USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 18
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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 has 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 dled; and no undertaker or otber person ahall exhume a human body and remove it from a town, from one cenietery to another, or from one grave or tomb other thau the receiving tourb to another In the same cemetery, until he has received a permit from the bosrd 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 board, agent or clerk, as the case inay be, a satisfactory written statement 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 auy, as required by law, 01 in lieu thereof a certificste as lrereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate caunot 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 hy the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death Is caused by violence. the medl- cal examiner shali make such certificate. If such a permit for the removal of a liumsu body, not previously interred, froin one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of desth made as above provided and in the possession of the undertaker desiring to make such removal sliall 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 hody has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased aerved 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 transnit 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 ueces- sary information which can be obtained as to the deceased. or as to the manner of cause of the death, which the clerk or registrar uray require .- Cbap. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury . hunian hody or the ashes tbereof which have been brought Into the commonwealth until he has re- ceived a perinit so to do front the board of health or its sgent appointed to issue such permits, or if there is no such board, front the clerk of the town where the body is to be buried or the funeral is to he held, or from a person apointed 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 mske examiustion upon the view of the dead bodies of only such persons ss are supposed to have died hy violence. If a medical examiner hss 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, Cbap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calis for the observance of the following rules 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 physlolana wili certify to such deaths only as those of persons who, though disshled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose pbyaf- cian is absent from home when the certificate of death is needed.
(8) 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 resuiting septicemia), and hy the actlon of clientical (drugs or poisons), thermal, or electrical agenta, aml deaths following abortion, but also deaths from dlacasa resulting from Injury or Infection related to oooupatlon, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of deatlt means the disease, or complication which causes death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principai cause name tbe disease causing death. As related causes, name earlier morbid conditions, If any, related to the principal cause and any important complication of tbe principai cause.
Statement of Occupation .- Precise statement of occupation ia very im- portant, so that the relative healthfulness of various pursuits can he known. Make some eutry 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 he returned aa at school or at hoine. For a woman wbose only occupatiou waa that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as bousekeeper-private faniily, cook-hotel, etc. For a person wbo had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M 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 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
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
44 7 mole Ave
No.
The Commontocall 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. 48
Registered No. § ( If death occurred in a hospital or Institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
In nl G. Aguayo
(If deceesed is a married, widowed or divorced women, give also maiden name.)
(a) Residence. No.
4402-07: Ava
St.
(If nonresident, give city or town and Stete)
Length of stey: In hospital or Institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Mole
4 COLOR OR RACE|
Thite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
58 If married, widowed, or divorced P ....
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
years
> IF STILLBORN. enter that fact here.
ÅGE61 AGE Years Months .. .. Days
If less than 1 day
Hours ..........
Minutes
Usual
9 Occupation :
March at
Industry
Coffee & Ten
11 Social Security No. .
12 BIRTHPLACE (City)
(Siate or country)
PuertoRico
13 NAME OF
FATHER
Frenk Aguayo
PARENTS
14 BIRTHPLACE OF
FATHER (City)
....
-
(State or country)
Puerto Rico
15 MAIDEN NAME
OF MOTHER
20 Was disease or injury in any way related to oooupetion of deceased ?..... Y ..... If so, apeolfy.
(Signed)
(Address)
Winthrop Mass Date /Yar 8 1943
21
Place of Burial, Cremation or Removal.
DATE OF BURIAL.
(City, or Town)
I143
.... 19
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlahor transit primit was Issued ?
(Signature of Array of Board of Health or other)
Meatthe Officer
3/9/45
(Omcial Designation) (Date of Taque of Pepmit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
march
7
1943
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
That I ettended deceased from
Dec 15
1942 to
1943
I last sew h .... ( ....... ).alive on
March
7, 1943, death Is said to
heve occurred on the date stated above, at.
12.30P.
Immedlete cause of death
Pulmonary Embolism
IMPORTANT
.........
Due to.
Chronic Endocarditis
.......
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findIngs :
Of operations
Date of
Of autopsy.
What test confirmed diagnosis ?.
Clinical Signs
IMPORTANT Physician
Underline the cause to which death should be charged sta- tisticelly.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Puerto Rico
(
Relation, If any
17 Informant ( Address)
.. A UONO
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
.......
Recalvad and Alad.
19
( Registrar)
100M-4 - 2-42-8855
1
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
years
months
days.
In this community
20 yrs.
mos.
days.
( write the word)
10 or Business :
49
Duration
. M. D.
Yolwmatel
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 undertsker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of desth, ststing to the best of his knowledge and belief the name of the deceased, bis supposed age, the disesse of which he died. defined as re- quired by section one. where same wss contracted. the duration of his last ilineas, when isat seen alive by the physician or officer and the date of hia 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 srmny, 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, sud shall also certify in such certificate both the primary and the secondary or iinmeiliste cause of death as nearly as he can state the ssine. For neglect to comply with any provision of this section, such 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 humtred 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 hetwcen February fourteenth, eigliteen hundred and ninety- eight sud July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chisp. 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 ita agent appointed to Issue such perinits, or if there is no such bosrd, from the clerk of the town where the person died; and no undertsker or other person shall exhume a human body and remove it froin a town. from one cemetery to another, or fromin 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 sgent sforesaid or from the clerk of the town where the body is buried. No such permit ahall be issued until there ahall have been delivered to such board, agent or clerk, as the case inay 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 sttending physician, if any, as required by law, o1 in lieu thereof a certificate aa hereinafter provided. If there is no attending physician, or if, for sufficient reasona, 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 aelectmen for the purpose, shall upon application niske the certificste re- quired of the attending physician. If death is caused by violence. the medl- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, froin one town to another within the commonwealth cannot be obtained esrly enough for the purpose, the certifleste of death made as above provided and in the posaesaion ot 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 ohtalned hereunder. If the death certificate containa a recital, as required
hy section ten of chapter forty-six, that the deceased aerved in the army, navy or marine corpa 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 certificste, 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+ sary information which can be obtained as to the deceased, or as to the manner of cunse 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 its agent appminted 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 be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment ia made. ... Cbap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medicsi examiners shall make examination upon the view of the dead hodiea 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 body liea and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa 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 physlolana 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 phyaf- cian is absent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all deatha sup- posabiy 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 1, thermal, or electrical agente, and deaths following abortion, but also deaths from dlacasa resulting from injury or Infeotlon related to ocoupatlon, 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. Aa principal cause name the disease caualng 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 la 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 ou 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 aa at school or at hoine. For a woman whose only occupatiou waa that of honie housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FORM R-301
MARGIN RESERVED FOR BINDING
is very important. Sea 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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 200m-10-'39. No. 8427-d
PLACE OF DEATH
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Walter Edward Nichols
(If deceased is a married, widowed or divorced woman, give also maiden name.)
288 Court Road
(a) Residence. No.
(Usual place of abode)
: ength of stay: In hospital or institution
(Specify whether)
years
months
7
days.
In this community 5
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
(write the word)
Married
or DIVORCED
. widowed, or divorced nda Harrington
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
72
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
.73
AGE
Years
7
Months.
20
Days
If less than I day
Hours.
Minutos
Usual
9 Occupation:
Art Dealer
Industry 10 or Business:
1I Social Security No .....
None
12 BIRTHPLACE (City)
fast Boston
(State or country)
Lass.
13 NAME OF
FATHER
William Nichols
14 BIRTHPLACE OF
FATHER (City)
Birmingham
(State or country) Ingland
15 MAIDEN NAME
OF MOTHER
Eva "artyn
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
england
17 rs. Amanda Nichols
Relation pig any
Intormant .*
(Address)
288 Court Road
I HEREBY CERTIFY that a satisfactory standard certificate of death was Hled with me BEFORE the burial or transit permit was issued Www. D. Childressr.
(Signature of Agem &t Board of Health or other) Realthe offer 3/11/43
(Official Designation) (Date of Issue of Dermity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from Necamber 15 1948 to.
19.99
I last saw him .. .. alive on.
19.Y ... 3., death is said
to have occurred on the date stated above, at 0
...... m.
Duration
Immediate cause of death ..
Caro
12 years ...
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
PHYSICIAN Underline the cause to
should be charged sta- What test confirmed diagnosis ? Canção Segno
tistically.
20 Was disease or injury In any way related to occupation of deccased ?
If so, specify.
(Signed)
Withegg, Dass Da10 01 8
19.445
21 Woodlawn, Everett
Place of Burial, Cremation or Remove, Icui & Town)
DATE OF BURIAL
19
22 NAME OF
Thomas ". Rhodes
FUNERAL DIRECTOR
ADDRESS
Lynn, lass.
Received and filed
....
1
INTU
19
A TRUE COPY ATTEST: (Registrar)
1
Winthrop (City or Town)
No Winthrop Community Hospital
(If U. S.
War Vetamin.
specify WAR)
St.
(If nonresident, give city or town and state)
1943
Due to
cesteria-acherasio
Dostalo Retocar
Date of
........ Om 8, My which death
M. D.
(Addres
Of autopsy
....
Manchester
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 deccased, his supposcd 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, Scc. 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 sueh 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 elerk, 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 ecrtifieate 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 sueh eertificatc. 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 sueh statement and certificate, shall forthwith countersign it and transmit it to the elerk 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 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 eertify 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.
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