USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 12
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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, aerved 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 scetions 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 hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; 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, 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 be obtained early enongh 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 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 rensoval; 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 aection ten of chapter forty-aix, that the deceased aerved in the army, navy or marine corps of the United Statea in any war in which it haa 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 ia 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 examinera 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 calls for the observance of the following rulea of practice :
(1) Attending 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 physiclans will certify to such deaths only aa those of persons who, though disabled by recognized discase unrelated to auy 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 aepticemia), 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 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'iccixe 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 deatlı, 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 honte housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, coq+-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 =
Suffolk
(County)
Winthrop
-
No.
{ { if death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Charles Edward Rowe
( If deceased is a married, widowed or divorced woman, give also maiden nanie.)
(a) Residence. No.
110 Loring Road
St.
(If nonresident, give city or towu and State)
Length of stay : In hospital or institution
" Before death )
years
months
days.
In this community 20 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
Whote
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
Sa If married, widowed, or divorced
HUSBAND of
(Cive maiden name of wife in fuil)
Louise A Austin
(or) WIFE of
( Ilushand'* name in full)
6 Age of husband or wife if alive 71 years
7 IF STILLBORN. enter that fact here.
8
AGE
Years
1
28
if less than 1 day
Hours
Minutes
Usual
9 Occupation :
Supintendent (Retired)in
Industry
Sand & Gravel
10 or Business :
11 Social Security No.
None
Richmond
12 BIRTHPLACE (City)
( State or country)
Maine
13 NAME OF
FATHER
Robert Rowe
14 BIRTHPLACE OF
New Castle
FATHER (City)
(State or country) Maine
15 MAIDEN NAME
OF MOTHER
Laura B Knight
16 BIRTHPLACE OF Bowdoinham
MOTHER (City)
(State or country ) Maine
17 Louise Rowe
Informant. 110 Loring Rd. Winthrop
WHaftgy, If any
DATE OF BURIAL
.Feburary
17
1543
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued : UmD. Children
Signature of Agent of Board of Health or other)
Health Officer 2/16/83
(Official Designation)/ (Date of Issue of Permit)
18 DATE OF
DEATH
Ichmany
13
1943
(Montis )
( Day)(
(hear )
19 | HEREBY CERTIFY,
That I attended deoeased from
to.
1940
Ich 11
19.
43
.........
i last saw halive on.
Ich 11,
1943
death is said to
have occurred on the date stated above, at.
630 G
Duration
Immediate cause of death
Beschall Hemorrhage
IMPORTANT
01140
(3rd grade)
Due to ..
Cerebrali anterio - Schermi
01942
3 1943och
Due to.
Hypertens
re vascular dem
3400. 10yrs ....
1940
Major findings :
Of operations.
X- Quy + laborator
Physician
Une
blood
Date of
Of autopsy
What test confirmed diagnosis Beton But Grisham 4940
Imleriine the cause to which death livull be chargeil sta- tistically.
20 was disease or injury in any way related to ocoupation of deceased ?............
If so, specify.
(Signed)
John 7 Caya JV
M. D.
(Address)
470 Cmque Boli Date det 15 1943
21
Winthrop. I.
Winthrop
I'mace of Burial, Cremation or Removal.
(CIty or Towu)
22 NAME OF
FUNERAL DIRECTOR ...
Howard Hunolds
ADDRESS
Winthrop -maso.
Received and filed.
19
(Registrar)
100m (d)-1-41-4667
1
PLACE OF DEATH
(City or Town)
110 Loring Road
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.
21
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
( Specify whether)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital 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. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
Other conditions Stemplegia + chime
((Inciude pregnancy within 3 months of death)
bronchitis
IMPORTANT
PARENTS
76
Months
Days
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 number 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 contrasted, 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 humired and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall. for said purposes, he deemed to have taken place betweco February fourteenth. eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of oineteen 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 exhunne 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 peroiit from the board of health or its agent aforesaid or from the clerk of the town where the body is huried. 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, of 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 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-six, that the deceased served in the army, navy or nmarine corps of the United States in any war in which it has been engaged. such recital shall appear upon the permit. The board of Irealth, 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 manter 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 hody 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 hody is to he buried or the funeral is to be held, or from a person apiminted 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 persoos 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 calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persoos 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 physi- cian is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate aod 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 eliemical (drugs or poisons), thering), or electrical agents, aml 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 dying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, naine earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known .. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the 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 honre 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
FORM R-301
Suffolk
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name,)
892 liter tx
.St.
Wontwork
(a) Residence. No .. (Usual place of abode)
length of stay: In hospital or institution Hospital
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE | 5 SINGLE
White
MARRIED
WIDOWED
or DIVORCED
Widow
5a If married, widowed, or divorced
Katherine 3. Water
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, onler thal fact here.
8 79 Years Months .... - Days
If loss than 1 day
Hours.
Minutes
Retired
II Social Security No.
Halifax N.S.
13 NAME OF
FATHER
James 13 arber
14 BIRTHPLACE OF
FATHER (City)
Novia Scotia
15 MAIDEN NAME
OF MOTHER
Mary A. Power
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
17 Mrs Gladys Whalen Informant. (Address) 892 Shirley St , daughter)
I HEREBY CERTIFY that a satisfactory standa teattached to death was Eled with me BEFORE the burial or transit permil was issued:
WilliamD. Childrens
(Signature of Agent of Board of Health or other)
agent Feb 15/43
(Official Ile: gnation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF'
(write the word)
DEATH
FeburAry
14
1943
(Month)
(Day)
(Year)
19 IHEREBY CERTIFY, That I attended deceased from
an 15
19 .... , to ......
feb14
1945
1 last saw h .... f .... alive on.
1945, death is said
to have occurred on the date stated above, at ..........
the cause of / t(R.)
....
Duration
............
Sudden
Due to acute ThelbiTis
......
6 DAYS
Due t
Chronic hypertrophy
of ProstAle
1 year
.....
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Hypertrophy of
Frostale
Date of Van 31,1943
Of autopsy
What test confirmed diagnosis? ClinicalSigns
20 Was disease or injory lo any way related to occupation of deceased ? -
If so, specify ...
Daniel OPPrien
M. D.
(Signed)
&Wash. Raus Winthrop Da Je6 15 19413
21
St. Josephs
Boston
Place of Burial. Cremation/Or Removal, DATE OF BURIAL
Fity or Town)
2-18-43
19
22 NAME OF
FUNERAL DIRECTOR
File Crosby
ADDRESS
867º Beaconist, Boston
Received and fled 19
A TRUE COPY ATTEST:
(Registrar)
MARGIN RESERVED FOR BINDING
200m-10-'39. No. 8427-d
- 3 SEX Male (or) WIFE of. AGE ... Usual 9 Occupation: Industry PARENTS N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. See instructions and extracts from the laws on back of certificate. 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 10 or Business:
(City or Town) PLACE OF DEATH No. albert I, Barber
Winthrop Community Halb
(City or town making return)
(If U. S.
War Veteran.
specity WAR)
(If nonresident, give city or town and state)
In this community 40 yrs.
mos.
days.
years
months
days.
...
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
12 BIRTHPLACE (City)
(State or country)
(State of country)
Relation, if any (Addre
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 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.
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 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 dc- livercd to such board, agent or clerk, as the case may be, a satisfac- tory 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 physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by 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 desiring 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 body has been sooner obtained hereunder. If the death certificate contains a recital, as required by scetion 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 fur- nish for registration any other necessary information which can be
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