USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 17
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No undertaker or other person shall bury a human body or the ashes thereof which have heen brought into the commonwealth until he has received a permit so to do from the hoard 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 he huried or the funeral is to he 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 Ilealth physicians will certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahly due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia). and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from dlsease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled by recognized dlsease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DORM R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. 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 extracts from the laws on back of certificate. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK -- THIS IS A PERMANENT RECORD. Every item of information PARENTS
PLACE OF DEATH
(County)
Winthrop
(City or Town)
No.
56 Lowell Rd.
The Commontoralih 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.
46
( ( If death occurred in a hospital or Institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Clarence Edwin Perkins
(If deceased is a married, widowed or divorced woman, give also maiden name.)
56 Lowell Rd.
St.
(If nonresident, give city or towu and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
in this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED grried
Sa If married, widowed, or
HUSBAND of
DIvia Shuttleworth
(Give maiden name of wife in full)
(or) WIFE of
( Inshand's name in full)
6 Age of husband or wife if alive 50
years
7 IF STILLBORN. enter that fact here.
AGE
Years
Months
If less than 1 day
Hours
Minutes
Usual
Investment Broker
Industry
10 or Business :
11 Social Security No ...
011-01-1629
12 BIRTHPLACE (City)
(State or country)
Basteri
Mass
13 NAME OF
FATHER
Henry J. Perkins
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Oregon
15 MAIDEN NAME
OF MOTHER
Ellen Mary Dustin
16 BIRTHPLACE OF
Lee
MOTHER (City)
(State or country)
N.H.
Boston, Mass.
l'lace of Burial, Cremation or Removal
DATE OF BURIAL
March 5,
1942
"Town)
19
22 NAME OF
Thomas W. Rhodes
FUNERAL DIRECTOR
ADDRESS
Lynn, Mass.
Received and filed 19
(Registrar)
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 : Im. D. Children Signature of Agent of Board of Health or other)
( Official Designation) (Date of Issue of Permit) 3/5/42
18 DATE OF
DEATH
March 3, 1942
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
may
1936
march 3
19 42
to
I last saw him alive on.
March 2, 1942, death Is said to
have occurred on the date stated above, at.
12:05 A
Duration IMPORTANT
immediate cause of death.
Cacheria
2 mo.
Due to
Carcinoma of lives (metastatic) 6 mois.
Due to.
Carcinoma of the rectum
1 year
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findings :
Of operations ...
Carcinoma Directum
Of autopsy
What test confirmed diagnosis ?
broken
charged sta. tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify/2
M. D.
(Signed) Arthur
(Address)
Mintha
Du Mase Date 3/4
1942
21
Forest Hill
17 Mrs.Olivia Perkins
Informant.
( Address)
56 Lowell Rd.
wione any
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No.
(Usual place of abode)
31
Date of May 1941
l'uderline the cause to which death
8
70
9
Days
9 Occupation :
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 hest 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 bis 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 ariny. 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 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 bumired 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 hetwcen February fourteenth, eighteen hundred and ninety-eight and July fourth. nineteen hundred and two, and the Mexi- can horiler service of nineteen hundred and sixteen and nineteen bundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a buman 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. trom the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it froin 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 aforexaid or from the clerk of the town where the body is buried. No such perniit 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 he 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 lrereinafter 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 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 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 aooner obtained hereunder. If the death certificate contains a recital, as required
by section ton of chapter forty-aix, that the deceased served in the army, navy or marine corps of the l'uited States in any war in which it has been engaged. such recital shall appear upon the permit. The board of health, or ins 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 maner of canse, of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition ).
No undertaker of 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 primits, 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 he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is niade. ... Chap. 114. Soc. 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 body of such a person, he shall forthwith go to the place where the bady 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 obaervance 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 physiclans 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 physi- cian is absent from home when the certificate of death is needed.
( 3) Medioal Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting aepticemia), and by the action of chemical ( drugs or poisons), thermal, or electrical agents, and deatbs 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. nof 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 ou 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 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, aa housekeeper-private fautily, cook-botel, etc. For a person who bad no occupation wbatever write none.
SPACE FOR ADDITIONAL INFORMATION
O.M R-301 A
1
PLACE OF DEATH
Suffolk (County ) Winthrop
....
The Commonturalth 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.
(City or Towme 21 Starben View are No.
St.
( ( If death occurred In a hospital or institution, give its NAME instead of street and number)
En na mary Gillespie
(If deceased is a married, widowed or divorced woman, give also maiden name.)
21 Starben View arest.
(a) Residence. No. (Usual place of abode)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
years - months days.
In this community
30 yrs. -
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
Shiite
S
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Endowed
18 DATE OF
DEATH
March
6
1942
()fonth )
(Day)
(Year)
Sa If married, widowed, or divorced
HUSBAND of
...
(or) WIFE of
W 24 Give raiden home office in the
( Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN. enter that fact here.
8
AGE
76
7
Months
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Cambridge
13 NAME OF
FATHER
alexander coombs
14 BIRTHPLACE OF
Itali fox
FATHER (City)
(State or country)
U. S. Canada
15 MAIDEN NAME
OF MOTHER
Element. winter
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
-
Leo. Sigg
Informant (Address) 21 /autorWwwdie.win
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Www. D. Chil dress x (Signature, of Agent of Board of Health & other) realthe Officer 3/9/4
(Official Designation) (Date of Issue of Permit)
HEREBY CERTIFY, That I attended deceased from
march 3
I last saw her
alive on
March 6, 1942
have occurred on the date stated above, at.
11:45pm
acute Cormay Thrombosis
Due to. arteriosclerosis
Due to. Senility
Jean
Other conditions.
none
(include pregnancy within 3 months of death)
IMPORTANT Physician
Major findings :
Of operations
none
Date of.
l'nierline the cause to which death
Of autopsy.
none
What test confirmed diagnosis ?.. Chimicaex las charged sta- listioatty.
20 Was disease or injury in any way related to occupation of deceased 240 If so, specify .
COM. D.
('Signed)
(Address) 662 StelleDate.
3/7 1942
DATE OF BURIAL ..
100
lay
1942,
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
are
Received and filed
MAT 1 8 1942
19
( Registrar) X
if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
100m (d)-1-41-4667
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
N. B .- WRITE PLAINLY, WITH UNFADING DLACN INA-INIS I'M TERMANETI. ... VI ..
extracts from the laws on back of certificate.
Relation, if any
Place of Burial, Crea
Cremation or Romoval,
Registered No.
2 FULL NAME
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(If nonresident, give city or town and State)
to ..
1941
March 6
1942
Duration
IMPORTANT 2 dus /year .....
3
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 au 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 behef the name of the deceased. bis supposed age, the disease of which he died. defined as re- quired hy section one, whirre 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 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 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 inelnde 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; aud 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 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 perniit shall he 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 he 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 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 hy 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 carly 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 I'nited 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, skall forthwith counter-igu 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 manoer 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 re- ceived a [wrmit so to do from the hoard 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 hell, 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).
Medieal 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. 33, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : 1
(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 form of injury. have died without recent medical attendance or whose phyal- 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 reaulting aepticenila), 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 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 moile of dying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes. naine 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, however, designate the occupation by the appropriate terins, as housekeeper-private family. cook-hotel, etc. For a person who had no occupation whatever write tone.
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