USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 40
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it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer- tifying 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 inanner or cause of the death, which the clerk or registrar may re- quire .- 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 bosrd, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to liave 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 body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
... Ile shall in all cases certify to the town clerk or registrar in the place where the deccased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of deatb .- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the best of his knowledge and belicf.
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 physiolans 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 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 persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicemia (gss bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension,, suicidal." "Syncope while under the influence of ethier administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify : (1) Under cause its known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example: "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
-301 A
BOSTON NOTIFIED 6/9/43
Suffolk
(County)
Winthrop (City or Town) Station Hospital, Fort Banks, Mass. No.
The Commontorralth ot 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.
113
[( If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Arthur Stewart Andrews
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
57 Garfield Ave,
(Usual place of abode)
St.
Hyde Park,
ass
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death )
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Male
Porto Rican
19 I HEREBY CERTIFY,
That I attended deceased from
May 25
43
19!
to
Hay 25
19.113
1 last saw
im
alive on.
Lay 25
19.43, death Is sald to
have occurred on the date stated above, at.
5:20
p.m.
Immediate cause of death.
Acute coronary
IMPORTANT 20
thrombosis.
Due to.
Chronic myocarditis (ratient
2 Yrs.
has been observed at this hospital
for previous coronary attacks
during past 2 years.)
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of ..
-
Of autopsy
not done
What test confirmed diagnosis ?
I.V.G.
20 Was disease or injury In any way related to oooupation of deceased ?......... If so, specify. Franse R. albert caps m.c. M. D. (Signed)
(Address)
Fort Banksa59.
.Date. werde
..... ,1913
ST 25.
Boston Man
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
May 29th
19 4/3
22 NAME OF
FUNERAL DIRECTOR
Jucy the Beardon
ADDRESS
Hyde Jack Man
19
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Lay
25
1943
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here. -
8 55 Years 7 Months 23 Days
If less than 1 day Hours ...... Minutes
Usual
9 Occupation :
Engineering Aide.
10 or Business :
Industry
Engineer
11 Social Security No.
nome
12 BIRTHPLACE (City)
Hyde Park, Boston,
( State or country)
Massachusetts.
13 NAME OF
FATHER
Jacob R. Andrews
14 BIRTHPLACE OF
FATHER (City)
Philadelphia
(State or country)
Penn
15 MAIDEN NAME
OF MOTHER
L'arrietta Gray
16 BIRTHPLACE OF
MOTHER (City)
Norfolk
(State or country)
Virginia
17 Joseph C . Andrews
Relatiop, if any .... brommer.
Informant
( Address)
5] Garfield ve. Hyde Park Pass
I HEREBY CERTIFY that anysatisfactory standard certificate of death was filed with me BEFORE the Burial or transit permit was Issued :
Children
(Sighiature of Agent of Board of health or other) health Officer 5/26/43
Received and filed MAY .2 7 1943
(Registrar)
1
PLACE OF DEATH
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effect. PARENTS
100m (d) .1-41-4667
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran, Torld Marl.
if so specify WAR) ....
15 min.
years
- months
days.
In this community
yrs.
-
mos.
- days.
Duration
IMPORTANT Physician
l'uderline the cause to which death hwould be charged sta- tistically.
21
Fairview
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 decrased, furnish for registration a standard certificate of death, stating to the best of his knowledge aml behof the name of the deceasedl, bis opposed 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 hy 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 seetion 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 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 aml the secomlary or immediate cause of death as nearly as he eau 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 said chapter one humlred 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 aml July fourth, nineteen hundred and two, and the Mexi- can bonler 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 hunran body in a town, or remove therefrom a human boily 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 ยท 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 huried. No such permit shall he 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 provideil. If there is no attending physician, or if, for sutlicient reasons, his certificate caimot 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 by the selretmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the meili- 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 cammot be obtained early enough for the purpose, the certificate of death made as above provided aml 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 herunder. 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 I'nited States in any war in which it has been engaged. such recital shall appear upon the permit. The board of health, or its agent. upor receipt of such statement and certificate, shall forthwith counter-igu it and trausinit it to the clerk of the town for registration. The person to whoon 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 deerased, or as to the marmer or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).
No umlertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth nutil 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 hell, or from a persou 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 inodical examiner has notice that there is within his county the body of sueli 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 fulfillinent 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 lastilluess 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 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 septicenila), 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 ocoupation, 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 mnoile 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 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 business, report the usual occupation prior to retiremeut. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home Itousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate termis, as housekeeper-private family, cook-hotel, etc. For a person who had no occupatiou whatever write uone.
SPACE FOR ADDITIONAL INFORMATION
R-301 A Suffolk.
(County)
H
No.
ses grou Sacudain
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. 111
t
{ { If death occurred in a hospital or institution, St. [ give its NAMIE' instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced7woman, give also maiden name.)
88 Baudoin
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution.
( Before death)
( Specify whether)
years
montlis days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX 4 COLOR OR RACEI Female Sufito
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH
may
27
(Months
(Pay)
(Year)
Sa If married, widowed, or divorced
HUSBAND of
( Give maiden name of wife in full)
(or) WIFE of
( Inshand's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here.
8 AGE Years Months ....... Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
none
Industry
10 or Business :
none
11 Social Security No ..
12 BIRTHPLACE (City)
( State or country )
13 NAME OF
FATHER
William B Thorne
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or conutr
Multan
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country )
17 Relation, If/mny Informant .. 88 Bandan Father)
I HEREBY CERTIFY thet a satisfactory standard certificate of death was filed with me BEFORE/ the burial or transit permit was issued : Www. D. Celdeling.
Signature of Agent of Board of llealth og, other)
6/1/43
(Official Designation) (Date of Issue of Permit) /
20 was disease or injury in any way related to occupation of deceased ? 20 If so, specify. (Signed) ... DalO Brien. .............. M. D.
( Address)
Winthrop, Mass Data May 2 1943
21 thatthe
l'lace of Burial, Creniation or Iremoval. (City or Town) 29
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTORY
ADDRESS
Received and filed
19
JUNI -1949
IMPORTANT
Physician
Major findings : Of operations.
Of autopsy
What test confirmed diagnosis ?
Clinical Signs
Duration
Immediate cause of death. Still born
IMPORTANT
(died in Utero)
Due to.
Due to.
Other conditions.
(luclude pregnancy within 3 months of death)
Date of
U'ndlerline the cause to which death ./wull be charged sta- listically.
100m (d) -1-41-4667
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.
PLACE OF DEATH
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
St.
(If nonresident, give city or town and State)
1943
19 1 HEREBY CERTIFY,
That i attended deceased from
may 27
. 1943, to
19.
43
I last saw h.
Stech born
19
death is said to
have occurred on the date stated aboverat 7.15 P m.
(Both)
.....
(Registrar) Y
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 behef the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by seetion one, where same was contraeted. the duration of bis 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 nr offieer furnishing a certificate of death as required by the preceding section or by seetion 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 nf the United States in any war in which it has been engaged, insert in the certificate a reeital 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 ean state the saine. For neglect to comply with any provision nf this seetion, such physician or offieer shall forfeit ten dollars. For the purposes of this sec- tion and of seetions 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 Fehrnary 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 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 perniit 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 he issued until there shall have been delivered to sueh board, agent or clerk, as the case may be, & satisfactory written statement containing the faets 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 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 litiman 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; 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 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 United States in any war in which it has been engaged. such recital shall appear upon the perinit. The board nf 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 neces- sary information which can he 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 hndy 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 snch permits, or if there is no such board, from the clerk of the town where the body is to he buried or the funeral is to be beld, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114. See. 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 eounty 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 :
(]) 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.
(=) Board of Health physicians will certify to such deaths only as those of persons who, thengh disabled 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 inelnde not only deaths eaused directly or in- directly by traumatism (including resulting aepticemia), 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 persons not disabled by recognized disease, and those of persons found dead.
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