USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 13
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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 bury a human body or the ashes thercof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buricd 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.)
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 care 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 by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examinere will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), 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 occupa- tion, the sudden deaths of porsons 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 con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- 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 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 !
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
Suffolk
BOSTON NOT; !- 3-9:48
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return) 33
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number) 1
2 FULL NAME.
(If decesecd is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... (160) Ститеплавать
(Usual place of abode)
ength of stay : In hospital or institution
(Specify whether)
years
months
/ days.
(If nonresident, give city or town and state)
In this cominunityl
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE |5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Married
5a If married, widowed, or divorced HUSBAND of .... ve maide ace of 19h need
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
Yoars
7 IF STILLBORN, enter that fact here.
AGE
8 62 Years. -Months Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation:
Industry 10 or Business:
11 Social Security No ..... mone
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
PARENTS
14 BIRTHPLACE OF FATHER (City) ..........
(State or country)
15 MAIDEN NAME OF MOTHER
16 BIRTHPLACE OF
MOTHER (City
(State or country)
13otom
17 John
Relation, if any
Informant. (Address)
1607 Com. lapis
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Skuature of Agent of Board of( Health or other)
Health
Officer
2/17/43
(Official Designation ) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Feb
15
1843
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, That I attended deceased from
art 1
19 4 7 F6615-
1943
I last saw h. Ama .. alive on.
19 ..... , death is seid
Duration
to have occurred on the date stated above, at 8.21
Immediate cause of death ..
acute cardiac
...
1943
Due to
Publicatat
Due to
...
descao
1942
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
Date of ..
Of autopsy
........
What test confirmed diagnosis ? Authe
20 Was disease or Injury In any way related to eccopatioo of deceased ?
If so, specify .....
(Signed) ...
AnaBand
Date 2-16 19 3
21 amargo
(Chy or Town)
Place of Burial, Cremation or Removal. DATE OF BURIAL. 18" 19 43
22 NAME OF
FUNERAL DIRECTOR
Recijuly
ADDRESS
Received and filed.
FLB 2 4 1943
A TRUE COPY ATTEST:
(Registrar)
200m-10-'39. No. 8427-d
PLACE OF DEATH
1
County) Winthrop
(City or Tom) Winthrop Community Top St. No ......
Mary E. Otell
St.
(If U. S. War Veteran. (specify WAR) Bugacon
62
......
MARGIN RESERVED FOR BINDING
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
M. D.
(Address).
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during bis 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 de- livered 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 sball 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 section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the 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
obtained as to the deceased, or as to the manner or cause of tbe death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a buman body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town 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.)
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 care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deatbs only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from bome when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deatbs from disease resulting from injury or infection related to occupa- tion, the sudden deaths of porsons 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 con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- 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 by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
Laffeld (County>
(City or Town 17 Vine are
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.i
Registered No.
( If death occurred in a hospital or institution,
give its NAME instead of street and nuniber)
2 FULL NAME
Jennie 4. King
dowed or divorced
Voman, give also maiden name.)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
yeera
months
days.
In this community 25 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Fel
17
1943
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
That I attended deceased from
19 42
....
Feb 17
19
43
....
I last saw h.
en
.. alive on.
721-17
, 19.3., death Is sald to
have occurred on the date stated abova,
.
9:30 P.
.m.
Pulmonary
Duration IMPORTANT
Embolis
Hypertonin Heart Disease
Due to
Other conditions
Crossed Hemiplegia Right
( Include pregnancy within 3 months of death)
5 /2 mon 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 deosesed ?...... z). if so, spoolfy.
....
(Signed) ...
M. D.
21
H.9 Gnor Malien
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
218:no
1943
22 NAME OF
Trinh Bros
FUNERAL DIRECTOR
ADDRESS
210
Wenche at
Received and Aled. ........
19
( Registrar)
100M-4 - 2-42-8855
I HEREBY CERTIFY that a satisfactory standerd certificate of deeth was filed with me BEFORE /the burgal er transit bermit was Issued ? W/m.D. Chuldress ( Signature of Agent of Board of health of other) Health Officers
2/20/43
(Omclal Designation) ( Date of Issue of Permity
5 SINGLE
( write the word)
MARRIED
WIDOWED weder
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
mucche maiden name of white in full )
( Husband's fame In full)
6 Age of husband or wife if alive
years
> IF STILLBORN, enter that fact here.
8 AGE 65 . Years Months - Days
If less than 1 day
Hours
Minutes
at home
11 Social Security No. None
'2 BIRTHPLACE (City)
( State or country)
Ireland
13 NAME OF
FATHER
Valentine King
14 BIRTHPLACE OF
FATHER (City)
Aveland
(State or country)
15 MAIDEN NAME
OF MOTHER
unkname.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
May King
17 Informent ( Address) 17 this one
Mejor findIngs:
Of operations
Date of
Of autopsy
What test confirmed diagnosis? Chemical
1 3 SEX Female (or) WIFE of Usual 9 Occupation : If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effeot. PARENTS 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. should be carefully supplied. AGE should be stated ERACILT. PHYSICIANS should state CAUSE OF DEATH in plain Industry 10 or Business :
No.
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
( I) deceased Is a married,
(a) Residents. No. 17 Vine are (Usual place of abode)
4 COLOR OR RACE
White
...
Fc+19 1943
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or regiatered hospital medical officer shall forthwith, after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other authorizeil person or of any member of the family of the deceased, furnish for registration a atsudard certificate of death, 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 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 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 immeiliate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, sucb physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bumlred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, 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 bundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a buman body in a town, or remove therefrom a human body which has not been buried, until he haa received a permit 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 person died; and no undertaker or other person shall exhume a human body and remove it froin a town. from one cenietery to another, or from one grave or tomb other thau tbe receiving tomb to another In the same cemetery, until he has received a permit from the board of health or its agent aforexaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there aball bave been delivered to sucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law. 01 in lieu thereof a certificate as liereinafter 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 pbysi- cian who is a member of the board of health, or employed by it or by the aelectmen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death is caused by violence, the medl- cal examiner ahall make such certificate. If such a permit for the removal of a human body, not previously interred, from one towi to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtalued hereunder. If the death certificate contains a recital, aa 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 heen engaged. sucb recital shall appear upon the permit. The bosrd of health, or its agent. upon receipt of such statement and certificate, shall forthiwith 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 nece+ 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 .- Cbap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the hoard of health or its sgent appointed to issue such permits, or if there is no such hoard, 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 have tbe care of the cemetery or burial ground in which the interment is made .... Cbap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as sre supposed to have died hy 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 boily liea aud 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 deatba 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 physlolans will certify to such deaths only aa those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyof- cian is ahsent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to sll deatba sup- posably due to Injury. These include not only desths cansed directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical sgents, aml deatbs following abortion, but also deaths from diseass resulting from Injury or Infeotlon 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 deathı means the disease, or complication which causes desth, not the mode of ilying, e. g., heart failure, asphyxia, aathenia, 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 .- Precise statement of occupation is 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 bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at boine. For a woman wbose only occupation was that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that offoot. 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
Suffolk (County) Winthrop ...
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. 35
Registered No.
§ ( If death occurred in a hospital or institution, St.
give its NAME instead of street aud number)
PHYSICIAN - IMPORTANT
2 FULL NAME
( If deceased is a married, widowed or divorced /woman, give also majden name.)
(a) Residence. No.
62 Sargent
St.
(If nonresident, give clty or town and State)
Length of stay: In hospital or institution
(Before death)
yeare
months
days.
In this community
16 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Male White
5 SINGLE
( write the word)
MARRIED
Widowed
or DIVORCED
HUSBAND of
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if alive deceased years
IF STILLBORN. enter that fact here.
8 56
AGE Years -
Months
....... Days
If less than 1 day
Hours.
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