USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 50
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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, 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, sucb 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, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mfexi- 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, froin 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 tonib 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 lieen delivered to such board, agent or clerk, as the case may be, 8 satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmien 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 hody, 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 sucb 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 aerved 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 tbe cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to tbe manier or cause of the deatb, which the clerk or registrar may require .- Cbap. 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 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 froin 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 body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calle 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 physl- 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 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 Causs 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 tbe principal cause and any important complication of the principal cause.
Statement of Occupation .- l'recise 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 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 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-botel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1
.
..
R.303A
PLACE OF DEATH
Sullink (County)
Withrok Harbor Belle De Julet
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
149
Registered No.
$ (If death occurred in a hospital or institution, St. {give its NAME instead of street and numher)
Beale
(If deceased is a married, widowed or divorced woman, give also maiden name.)
25 Loring Road Winthrop
(If nonresident, give city of town and state)
In this community
hvis. Le mos.
days.
3
11 28
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
21-1942
(Month)
(Day){
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Drowning
-
20 Accident, suicide, or homicide (specify) acudirstat
Date of occurrence Queg - 21-
19.4.2
Where did
Injury occur?
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place,in public place? beach
(Specify type of place)
Manner of
Injury ..
Found dead Belle Jale Markt
Nature of
Injury
aug-24-1942
While at work ?. Was there an autopsy? na
21 Was disease or injury in any way related to occupation of deceased?
If so. specify ..
M. D.
(Signed)
Bitte
Ledate 24-
22. Galvan
Place of Burial, Cremation'or Removal.
(City or Town)
8-26-42
19
23 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Received and filed .......... 19
(Registrar)
25m-2-'40-D-729-b
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
foto 198
(Official Designation)
(Date of Issue of Permit)
(write the word)
years
If less than 1 day .Hours ... .Minutes
12 BIRTHPLACE (City) ....
(State or country)
Wirthof mass.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
EDboston-Mais.
15 MAIDEN NAME
OF MOTHER
Anna R. I Donald
Relation, if any
(Master) DATE OF BURIAL .:
(If U. S. War Veteran. specify WAR)
1
D
years
months
.days.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED hak
1 (City or Town) No 2 FULL NAME mildred (a) Residence. No ... (Usual place of ahode) Length of stay: In hospital or institution (Specify whether) PERSONAL AND STATISTICAL PARTICULARS 3 SEX 4 COLOR OR RACE 5a If married, widowed, or divorced HUSBAND of. (Give maiden name of wife in full) (or) WIFE of (Husband's name in full) 6 Age of husband or wife if alive 7 IF STILLBORN. enter that fact here. 8 3 28 Days AGE .... .Years Monthe. Usual 9 Occupation :.. Industry 10 or Business: 11 Social Security No ... 13 NAME OF 16 BIRTHPLACE OF PARENTS MOTHER (City) .......... (State or country) 17 Thank a Real Informant. (Address) of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF 11 (Signature of Agent of Board of Health cr other) N. D .- WRITE PLAINLI, WITIT ONFADING DLAVA INS ITTIS IS A TENMANIENTE ALVORD. LYEFY Item or FATHER thank a Realy
Watterit
(Address)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, after the death of a person whom he has attended during his last illness, at the request of an undertaker or otber 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 tbe name of the deceased, hls supposed age, the disease of which he died, defined as required hy section one, wbere same was contracted, the duration of his last illness, when last seen alive by tbe physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shali bury or otherwise dispose of a human body in a town, or remove tberefrom a buman body which has not been buried, until he has received a permit from the board of heaith, or its agent appointed to issue sucb permits, or if there is no such hoard, from the clerk of the town wbere the person died; and no undertaker or other person shail exhume a human hody and remove it from a town, from one cemetery to anotber, or from one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until be has received a permit from the board of health or its agent aforesaid or from the clerk of the town wbere the body Is buried. No such permit shall be issued until there shall have been delivered to sucb 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 bereinafter 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 tbe selectmen for the purpose, shall upon application make the certificate required of the attending physiclan. If death is caused by violence, tbe medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously Interred, from one town to anotber within the commonwealth cannot be ohtalned early enough for the purpose, the certificate of deatb made as above provided and In the possession of the undertaker desiring to make such removal shali 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 sucb removal, unless a permit In the usual form for the re- moval of such body has been sooner obtained hereunder. If the deatb 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 shail appear upon the permit. The board of health, or its agent, upon receipt of auch statement and certificate, shall fortbwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the pbyslclan certifylng the cause of death shaii thereafter furnisb for registration any other necessary Information which can be obtained as to the deceased, or as to the manner or cause of the deatb, which the clerk or registrar may require .- Chop. 114, Sec. 45. G. L., (Tercentenary Editiox).
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 wbere the body is to be burled or the funeral ls to be beld, or from a person appointed to have the care of the cemetery or burlal ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
Medical examiners shaii 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 bis county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . .. - General Laws, Chap. 38, Sec. 6.
. .. He sbail in all cases certify to the town cierk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of deatb. -General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for tbe 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 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 hy recognized disease, and those of persons found dead.
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." "Pistoi shot wound of the chest with associated hemorrbage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope wbile under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internai 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 presumahle nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basai ganglia) (found dead in bed)." "Heart disease, presumably coronary scierosis. (Sudden death.)"
DESCRIPTION (for unknown person).
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute thercfor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-301
Suffolk
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
150
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Margaret Crowley Sharke
(If deceased is a married, widowed or divorced woman, give also maiden name.)
168 chestnut .
.St.
Everett,
Jests
Hospital
years
months
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
Widowed
(Give maiden name of wife in full)
6 Age of husband or wife if alive. years
If less than I day
Hours.
Minutes
9 Occupation:
house surfe
12 BIRTHPLACE (City)
(State or country)
13
FATHER
Michael Crowley
15 MAIDEN NAME
OF MOTHER
Ellen Connelle
Leland 4
17 Catherine Mayne Relation," if any
Informant ..
(Address)
48 adams Che Eirrell
I HEREBY 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)
Cluq 21/42
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
21, 1942.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
4
19 42, to Que 21
1942
I last saw how alive on Cung 2%, 1942 death is said Duration to have occurred on the date stated above, at 6.400m. Immediate cause of death Cureis Sigmoiditis with ob struct aus 4, 42
Due to arteriosclerosis since
1932-
....
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN ...
Major findings :
Of operations
Chronic Signist-
iti
Date of Oug 13,47
Of autopsy
none
should be charged sta- What test confirmed diagnosis ?. Clinical
tistically.
20 Was disease or lojury lo any way related to occopatioo of deceased ? 200
If so, specify .............
M. D. (Signed).
(Address)
Date Curse/ 1947
21
Holy Graw
·Malden ....... Place of Byfial, Cremation or Removal. (City or Town)
DATE OF BURIAL trequest 240
19:4/2
22 NAME OF
FUNERAL DIRECTOR
Daniel Semanal
ADDRESS
350 Rway Vosmath
Received and filed. 19
Å TRUE COPY ATTEST:
(Registrar)
County)
Hanthrop
1
PLACE OF DEATH
(a) Residence. No ....
(Usual place of abode)
Length of stay : In hospital or institution
3 SEX
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
John
(or) WIFE of ...
(Husband's name in full)/
7 IF STILLBORN, enter that fact here.
8
74
AGE ..
.Years.
2
.Months
.Days
Usual
Industry
1I Social Security No ..
none
Ireland
14 BIRTHPLACE OF
FATHER (City)
Dieland
(State or country)
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
is very important. See instructions and extracts from the laws on back of certificate.
-
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
10 or Business:
at home
200m-10-'39. No. 8427-d
10.2
Northrop Com: Hospital No
(If U. S.
War Veteran.
specify WAR)
(If nonresident, give city or town and state)
In this community
yrs.
mos. / 6 days.
19 38
Underline the cause to which death
Seatac)
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 regis- tration 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 hy section one, where same was contracted, the duration of his last illness, when last seen alive hy 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 huried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such hoard. from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the elerk of the town where the body is huried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the faets required by law to be returned and recorded, which shall he accompanied, in case of an original interment, hy 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 hy it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy 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 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 deslring to make such a 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 hody 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 elerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish 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 nndertaker or other person shall hury 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 elerk 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, Ses. 46, G. L., (Tercentenary Edition.)
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