USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 20
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rd
Butterworth
(War deceased PHYSICIAN - IMPORTANT U. S. War Veteran, { if so spoolfy WAR)
St.
(I! nonresident, give clty or town and State)
In this community
yrs.
2
mos. 10
days.
18 DATE OF
DEATH
March
14
( Month)
(Day)
1443 (hear)
19 1 HEREBY CERTIFY,
File
...
1943, to March 14
19.
That I attended deopasad f from
1 last saw h
lalive on.
March13, 1943 death Is said to
have occurred on the date stated above, at. 5 45 A m.
Immediate cause of death .... myocarditis security
Duration Feli
"IMPORTANT
Due to.
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Of autopsy.
What test confirmed diagnosis?
Underline the cause to which death should ba charged sta- tistically.
20 Was disease or injury in any way related to popupation of deceased de If so, spaoify.
(Signed)
M. D.
(Address) 108 Meudass Date 3/14 1943
21
22 NAME OF
FUNERAL DIRECTOR
Bradford H. Butter
ADDRESS 175 5 Main St. Franklin, HX
Racaived and Aled
19
IMPORTANT Physician
Cola
100M-6 · 2·42-8855
yeara
months
days.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hoapital medioal offioer shall forthwith, after the desth of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration s standard certificate of death, stating to the best of his knowledge and behiel the name of the decessed, his supposed sge, the disease of which he died. defined as re- quired by section one. where ssme was contracted. the duration of his last filnesa, when last seen slive 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 aa required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the decessed, 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 s 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 desth as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia aec- tion and of sections forty-five, forty-six and forty-seven of said clispter 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 hetwcen February fourteenth, eighteen hundred and ninety- eight and July fourth, nineteen hundred and two, and the Mexi- can horder service of nineteen hundred and sixteen and nineteen bundred and seventeen. G. L. Clisp. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in s 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 undertsker or other person ahall exhume a huinan body and remove it froin a town, from one cemetery to another, or from one grave or tomb other thau the receiving toush to another In the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such hoard, 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 internient, by a satisfactory certificate of the attending physician, if any, as required by law. 01 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 ia insufficient, a pbysi- cisn 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 is caused by violence. the medi- cal examiner ahall 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 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 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 haa bren engaged. such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statenient and certificate, shall forthwith countersign it and transniit 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 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 .- Cbsp. 114. Sec. 45, C. L., (Tercentenary Editlou).
No underisker or other person shall bury a human body or the ashea thereof which have been brought Into the commonwealth until he has re- ceived s permit so to do from the hoard of health or its 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 he held, or from s person apointed to have the care of the cemetery or burial ground in which the interment is made ... . Chap. 114. Sec. 46. G. L., (Terceutenary Editiou).
Medical examiners shsli make examination upon the view of the dead bodies of only such persons as 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 pisce where the body lies aud take charge of the same; ... - General Laws, Chap. 38, Suc. 6.
RULES OF PRACTICE
The fulfiliment of the purpose of these lawa calia 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 hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolans 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 ia ahsent from home when the certificate of death is needed.
(8) Medlosl Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only desthe caused directly or in- directly by traumatiam (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electricsl agents, sud deaths following abortion, but also deaths from disease resulting from injury or Infection related to oooupation, the sudden deaths of persons not disabled hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Csuse of deatlı 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 principai cause.
Statement of Oocupatlon .- Precise statement of occupation ia 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 ou account of the disease causing death, report the usual occupation prior to illness. if the deceased bad retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may he returned aa at school or at boine. For a woman whose only occupation waa that of honie bousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as bousekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
1
PLACE OF DEATH
Suffolk County) Windup
(City ofrer 22 Prescott
The Commonturalth 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. 53
Registered No. " (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give also maiden name.)
22 Grasaett
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ..
( Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE!
5 SINGLE
MARRIED
WIDOWED
or DIVORCI
(write the word) Married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive 45
years
7 IF STILLBORN, enter that fact here.
8 47 AGE - Months Days
If less than 1 day
Hours ..
Minutes
Usual
9 Dccupation :
Industry 10 or Business :
11 Social Security No ... Mour
12 BIRTHPLACE (City)
( State or country )
marie.
13 NAME DF
FATHER
Joseph F. Berry
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Portland.
15 MAIDEN NAME
OF MOTHER
Annie E. O 'Connor
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Informant Howard E. Butter. ( Adilress) 22 Prescott St win. ...
100m (d) -1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burhay or transit permit was Issued : Www. D. Childrens .
(Signazare of Agent of Board of Health of other)
Healthe Office 3/18/43
( Official Designation) (Date of [amue of Permit)
18 DATE DE March
DEATH
15
1943
(Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
Jan. 15,
19
That I attended deceased from
I last saw h.
er
alive on
Marchly, 1943, death is said to
have occurred on the date stated above, at
8.45 P.m.
Immediate cause of death ........
Carcinoma of
Uterus, + Rectum
16 MOS.
Due to
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
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify ...
(Signed)
(Address)
Winthrop
Date Mar 16 1943
21
Place of Burial Cremation or Removal.
march
15
DATE OF BURIAL
19423
22 NAME DF
FUNERAL DIRECTOR
ADDRESS
Boston
Received and filed 19
MAR 2 0 1848
( Regiatrar)
1
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
PARENTS
If deceased was a U. S. War Veteran. G. L. Chap. 46. Section 10. requires physicians to Insert a reoital to that effect.
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
extracts from the laws on back of certificate.
No.
Louise Grenz Butler
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No.
(Usual place of abode)
years
months
days.
In this community
1
yrs.
mos.
days.
& SEX Fenda White
43
to.
March 15, 1943
Duration IMPORTANT
En Boot
M. D.
Brookline
(City or Town)
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 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 dicd, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physiciau or officer and the date of his death ... Gen. Laws, Chap. 46, Scc. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person sliall 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 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 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 conunouwealth 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 been engaged, such recital shall appear upon the permit. The board 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 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 cenictery or burial ground in which the interment is made. ... Chap. 114. Sec. 46, G. L., (Terccutenary 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 hls 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. 0.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physiolans 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 disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or wliose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deathis from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized 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 .- Precise statement of occupation is very im- portant, so that the relative licalthfulness 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 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 hone 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
RM R-301 A
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth 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
( (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR) .. ..... 090
(If nonresident, give city or town and state)
In this community yrs. 5 mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF March
16
1943
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
.. , 1943 to March 16, 1945 I last saw h .......... alive on. monde 16, 1943 death is said to
have occurred on the date stated above, at ... 3:15 a.m.
Immediate cause of death. Pulimany educa
Due to
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 ?.
Waa disease or injury in any way related to occupation of deceased ?.
If so, specify (Signed). (Address) 49 Casa as Date ..
M. D.
Mach 14943
21
Place of Burial, Ofemacop or Removal. (City or, Town)
DATE OF BURIAL
22 NAME OF FUNERAL DIRECTOR Asuc ADDRESS Off Laverie
....
Received and filed.
19
(Registrar)
(Official Designation)
(Date of Issue of Peanit)
(write the word) DEATH
5a lf married, widowed, or divorced HUSBAND of ... Genaro Forgeme (Give maiden name of wife in full) (or) WIFE of. (Husband's name in full
6 Age of husband or wife if alive.
.years
7 IF STILLBORN, enter that fact here.
If less than 1 day
- Months. .. Days
Hours Minutes
11 Social Security No. 1700
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Carmine De Luca
14 BIRTHPLACE OF FATHER (City) (State or country) Italy
15 MAIDEN NAME OF MOTHER.
16 BIRTHPLACE OF MOTHER (City) ..... (State or country)
Italy
Relation If any
17 Catomic tarrina you.)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William 8 Childress
(Signature of Agent of Board of Health or other)
Health Officer man 11/43
....
..... ......
(If deceased is a married widowed or divorced woman, give also maiden name.) 630 Markante Che St
(a) Residence. No .... (Usual place of abode) Length of stay: In hospital or institution. (Specify whether)
years
months days.
St.
Ms Christina Forgione.
2 FULL NAME
130 Maxkenton Chame No
1 3 SEX timale Usual 9 Occupation :. PARENTS 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 AGE 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 Industry 10 or Business: 100m-2-'40-D-729-a
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
8 E 12 Years at home
Duration IMPORTANT 2 day
›
240000 Y
Underline the cause to which death should be charged sta- tistically.
MAR 2 0 1819
....
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 inember of the family of the deceased, furnigli 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 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 hody and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to 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, 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 in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 hody 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 re- moval 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, ghiall 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 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).
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