USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 73
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RULES OF PRACTICE
The fulfillment of the purpose of these lawe calla for the observance of the following rules of practice:
(1) Attending physiciana 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 physiolans 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 atteinlance or whose pbyaf- cian is ahsent from home when the certificate of death ie needed.
(3) Medlosl Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths cansed directly or in- directly hy traumatism (incinding resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aml deatbs following abortion, but also deaths from diseasa resulting from Injury or infootion 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 meana the disease, or complication which causes death. not the mode of lying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng 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 Ocoupation .- Precise statement of occupation la very im- portant, so that the relative bealthfulness 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 bsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned aa at school or at hoine. For a woman wbose only occupatiou was that of home bousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terma, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffolk (County)
.........
inthron
(City or Town)
"inthron Community Hospital No.
St.
{ { If death occurred in a hospital or institution, ( give its NAME instead of street aud nuniber)
2 FULL NAME
Francis je bert
FOOTE
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
100 Circuit Road
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX "ole
4 COLOR OR RACE|
/hit-
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED arred
5a If married, widowed, or -divorced A English
HUSBAND of A. C.4587
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in fuli)
6 Age of husband or wife if alive years
" IF STILLBORN. enter that fact here.
8
AGE
Years
Months ....
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Salesman Retired
Industry
Electrical Supplies
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
( State or country)
Canada
13 NAME OF
FATHER
Oscar Foote
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Catherine Clon
16 BIRTHPLACE OF
MOTHER (City)
(State or country) Prince Edward Island
17 har aret Foote
21
Relation, if any
thron
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)
He alle Officer
11/24/42
(Official Designation) ( Date of Issue of Permit)!
18 DATE OF
DEATH
urs
23
1942
(Month )
(Day)
(Year)
19 | HEREBY CERTIFY.
www.6
194%.
to
Www.23
19
I last saw h
In alive on
L2, 1942
death is sald to
have occurred on the date stated above, at 12.200
m.
Duration
Immediate cause of death ....
IMPORTANT
Due to
adem salario
Due to Lis Other conditions Sigmondectomy
( Include pregnancy wimin 3 months of death)
Major findIngs :
Of operations
Cammina signial
Date of.
11/6/4V
Of autopsy
What test confirmed diagnosis ?
2 wks IMPORTANT
Physician 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)
(Address)
Place of Burial, Cremation or Removal.
DATE OF BURIAL ..
ovember 25 --- 1942
....
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
lintryto ass.
Received and fied
19
(Registrar)
100M-€ - 2-42-8855
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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. PARENTS
1
....
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.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so speolfy WAR)
months
16 days.
In this community20
yrs. - mos.
- days.
years
MEDICAL CERTIFICATE OF DEATH
That I attended
deosased from
., M. D.
(City or Town)
informant
( Address)
72
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized person or of any meniber 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, l.is supposed age, the disease of which he died. defined as re- quired by section one. where same was contracted. the duration of his last ilinesa, when last seen alive hy the pbyaician 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 hoth 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 thia sec- tion and of sectinns forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the Chins relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Stexi- can border service nf nineteen hundred aud sixtcen and nineteen hundred and seventeen. G. L. Clisp. 46, Sec. 10.
No undortaker or other person shall hury 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 ita agent appointed to lesue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a buman body and remove it from a town. from one cenietery to another, or from one grave or tomb other thau the receiving tomb to another In the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to sucb hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facta required by law to be returned all recorded, which shall be accompanied. In case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who ie a member of the board of health, or employed by It or hy the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, tbe medi- cal examiner chall 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, tbe certificate of desth made as above provided and in the possession of the undertaker desiring to make such removal slisll 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, se 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. sucb 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 transniit It to the clerk of the town for registration. The person to whom the permit la so given and the physician certifying the cause of death shall thereafter furnish for registration any other uece+ eary information which can be obtained as to the deceased. or as to the mallier 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 permita, 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 he held, or from a person appointed to heve the care of the cemetery or burial ground in which the interment is made .... Cbap. 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 aud take charge of the same; ... - General Laws, Cbap. 38, Suc. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulee of practice :
(1) Attending physicians will certify to such deatha only an those of persons to whom they have given bedside care during a last lilness from disease unrelated to any form of injury.
(2) Board of Health phyalolans will certify to such deatha only an those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose pbyaf- cian is ahsent from home when the certificate of death ie needed.
(3) Medloal Examiners will Investigate and certify to all ilcatha aup- posably due to Injury. These include not nnis deaths caused directly or In- directly by traumatism (including recuiting septicemia), and by the action of chemical (drugs or poisons), therinal, or electrical agents, and deatbs following abortion, but also deathe from diseasa resulting from Injury or Infeotlon related to occupation, the audden deaths of persons not disablad hy recognized disease, and those of persons found dead.
Statement of Cause of Death. Cause of death meana the disease, or complication which causes death. not the mode of dying, e. g., heart fallure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng death, As related causes, name earlier morbid conditions, If any, related to the principat cause and any important complication of the principal cause.
Statement of Ocoupatlon .- 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 bad retired from businesa, report the usuai occupation prior to retirement. Children not gainfuily employed may be returned as at school or at hoine. For a woman wbose only occupatiou was that of bome housework. write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, aa bousekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1 R-301 A
Suffolk
(County)
inthron
(City or Town)
No. Station H spital, Fort Banks, Lass
St.
{ ( If death occurred in a hospital or institution,
{ give ita NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME.
EDWARD ... PORERT ...
w .......... HAIG1.BA
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
179 Beatty Avenue
St.
Johnstown.
( If nonresident, give city or town and State)
Length of stay: In hospital or Institution,
(Before death)
(Specify whether)
years
months
18
davs.
In this community
-
yra. - mos.
-
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
white
4 COLOR OR RACE| 5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
18 DATE OF
DEATH
November
21.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
That I attended deceased
November 6,
42
19
to
November 24,
42
19
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at
9:55
a
m.
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE 22
Years
3
Months.1.2 ..... Days
If less than 1 day
Hours .......
.Minutes
Usual
9 Occupation :
Soldier
Industry
10 or Business :
U. S. Army
11 Social Security No ..
l!one
12 BIRTHPLACE (City)
Johnstorm
(State or country)
Pennsylvania
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
None
Physician
14 BIRTHPLACE OF
FATHER (City)
IronCity
(State or country)
Czechoslovakia
15 MAIDEN NAME
OF MOTHER
Mary Autko
16 BIRTHPLACE OF
MOTHER (City)
Hautzdale
(State or country)
Pennsylvania
17
Relation, if any
Inform
ister
Ann Palm. Irs.
(Address) 38 Prospect Park S. V. New York City
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
Sidney Olano, Capt. m
(Signed).
(Address) Station Hospital
Fort Banka
Date:NOV. 2419
42
21
Place of Burial, Creation Of Removal.
stown
Perenco
(City or Town)
...
DATE OF BURIAL ...
nov.27
19
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS 254 Beach St Revive
Received and filed.
19
( Registrar)
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
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filed with me BEFORE the burjal or transit permit was issued : Muy. S. Childrenex (Signature of Agent of Board of Health of other) Healthe Officer 11/24/42
(Official Designation) (Date of Issue of Permit)
Immediate cause of death. Tumor, malignant, superior, medi-
Duration
IMPORTANT
Unknorm
astinum, type unknown.
Due to
(pending pathological studies)
Due to.
Tumor, malignant, right chestUnknown
wall type undetermined. (pending
pathological findings.)
Date of
Of autopsy
See above
What test confirmed diagnosis ?.
Autopsy
Underline the cause to which death should be charged sta- tistically.
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
1
PLACE OF DEATH
The Commonfocalth 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. 218
Registered No.
(Was deceased a
U. S. War Veteran,
If so specify WAR)
Pennsylvania
7942
from
5a If married, widowed, or divorced
-
HUSBAND of
(Give maiden name of wife in full)
I last saw him
alive on.
November 24: 1912
death Is sald to
13 NAME OF
FATHER
George Hamara
D.
(Usual place of abode)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan 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 best of his knowledge and belief the nanie of tbe deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of bis 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, he 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.
No undertaker or other person .shall bury or otherwise dispose of a human body in a town, or reniove 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 health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may be, 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 be 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 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 connnonwealth cannot be obtained carly enough for the purpose, thie certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has heen engaged, such recital shall appear upon the permit. The board of health. or its agent, upon receipt of sucb 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 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 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 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 calla 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 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) 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 deathis from disease resulting from Injury or infection related to occupation, the sudden deaths of persons not disabled by recognized diseasa, and those of persons found dead.
Statement of Causa 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 tba 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 bealthfulness of various pursuits can he 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 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)
Tinthroz
(City or Town)
47 Bartlett Przy
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