USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 16
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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 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 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 wben tbe 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 deaths from disease resulting from injury or infection related to occupa- tion, 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 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 homc. 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
1. -
M R-301 A
Suffolk
REVERE NOTIFIE 3-9.43
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. 40
Registered No.
th occurred !
St. ( give its NAME instead of street and number)
Stillborn D'amore
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 72 Pearl are
1
2 FULL NAME
(Usual place of abode)
Length of stay : In hospital or institution.
( Before death )
( Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
Male
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
L
HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
(Ilusband's name in full)
6 Age of husband or wife if alive
8
AGE
Years.
Months
Days
...
-
Usual
9 Occupation :
industry
10 or Business :
11 Social Security No.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Informant
(Address) 2 Years of Beans
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. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
12
(State or country)
Wenthup Mars.
8 Mars.
5 SINGLE
(write the word)
years
7 IF STILLBORN, enter that fact here. Stillborn
If less than 1 day Hours .. Minutes
13 NAME OF
FATHER
Frank Lamal
Indiana
15 MAIDEN NAME
OF MOTHER
Margaret Mazzaro
Kever Mars
17 Frank D'amore ( - father
Relation, if any
i HEREBY CERTIFY that atatractory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : Nm. D. Childress y
(Signature of Agent of Board of Health or other) 1 healthe officer 3/1/43
(Official Designation ) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Feb.
24
(Month)
(Dấy)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
Atilla Cion
19
I last saw h ..........
alive on
19
..... , death Is said to
have occurred on the date stated above, at
4:48 x
m.
Duration IMPORTANT
Immediate cause of death.
Haile bow
Due to.
Due to.
Other conditions
(Include pregnancy within 8 months of death)
IMPORTANT Physician
Major findings :
Of operations.
Dato of.
Of autopsy
What test confirmed diagnosis?
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to gooupation of degeased ?. If so, specify.
(Signed)
(Address).
72 Hines Du
suget
.. , M. D.
Holy Cross Cemetery Malden Man
Place of Burial, Cremation or Removal
DATE OF BURIAL March
(City or Town)
1, 1943197
Date ....
24/22 1943
T7.
22 NAME OF FUNERAL DIRECTOR Charles Bruno I Son
ADDRESS
14 Prochão are Renee Maso
Received and filed
19
(Registrar)
(Was deceased a
U. S. War Veteran,
if-to specify WAR)
grasa
St.
Revere
(If nonresident, give city or town and State)
years
- montlis 1 days.
In this community ~ yrs.
mos.
days.
-
100m (d) -1-41-4667
PLACE OF DEATH
(County) Winthrop (City or Town)
Winthrop Community Hospital No.
PHYSICIAN - IMPORTANT
1943
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 nudertaker 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 behef 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 helief, served in the army. navy or marine corps of the l'uited 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 canse of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one 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 bundred 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 be issued until there sball bave been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall be accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law. o1 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the hoard of health, or employed by it or by the 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 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 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 such statement and certificate, shall forthwith counter-ign 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 nec++ 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 hoard of health or it> agent 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 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 hody 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 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 disahled 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 deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persona 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. Aa principal cause name the diaease cauaing 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 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 occupatiou was that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family. cook-botel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
- PLACE OF DEATH
Buff.17- (County)
............
(City or Town) /in brow jo No.
muito.
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.
Registered No.
4.1
Hospital
St.
( If death occurred in a hospital or institution,
give its NAME instead of street aud nuniber)
PHYSICIAN - IMPORTANT
2 FULL NAME ..... Vory J Fraser Donovan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 207 Co'tere Pente Rond
(Usual place of abode)
St.
(If nonresident, give city or town and State)
in this community 25 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE|
Thite
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED 10 7700
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Conn (Give maiden name of wife in full)
( Husband's name in full)
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 :
Housi -
11 Social Security No.
12 BIRTHPLACE (City)
(Siate or country)
Cinada
13 NAME OF
FATHER
illiam Fraser
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
C. n= d.
21
Piace of Burial, Cremation or Removal.
DATE OF BURIAL
(City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
(Simature of Agent of Board of Health of other)
3/2/43
(Omclal Designation) ( Date of leque of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
( Month)
28
1943
(Day)
(Year)
19 i HEREBY CERTIFY,
That I attended deosased from
19 YY,
to tor.28
1943
I last saw han
alive on
INN. Lt, 1943
death is sald to
have occurred on the date stated above, at
GP
m.
Immediate gause of deathfreemoney
Duration
IMPORTANT
Due to.
ship
Due to.
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findIngs :
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
4my
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to dooupation of deceased ?wwwwww ...
if so, spaoify
(Signed)
M. D.
(Address) Chiaak
Date 3-1- 1943
informant
C. J. Do orn
Relation, If any
( Address)
Cotter
200
I HEREBY CERTIFY that a satisfactory standard certifioats of death was filed with a BEFORE the burlar or transit permit was issued: Www. D. Childelf
Johny Vil Thater
Reosivad and Alsd ....... .19
( Registrar)
1
100M-G - 2-42-8855
1 3 SEX PARENTS 17 If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a reoitai 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 Industry 10 or Business :
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
years
5
months
days.
Our Home
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 attemled during his last illuesa, 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 lest illneaa, when laat seen alive by the physician or officer and the date of his death ... Gen. Lawa, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa 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 corpa 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 aection, auch physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humulred and fourteen, the word "war" shall incinde the Chius relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Siexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chiap. 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 haa received a permit from the board of health, or its agent appointed to isaue such permita, 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 huinan body and remove it froin 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 haa received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the body is buried. No such permit ahall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a aatisfactory written atatenient containing the facta 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, aa required by law. o1 in lieu thereof a certificate aa hereinafter provided. If there ia no attending physician, or if, for sufficient reasona, hia certificate cannot be obtained early enough for the purpose, or ia insufficient, a physi- cian who ia 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 ia caused by violence, the medi- cal examiner shall make such certificate. If auch 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 posaesaion ot the undertaker desiring to make such renioval 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 haa been sooner obtained hereunder. If the death certificate containa a recital, aa 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. 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 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+ aary 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 conimionwealth until he has re- ceived a permit so to do froni the hoard of health or its agent appointed to issue such permita, or if there is no such hoard, from the clerk of the town where the boily is to be buried or the funeral is to he 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. 16. G. L., (Tercentenary Edition).
Medical examinera shall make examination upon the view of the dead bodies of ouly such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the hody of such a person, he shall forthwith go to the place where the body iles 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 rulea of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whom they have given bedside care during a last iliness from disease unrelated to any form of injury.
(2) Board of Health phyalclans will certify to such deatha 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 phyaf- cian ia ahsent 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 cansed directly or in- directly by traumatism (including resulting septicemia), and by the action of clientical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deatha 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 meana the disease, or complication which causea death, not the moile of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditiona, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation ia very im- portant, so that the relative healthfulnesa of various pursuits can be known. Make aome 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 dixcase causing death, report the usual occupation prior to illness. If the deceased had retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at hoine. For a woman whose only occupatiou waa that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as housekeeper-private faniily, cook- hotei, etc. For a person who had no occupation whatever write none.
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