.o.lk. (County)
Winthrop
(City or Town)
No. 44 Irwin mx.
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 142
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
-
years
months
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
/ (Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased froms-
19
... , to ....................
19
I last saw h ...
.. alive
19
death is said y
6:10 AM to have occurred on the date stated above, at. ..... m. Immediate cause of death. .....
1
years
natura chinees
Due to
reneraised areno-sclerosis Means
Due to a ...
Chronic cardio-renal disease
. neare
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
inone
PHYSICIAN Underline the cause to which death
Date of ..
Of autopsy
me
should be charged sta- tistically.
20 Was disease or Injury In any way related to occupation of deceased? no
If so, spe
(Signed)
.. 19 .. 47 ......
(Address) March 19
1
Daté 8 9
.
M. D.
21 Winthrop Winthrop
of health
Place of Burial, Cremation or Removal. DATE OF BURIAL
19.41!
19
FUNERAL DIRECTOR
22 NAME OF
Richard W White
ADDRESS
147 Winthrop st .Winthrop
Received and filed 19
(Registrar)
-
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
Not mewn
16 BIRTHPLACE OF MOTHER (City) (State or country) Canada
Harry Blanchard
Relation, if any Husband ......
17 Informant. (Address) 44 Irwin st. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Childrens (Signature of Agent of Board of Health or other) Heatthe office 8/12/41 Official Designation) (Date of Issue of Fermit)
(write the word)
female
whit
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Harry Blanchard
(Husband's name in full)
79
.years
7 IF STILLBORN, enter that fact here.
8
80
3
Months
25,
If less than 1 day
AGE Years.
Days
Hours.
.Minutes
Usual
housewife
9 Occupation:
10 or Business:
at home
11 Social Security No.
.none
12 BIRTHPLACE (City)
(State or country)
Fort Fairfield
13 NAME OF
FATHER
Daniel Turner
1 3 SEX PARENTS information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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. 100m-10-'39. No. 8427-e N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry
2 FULL NAME
Eva May Turner Blanchard
(If deceased is a married, widowed or divorced woman, give also maiden name.)
spe
44 lowin Street
St.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days
4 COLOR OR RACE | 5 SINGLE
9
194,
6 Age of husband or wife if alive.
Duration IMPORTANT
What test confirmed diagnosis ?.
(City or Town)
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 anthorized person or of any member of the famlly of the deceased, furnish for regla- tration a standard certificate of death, stating to the best of bly 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.
No undertaker or other person shall bnry 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 dicd : and no undertaker or other person shall exhunie 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 fts agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until therc shall have been de- livered to such board, agent or clerk, as the case may be, a satisfao- tory 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 physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death Is caused by violence, the medical exam- iner shall make such certificate. If such.a-permit for the.removal.of.
a human body, not previously interred, from one town to another
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