USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 29
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by section ten of chapter forty-six, that the deceased served 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 hoard 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 veces aary information which can be obtained as to the deceased, or as to the manner or canse of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a human hody or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the huard of health or its agem appointed to issue such permita, or if there is no such hoard, from the clerk nf the town where the body 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 internient ia made. .. . Chap. 114. Sec. 46. G. L., (Terceutenary Edition).
Medical examinera shall make examination upon the view of the dead hodiea 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 hody of such a person, he shall forthwith go to the place where the body lles aud take charge of the same; ... - General Lawa, 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 phyalcians will certify to such deatha only as those of persona to whom they have given hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolana will certify to such deatha only aa those of persons who, though disabled hy 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) Medloal Examiners will investigate and certify to all dlcatha sup- posably due to Injury. These include not only deaths caused directly or in- directly hy traumatism (Including resulting septicemla), and hy the actlon of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deatha from diseasa resulting from injury or Infootion related to oooupation, the sudden deatha of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Csuse of death means the disease, or complication which causea death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng death. Aa 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 healthfulnesa of various pursuita can be known. Make some entry in this section for every persou aged 10 yeara 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 husineaa, report the usual occupation prior to retirement. Children not gainfully employed may he returned aa at school or at home. 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 hy the appropriate terma, aa housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
f
IR-301 A 1
1
PLACE OF DEATH
Jufbulk (County) Minthaof (City or Town) 64 Herman LA No.
The Commonforalth ot Hassarlutsetts 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.
81
( { if death occurred in a hospital or institution, St. [ give its NAME instead of street and number )
2 FULL NAME .. alice M. Salon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
68 Hemin L
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death )
( Specify whether)
years
months
days.
In this community20
yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEI
5 SINGLE
(write the word)
MARRIED
WIDOWED
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
ive maiden name of wife in full)
garten
( Thushand's name in full)
6 Age of husband or wife If alive years
7 IF STILLBORN. enter that fact here.
8
AGE
84
Years
Months
Deys
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
at sauce
Industry
10 or Business :
Il Social Security No.
12 BIRTHPLACE (City)
( State or country )
Boston
Muss.
13 NAME OF
FATHER
Leharlee Curtis
14 BIRTHPLACE OF
FATHER (City)
Newmarket
(State or country)
15 MAIDEN NAME
OF MOTHER
Catherine Casey
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
- Guland
17 InformantChances & Carlen (Address) LY Havea Ir Mulig
Relation, if any
I HEREBY CERTIFY thet a satisfactory standard certificate of death was filed with me BEFORE the buffel pf transit permit was Issued : Im.D. Childreng.
Signature of Ageht of Board of Health or other) Health Officer 4/6/43
(Officlel Designation) ( Dete of Issue 'of Permit )
18 DATE OF
DEATH
( Month )
(Day)
1943
(Year)
19 | HEREBY CERTIFY, March 2055
That I attended deoeased from
1943, to
April 4
1943
I last saw h. @ .......... allve on ..
April 3, 1943, death is said to
have occurred on the date stated above, at
6-30 0 m.
Immediate cause of death.
MyoCarditis
Due to
Senility
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of ...
-
I'nderline the cause to which death should be charged sta- Istically.
20 Was disease or injury in any way/related to oooupation of deceased ?
If so, speolfy
Daniel 10 Pri
...............
M. D.
( Sigred) .....
Winthrop Mass Date Camp6 1943
(Aodress)
21 Smithing Cancelary
l'face of Burial, Cremation or Bemoval,
(City or Towny-
DATE OF BURIAL
1965
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed 19
APR.
1943
(Registrar)
----
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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physlolans to Insert a reoltal to that effect. PARENTS
100m (d)-1-41-4667
Duration
IMPORTANT Gre year
IMPORTANT
Physician
Of autopsy
What test confirmed diagnosl
Clinical Signs
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
St.
(If nonresident, give city or town and State)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall furthwith. after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any number of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and behef the name of the deceavril, his supposed age, the discase of which he died. defined as re- quired hy section one, where same was contraeted. the duration of his last illness, when last seen alive by the physician or officer and the date of his deatl ... Gen. Laws, Chap. 46, Sec. 9.
A physician or offieer furnishing a certificate of death as required by the preceding section or by section forty five of chapter one humlred and four- teen, shall, if the deceased, to the best of his knowledge aml belief, serveil 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, slu.ei- fying the war, and shall also certify in such certifieate both the primary ail the secondary or immediate canse of death as nearly as he ean 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 aml of sections forty-five, forty-six and forty-seven of sail chapter one hundred and fourteen, the word "war" shall inchide 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 honler service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exlmunte 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 he returned aml reeonled, 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 he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or hy 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 liman body, not previously interred, from one town to another within the commonwealth cannot be obtained carly enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; proviled, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual forin for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the l'uited States in any war in which it has hren 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 perrinit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neeps- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, wlrich the clerk or registrar may require .- Chap, 114. Sec. 45, G. L., (Tercentenary Edition).
No umlettaker or other person shall hury a human hody or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issne anch permits, or if there is no such hoard, from the clerk of the brown where the body is to be buried or the funeral is to he held, or from a persnu appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died ly violence. If a inoilical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physiclans will certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury. have died without recent moilical 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 trammatism (including resulting septicemia), and by the action of elimical ( drags or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Deatn .- Cause of death means the discase, or complication which causes death, not the mode of dying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause naine the discase causing death. As related causes, naine earlier morbid comlitions, if any, related to the principal cause and any important compdication of the principal cause.
Statement of Occupation .- l'recise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be 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, icport 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 home Imusework, 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 tone.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) No. A.m.,. Legion .... Hall ,Hermon .... St
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.
82
§ ( If death occurred in a hospital or Institution, St. [ give its NAME instead of street aud number)
PHYSICIAN - IMPORTANT
(Waa deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
305 Winthrop St
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In nnspital or Institution .
( Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEJ
5 SINGLE
( write the word)
MARRIED
WIDOWED
Female
White
Married
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
( Husband's name in full)
75
6 Age of husband or wife if alive years
> IF STILLBORN. enter that fact here.
8
AGE68
Years
Months
. Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
Own .... Home
11 Social Security No.
12 BIRTHPLACE (City)
South Boston
( State or country)
Magg
13 NAME OF
FATHER Francis F Powers
Major findIngs :
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
IMPORTANT Physician
Underline the cause to u hich death should be charged sta- tistically.
20 Was disease or injury in ony way related to oooupation of deceased ?.
If so, spaoify
('Signed)
(Address)
Date //1- 194)
21
Winthrop Cip Winthrop
l'Isce of Burial, Cremation or Removal.
{City or Town)
DATE OF BURIAL
April/16 / 1943.
Matey
19.
I HEREBY CERTIFY that a satisfactory atandard certificata of death was filed with me BEFORE the burial or tranzit permit was Issued ?
Health Office 4/12/43
(Oficial Designation) (Date of Toque of Permit)
18 DATE OF
DEATH
(Month)
10
1443
(Day)
(Year)
19 | HEREBY CERTIFY,
That, I attended deceased from
A€
1
1942.
Chp 10, 1943
Vlast saw h.
AMalive on
amal 1, 19
7.5 death Is sald to
have occurred on the date stated above,
at
11.150
m.
Duration
Immedlate oause of death .......
IMPORTANT
..............
15 mg ...
Due to.
Due to
Chimin Buret
Chronic (Bullets Nicieza)
Other conditions.
( Include pregnancy within 3 months of death)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
New found land
15 MAIDEN NAME
OF MOTHER
Margaret Rowe
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Newfoundland
Relation, if any
17
Informant 7.111.18m.
( Address)
Finch
Harker st Husband
22 NAME OF
FUNERAL DIRECTOR MOVIL
ADDRESS
Winthrop.
Reoaived and Aled. AFF $ 1943
19
( Registrar)
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
100M-6 - 2-42-8855
(Signature of Agent of Board. Bagged & Health or other)
2 FULL NAME ... Henrietta ........... Powers ..... Harber ( If deceased Is a married, widowed or divorced woman, give alao maiden name.)
Registered No.
20
.. M. D.
e in full)
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 undertaker or other authorized person or of any member of the family of the deceased, furnisb for registration a standard certifcate of death. stating to the best of his knowledge and belief the name of the deceased, his supposed sge, 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 slive by the physician or officer and the date of bia 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 immediate cause of death 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 this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bumired 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, 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 has received a permit from the board of health, or ita agent appointed to lasue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a human body and remove it from a town. from one cenietery 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 boily is buried. No such permit ahall be issued until there ahall bave been delivered to sucb 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 internient, by a satisfactory certificate of the attending 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 reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a meniber of the hoard 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 medl- cal examiner ahall make such certificate. If such a permit for the removal of a lrumian 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 ot 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 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 hren 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 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 way 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 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 he held. or from a person appointed to have the care of the cemetery or burial ground in which the internient is made. ... Cbap. 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 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 lies 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 physiciana will certify to sucb 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 physiolana 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 pbyaf- cian is ahsent from home when the certificate of death is needed.
(3) Medloal Examinera will investigate and certify to all dlcatba 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, gil deaths following abortion, but also deaths from diseass resulting from injury or Infeotlon related to occupation, the sudden deaths of persons not disabled by recognized dlaease, and those of persons found dead.
Statement of Cause of Death .- Cause of deatlı meana the disease, or complication which causes death. not the mode of ilying. e. g., heart failure, asphyxia. asthenia, etc. As 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.
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