USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 68
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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 hury a human body or the ashes thereof which have been brought into the commonwealth nntil he has received a permit so to do from the board of health or Ita 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 from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Seo. 46, G. L., (Tercentenary Edition. )
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance 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 carc during a last ill- ness 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 discasc un- related to any form of injury, have died without recent medical attendance or whose physician is absent from horje 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 hy traumatism (including resulting septicc- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deathis 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, namc earlier morhid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Ocenpation .-- Precise statement of occupation Is very important, 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 busi- ness, 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 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
*
R-301 A
suffolk (County)
Winthrop
(City or Town)
Winthrop Community Hospital
The Commonforalth 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. el
Registered No.
Silf death occurred In a hospital or Institution, St. [ give its NAME instead of street aud uuuiber)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 79 Terrace Ave.
.........
(Usual place of abode)
(If nouresident, give city or town and State)
Length of stay : In hospital or Institution.
Hospital
.....
years
months
5
days.
In this community
yrs.
mos.
days.
( Refare death )
( Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACEI
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
Sa If married, widowed, or dichristine Fairbanks
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Intshand's name in full)
6 Age of husband or wife if alive 71
years
7 IF STILLBORN. enter that fact here.
8 65 2 26
AGE
Years
Months
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Banker
Industry
Private Banking Co.
10 or Business :
11 Social Security No.
024-09-5901
12 BIRTHPLACE (City)
( State or country)
Mass.
Boston
13 NAME OF
FATHER
John Anderson
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Elizabeth Fraiser
16 BIRTHPLACE OF
MOTHER (City)
(State or country) unable to obtain
17 Christine Anderson IWatifwif any
Informant.
( Address)
79 Terrace Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
1 Children
(Signature of Agent of Board of Health or other>
Health Officer 10/31/42
(Official Designation) (Date of Issue of Permit)'
18 DATE OF
DEATH
October
29
1942
( Monllı )
(Day)
(Year)
That I attended deceased from
19 | HEREBY CERTIFY,
December 8
1936.
to ....
I last saw h.
un alive on
October 29, 1942
death Is sald to
.m.
Duration IMPORTANT 4 days.
Izen
Due to.
Uremia
3 days
Other conditions.
(luclude pregnancy within 3 months of death)
Major findings :
Of operations.
none
Date of
L'underline the cause to which death should be
What test confirmed diagnosis
Smally,
20 was disease or injury in any way related to occupation of deceased ?..... If so, specify
abraço
M. D.
(Signe
(Address) 362 Seuly UT
Date 10/31/1942
21
Winthrop
winthrop
(City or Towu)
l'lace of Burial, Cremation or Removal.
DATE OF BURIAL
Nov
1912
22 NAME OF
FUNERAL
Howard ; Pragmalos
ADDRESS
muro
Received and filed.
19
(Registrar)
100m (d)-1-41-4667
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. PARENTS extracts from the laws on back of certificate.
1
PLACE OF DEATH
No.
Ernest Edward Anderson
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
30
October 29.
1942
have occurred on the date stated above, at 11.30A:
Immediate cause of death ....
Cerebral Hemorrhage
Due to.
Diabetes Mellitus
IMPORTANT Physician
Of autopsy
notdone
MEDICAL CERTIFICATE OF DEATH
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 whum he has attended during his last illness, at the request of an uvelertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name uf the decrased. his supposed age, the disease of which he died. defined as re- quired hy section one, wlivre 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 preceiling section or by section furty-five of chapter one hundred and four- teen, shall. if the deceasul. to the best of his knowledge and belief, served in the army, navy or inarine 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 saine. 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 bundred 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 hetweon 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 buard 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 une cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has receivedl a permit from the buard uf health or its agent afore>aid or from the clerk of the tuwn 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 he returned and recorded, which shall be accompanied. in case uf an original internient, 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 meniber of the hoard of health, or employed by it or by the aelectmen 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 aerved in the army, navy or marine corps of the United States In any war in which It has hren engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement atal 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 the cause of death shall thereafter furnish for registration any other urce+ 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 thereuf which have been hronght 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 tlu're is no such hoard, from the clerk of the town where the boily is to he buried or the funeral is to he held, or from a person alsointeel 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 jurson. 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) Atiending 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 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 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 septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of ilying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbil conditions, if any, related tu 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 sectiun for every- person aged 10 years or over. If the occupation had been given up or changed un 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 fiome huusework, 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 persou wbo had no occupation whatever write uone.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
(County)
Tinthrop
(City or Town)
ZC Bellevue Ave
No.
{ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Celle han
2 FULL NAME Sarah & Veskle
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran.
If so speolfy WAR)
(a) Residence. No.
30 3:11en13 AT3
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or institution ..
(Before death)
years
months
days.
In this community O
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACEJ
Thite
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED/110722
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
1 ] ( Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at.
7.30PM
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
AGE
Months Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
How-e-in-
Industry
10 or Business :
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findings :
Of operations
22000
Date of
Of autopsy
-
What test confirmed diagnosis ?
Clinical Signs
Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury in any way related to occupation of deceased ? If so, specify
(Signed)
Daniel J. 11 Juin
M. D.
(Address) WinThetop, 1455 Date 1222, 1942
21
Holy Cross
Place of Burial, Cremation or Removal.
DATE OF BURIAL
WOV13 1042
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
inthron
Signature of Agent of Board of Health or other) The althe Officer
11/2/47
Received and filed ..
19
(Official Designation) (Date of Issue of Permit)
( Registrar)
100m (d)-1-41-4667
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.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeet.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
N.Y.
15 MAIDEN NAME
OF MOTHER
"annanot
Tobin
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
Nova Scotia
17 Tirs George Parsons
Informant ...
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlet or trapsit permit was issued : Www.D. Children
( Relationgitang
18 DATE OF
DEATH
Gelaber
30
1942
19 | HEREBY CERTIFY,
That I attended deceased from
Get27
1942
Oct. 30
1942
to
last saw h @ V alive on
Cenk 30, 1942 death is sald to
Immediate cause of death
Cerebral Nemanlage
Duration IMPORTANT 3 days
Due to. Chroni hypertension
17 years
Due to.
13 NAME OF
FATHER
-
C
L
V
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.
1
PLACE OF DEATH
(Specify whether)
Registered No.
(City or Town)
8
56
Years
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan or registered hospital medical officer ahall forthwith, after the death of a person whom he haa attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased. his supposed age, the disease of which he died, defined as 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 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 ariny, 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 horder service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from 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 liealth or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original 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- ciau who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate 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 shail 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 8 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 aection ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for 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 manuer 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 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 from a person appointed to have the care of the cemetery or burial ground in which the interment ia 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 ia within his county the body of such a persou, 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 theae lawa calls for the observance of the following rulea of practice :
(1) Attending physloians will certify to such deaths only as those of persons to whoin they have given bedside care during a laat illneaa from disease uurelated to any form of injury.
(2) Board of Health physiclans will certify to such deatha 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 ia 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 deatha following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons lot 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 cauae 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 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 waa that of home housework. write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
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