USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 54
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W
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Carfive maiden game of wife in full)
Squire
(Husband's name in full)
6 Age of husband or wife if alive.
Years
7 IF STILLBORN, enter that fact here.
8 ,52
AGE
Years
.Months
.Days
If less than 1 day Hours .Minutes
Usual
9 Occupation:
Housewife
Industry 10 or Business:
11 Social Security No .... none
(State or country)
Other conditions Generalized. Splanchnic Todayifpregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to which death
Of autopsy
above
should be
charged sta-
What test confirmed diagnosis ?.. Autopay
tistically.
20 Was disease er lojury In any way related to occupation of deceased ?
If so, specify
(Signed)
C A Powell
M. D.
(Address).Mas.s ... Mem.Hosp
Date 8-24-1942
21 PLACE OF BURIAL,
CREMATION OR REMOVALWinthrop
(Cemetery)
(City or Town)
DATE OF BURIAL
Aug-27-42
19
A TRUE COPY.
ATTEST:
Francis
(Registrar of city of town where death occurred)
DATE FILED
Aug-27-42
19
18 DATE OF
DEATH.
Aug-24-42
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
Aug-22-42
19 ........ , to .....
Aug ... 24 ... 42
19
...
I last saw he ......
... alive
Aug-24-42
19
death is said
to have occurred on the date stated above, at.12:50P
Immediate cause of death.
Generalized Peritonitis
m.
Duration
2days
Due to
Ruptured appendix and operation
therefor.
2dys
Due to
2days
12 BIRTHPLACE (City)
Roxbury
Mass
13 NAME OF FATHER Arthur Hubbard
PARENTS
14 BIRTHPLACE OF
London
FATHER (City)
......
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Laura B White
16 BIRTHPLACE OF
MOTHER (City)
Moulton
(State or country)
New Brunswick
17
Informant.
20 Tuxburg St
(Address)
Relation, if any ( ... daughter .....
Winthrop Mass
22 NAME OF
FUNERAL DIRECTO
Richard H White
ADDRESS
Winthrop. Mass
Received and filed.
Aug=27-42
19
SEP 11 13-2
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
1
No. MassachusettsMemorial Hospital
..... Sc. 1
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
59
That I attended deceased from
Date of.
-
RM R-302
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
(County)
Doston
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
101
(City or tofir making
Registered No.
7087
5
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Alice M Garrett
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 Wilshire
.St.
Winthrop,Mass
(If nonresident, give city or town and state)
In this community
yrs.
mos. 2
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX F
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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. .years
7 IF STILLBORN, enter that fact here.
8 AGE .74
Years
Months.
Days
If less than 1 day Hours Minutes
Usual
9 Occupation:
At Home
Industry 10 or Business:
II Social Security No. none
12 BIRTHPLACE (City)
St John
(State or country)
New Brunswick
13 NAME OF FATHER Samuel Garrett
PARENTS
14 BIRTHPLACE OF
Ireland
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary McJurkin
16 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
17 Fred Gillespie
Relation, if any nephew
A TRUE COPY francis
ATTEST:
(Registrar of city of town where death occurred)
DATE FILED Aug-31-42
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Aug-26-42
(Month)
(Day)
(Ycar)
19 I HEREBY CERTIFY.
Aug ...... 20-42.
19.
That I attended deceased from
Aug.26-12
19.
I last saw h ............ alive on.
Aug-26-42
19
death is said
to have occurred on the date stated above, at.
5:45₽
m.
Daration
Immediate cause of death
Pulmonary Edema
8/25/42
Due toCerebral Hemorrhage
8/20-42
Due to .
.Hypertension &Hypertensive
Heart Disease
130
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?
Physical Exam
20 Was disease ar Injury In any way related to occupation of deceased ?
no
If so, specify .....
Louis E Schiaffa
(Signed):
M. D.
(Address)E Boston Mass
Date8/26/
.19.42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Com
Winthrop
(Cemetery)
(City or Todas S
DATE OF BURIAL
Aug-29-42
19
22 NAME OF
FUNERAL DIRECTOR
Charles R Bonnison
ADDRESS
Winthrop Mass
Received and filed
Aug-31-42
19
OLI
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 3427-f
Dufour
No.
(City or Town) Strong Hospital-East Boston
St.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
2 days.
Date of.
Underline the cause to which death should be charged sta- tistically.
Informant (Address)
M R-302
uffour
PLACE OF DEATH
(County)
1
oston
(City or Town)
No.
The Boston Floating Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No
7180
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Baby Girl Daw
(a) Residence. No ..
8 Forest
(Usual place of abode)
Length of stay: In hospital or institution.
3 SEX
F
W
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
3
AGE
Years
Months.
.. Days
Usual
S Occupation:
Industry
10 or Business:
11 Social Security No.
(State or country)
13 NAME OF
FATHER
Robert Daw
14 BIRTHPLACE OF
FATHER (City)
Melrose
15 MAIDEN NAME
OF MOTHER
Alison Rose
16 BIRTHPLACE OF
Me
PARENTS
MOTHER (City)
(State or country)
17
Robert Daw
(Address)
50m-10-'39. No. 8427-f
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
(State or country)
Mass
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
(write the word)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
years
If less than 1 day
1.7 ... Hours ....
25 ... Minutes
12 BIRTHPLACE (City)
Winthrop
...... Mas8
A TRUE COPY
ATTEST:
mais
11
(Registrar of city of town where death occurred)
DATE FILED
Sept.2-42
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug-29-42
(Month)
(Day)
(Ycar)
19 | HEREBY CERTIFY, That I attended deceased from
Aug ... 28 ... 42 ...
19
........ , to ......
Aug.29-42
19.
I last saw h
.......... alive o
Aug-29-42
19.
death is said
to have occurred on the date stated above, at ..: 25A
m.
Duration
Immediate cause of death.
Atalectasis
17hrs
....
Due to
Prematurity
Due to
Other conditions
Cerebral Hemorrhage
PHYSICIAN
(Include pregnancy within 3 months of death)
and Edoms
Major findings :
Of operations
Underline the cause to which death
Of autopsy
as above
What test confirmed diagnosis ?.
20 Was disease or Injury In any way related to occupation of deceased ?
no
If so, specify
(Signed)
Charles H Hollis
M. D.
(Address)Boston
Date8/29 .19
42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop.
Winthrop, Mass
(Cemetery)
(City or 'Town)
DATE OF BURIAL
Sept.1-42
19
22 NAME OF
FUNERAL DIRECTOR
Maurice
Kirby
ADDRESS
Winthrop Mass
Received and filed
Sept 2-42
19
SEP 11 1912
(If U. S.
War Veteran,
specify WAR)
.. St.
Winthrop Mass
(If nonresident, give city or town and state)
16hrs
years
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Relation, if any father
Date of.
should be
charged sta-
tistically.
(Registrar of City or Town where deceased resided)
• ٠
M R-301 A
PLACE OF DEATH
Suffolk (County)
The Commontoralth 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.
S { If death occurred In a hospital or Institution, St. ( give its NAME instead of street aud uumber)
George Harrison Myrick
(If deceased is a married, widowed or divorced wonian, give also maiden name.)
34 Villa Ave.
St.
(If nonresident, give city or towu and State)
months
days.
In this community 30
yrs.
mos.
days.
MEDICAL) CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept
1
( Month )
(Day)
1942 (Year)
19 | HEREBY CERTIFY,
aug 28
19.
42
to
Sept 1
1942
I last saw h
... alive on
Sept 1
19.4 % death Is said to
have occurred on the date stated above, at
945 4
m.
Immediate cause of death.
Duration IMPORTANT
acute my acarditis
Due to
Due to.
Other conditions.
Phlebitis fliegt lig
4 days
(Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findings :
Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis?
t'ilerline the cause to which death should be charged sta- Itistically.
20 Was disease or Injury in any way related to occupation of deceased? .....
If so, specify
(Signed)
Lamint Salerno
M. D.
(Address) 175 Pleasant St
Date Sept / 1942
Everett
21 woodlawn Crematory
l'lace of Burial, Cremation or Removal.
(City or Towu)
42
DATE OF BURIAL
Sept .
3
19
22 NAME OF
FUNERAL DIRECTOR:
OR Forward S Wennoldo
ADDRESS
Received and filed
19
(Official Designation) (Date of Issue of/Permft)
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: Childrens 8
...... .......... (Signature of Agent of Board of Health or other)
Health Officer 9/3/42.
1
Winthrop
(City or Town)
34 Villa Ave
No.
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
years
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
( write the word)
White
Ma le
5a If married, widowed, or divorced Frances Duston
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Ilushand's name in full)
7 IF STILLBORN. enter that fact here.
8
65
AGE
Years
11
Months
27 Days
Usual
9 Occupation :
Bookkeeper
(Clerk)
11 Social Security No.
031-03-7052
12 BIRTHPLACE (City)
Callao
( State or country)
Peru
13 NAME OF
FATHER
Serge
Myrick
HARRISON
14 BIRTHPLACE OF
FATHER (City)
Nantucket Island
MCKELLAR
15 MAIDEN NAME
OF MOTHER
Mary L
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Glasgow
(State or country)
Scotland
17
Relation, if any
Informant .. Cz
54 Villa Ave winthrop Mass.
George A Myrick
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect.
Harison D. Myrick-
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
(State or country)
Mass .
Length of stay : In hospital or Institution ..
( Before death)
( Specify whether)
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
Industry
Eastman Storage Co.
10 or Business :
MARRIED
WIDOWED
or DIVORCEDMarried
6 Age of husband or wife if alive 33 years
If less than 1 day
Hours.
Minutes
2 days
(Registrar)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
That 1 attended deceased from
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 porr-on or of any number of the family of the deceased, furnish for registration a standard certificate of ilrath, stating to the best of his knowledge and belief the name of the deceased, bis supposed age. the disease of which he died. defined as re- quired hy section one, where same was contractel. the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Cen, Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceiling section or by section forty-five of chapter one humulred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the aring. 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 all the secondary or immediate canse 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 humilred and fourteen. the worl "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for sail 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. Clrap. 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 exlume 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 its agent aforesaid or froin the clerk of the town where the boily is buried. No such peruurit shall be issued until there shall bave been delivered to such board, agent or clerk, as the case may 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. o 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 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 forin 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-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. snch recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement aml certificate, shall forthwith countersign it aml 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 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 hnnian body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the huard 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 hoily is to be buried or the funeral is to be held, or from a person apointed 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, Suc. 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.
( ") 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) 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 clinical ( drugs or poisons), thermal, or electrical agents, and draths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized diseasc, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease. or complication which causes death. not the mode of dying. e. g., heart failure, asphyxia. asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- l'recise statement of occupation is very im- portant, so that the relative healtlifulness 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 retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook --- hotel, etc. For a person who had no occupation whatever write uone.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) 265- River Road
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.
No.
2 FULL NAME.
Louisa, Katherine Rogers. Simmons
(If deceased is a married, widowed or divorced woman, give also maiden name)
(a) Residence. No.
265 River Road
Winthropst.
(Usual place of abode)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
.... years
months
days.
In this community
3 5yrs
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
1.
1942
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
june 9 -
to ...
1942
August 29.
I last saw her
allve on ..
August Lg
197, death Is said to
have occurred on the date stated above, at
330
A.m.
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
AGE
65.
10
Months
5
Days
If less than 1 day
Hours ...
Minutes
at- home -
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
13 NAME OF
FATHER
James. Francis. Rogers
14 BIRTHPLACE OF
Boston muss
FATHER (City)
(State or country)
15 MAIDEN
OF MOTHER
adelia. actori
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country )
Maso
Sistex MusstElon. A. Rogers. Relation, if any (Address) Warwick neck O. R.S.
21 theday Selt 4# 1942
Place of Burial, Cremation or Removal
(City or Town)
DATE OF BURIAL Nuthanh Kerstin Winches
1942 .....
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued : Www. D. Childrensa
22 NAME OF
FUNERAL DIRECTOR Ch.s. R. Bennam
ADDRESS
windhast mass
Received and filed
19
(Official Designation) (Date of Issue of Permith
20 Was disease or injury in any way related to occupation of deceased ? NO
If so, specify.
Edward y, tranger.
(Signed)
M. D.
(Address) 200 Washight in ACE Date 9-20
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?.
pathological
8 mos
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
HyperAsphroma Extension
to
Visselstiv Date of Call
of autopey.
June 24-1942
Duration
IMPORTANT
years
Immediate cause of death.
HyperNephrome At
19.
42
(or) WIFE of
Men Give maiden name of wife
( Husband's name in full)
4 COLOR OR RACE
White
5 SHYOLE
MARRIED
WIDOWED
DIVORCED
(write the word)
widow
100m (d) -1-41-4667
(Signature of Agent of Board of Ilealth or other) Healthe Officer 9/3/42
St.
Registered No.
( (If death occurred In a hospital or institution, 'I give its NAME instead of street and nuniber)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
(If nonresident, give city or town and State)
5a If married, widowed, -or divorced
HUSBAND of
1 3 SEX Female Usual 9 Occupation : PARENTS 17 Informant If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai 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 :
( Registrar)
Due to.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal 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 nanie of the deceased, his supposed age, the disease of which he died, defined as re- quired 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 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 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, 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, be deemed to have taken place between 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.
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