USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 44
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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 sud 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 wsr. and shall also certify in such certificate both the primary and the secondary or immeiliate cause of death as nearly as he can state the same. For neglect to comply with suy provision of this aection, auch physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bunilred and fourteen, the word "war" shall include the Chins 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 s town, or remove therefrom a human body which has not been buried, until he haa received a permit from the board of health, or ita agent appointed to issue such permita, 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 cemetery to another, or from one grave or tomb other thau tbe recelving tomb to another In the same cemetery, until be haa received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the boily is buried. No such permit shall be Issued until there shall bave been delivered to sucb board, agent or clerk, as the case may be, & 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 any, aa required by law, or in lieu thereof a certificate as hereinafter provided. If there ia no attending physician, or If, for sufficlent reasons, hla certificate cannot be obtained early enough for the purpose, or ia insufficient, a pbysi- cian who ia a member of the board of health, or employed by It or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death la 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, from one town to another within the counnonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession ot tbe undertaker desiring to make such removal sliall constitute a permit for such removal; provided, that auch 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, aa required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war In which It has been engaged. sucb recital shall appear upon the permit. The bosrd 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 la 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 matter or canse 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 s 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 agem appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the boily is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment ia made. ... Cbap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examinera shall make examination upon the view of the dead bodies of ouly 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 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 rulea of practice :
(1) Attending physicians will certify to sucb deaths only as those of persona to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deatha 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- clan ia ahsent from home when the certificate of death is needed.
(3) Medloal Examiners will Investigate and certify to all deaths sup- posably due to Injury. These Include not only deaths caused directly or in- directly by traumatiam (including resulting septicemia), and by the action of chienrical (druga or poisons), thermal, or electrical agents, aml deaibs following abortion, but also deaths from diseass 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 .- Canse of death meana the disease, or complication which causea death. not the moile of dylng, e. g., heart fallure, asphyxia, astbenla, etc. As principal cause name the disease caualng death. As related causea, 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 la very 1m- portant, so that the relative bealthfulness of various pursuits can be known. Make some entry in this section for every persou 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 bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at boine. For a woman wbose only occupatiou was that of bone housework. write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, aa bousekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
>
-301 A
1
Winthrop
P. J. holipid
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. 127
[ { If deeth occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
CHARLES C. MANSOLILLO
(If deceased is a married, widowed or divorced woman, give aleo maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a wrong
U. S. War Veteran,
if so specify WAR)
$2
(a) Residence. No.
137 Hanover Street
St.
Providence,
R. I.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death )
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
April 18
1943
to
June 16
1943
I last saw h.J.m.
..... alive on
June
16, 19.43, death Is seld to
have occurred on the date stated above, at.
10:00
Pm.
Immediate cause of death. Peritonitis gener alized, with multiple abscesses and
extensive adhesions
Due to.
Perforation of the intestine
Due to.
Volvulus
Other conditions.
Extreme emaciation
(Include pregnancy within 3 months of death)
Major findIngs :
Of operations.
Peritonitis
Date of.Apr.18/13
Of autopsy
See Above
Whet test confirmed dlagnosis?
20 Was disease or inisty Wwrelated to oooupation of deceased ?. No.
If so, specify
M. D.
(Sigred) ................ BEASER, Captain ...... M. C ...
(Address) Fort Banks, Mass.
Date June17 19 1 3.
21
Providence
Rhode Island
l'lece of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
June 20
19.4.3
22 NAME OF
FUNERAL DIRECTOR
ـيس
ADDRESS
254
19
Received and filed .1.11 2 1 1943
( Registrar)
1 mo.
29 .days
IMPORTANT
Physician
l'uderline the cause to which death -Iwould be charged sta- listically.
14 BIRTHPLACE OF
FATHER (City)
Panni
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Grazia Grasso
16 BIRTHPLACE OF
MOTHER (City)
Panni
(State or country)
Italy
17 U. S. Army
Informent ( Addrese)
Reletlon, if any
Station Hospital, Ft Banks, Mass.
I HEREBY CERTIFY that a satisfactory stendard certificate of death was filed with me BEFORE the burial or transit permit was Issued : m. D. Childress
(Signature of agent of Death of Health or other)
6/17/43
Health officer (Official Designation ( Date of Issue/of Pefmit)
5 SINGLE
( write the wurd)
DEATH
June
16,
1943
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( flushand's neme in full)
6 Age of husband or wife if elive
yeers
7 IF STILLBORN. enter that fact here.
8
AGE
21
Years
2
Months
20
Days
If less than 1 day
-
Hours
Minutes
Usual
9 Occupation :
Soldier
Industry
U. S. Army
10 or Business:
11 Social Security No.
Unknown
Providence
12 BIRTHPLACE (City)
( State or country )
Rhode Island
13 NAME OF
FATHER
Giovanni Mansolillo
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 (d)-1-41-4667
PLACE OF DEATH
Suffolk (County)
7/9/43
(City or Town) Station Hospital, Fort Banks, Mass.
No.
(Usual piece of abode)
0
years
7
months
29
days.
In this community
0
yrs.
0
mos.
O dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE!
White
Registered No.
Duration IMPORTANT
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthiwith. after the death of a person whom he has attemled during his last illness, at the request of an undertaker or other anthorized 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 behof the name of the decrasel, bis supposed age, the di case of which he dio. defined as re- quired by section one, where same was contracted. the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one humlred and four- teen, shall, if the decrasel, 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 ail the secondary or immediate cause of death as nearly as he can state the same. For negleet 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 sabl chapter one humired and fourteen, the worl "war" shall include the China relief ex- peilition aml the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundrol 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, fromn 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 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 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, of 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 meli- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained 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 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. upon receipt of such statement atut certificate, shall forthwith counter-ign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other 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 umulertaker or other person shall bury a human hody or the ashes thereof which have been hronght into the commonwealth until he has re- ceived a permit so to do from the hoard of health or its agent appointed to issne such joumits, 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 hekl, ar 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 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.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, thengh disabled by recognized disease unrelatol 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 inchide not only deaths caused directly of in- directly by traumatism (including resulting septicemia), and by the action of elo mical ( drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths fromn 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 naine the discase causing death. As related causes, naine earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
X
301 A
1
PLACE OF DEATH
Suffalle (County) Nichole (City or dyn) .... 45 Travers que Menchol No. Francke a Buhne
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 .; 128
Registered No.
§ ( If death occurred in a hospital or institution, St. { give ite NAME instead of street aud nuniber)
PHYSICIAN - IMPORTANT
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. .
93 Grover que.
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In'Incoltal or Institution.
( Before death)
(Specify whether)
years
months days.
In this community 2 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mace
4 COLOR ØR RACE
Hlute
5 SINGLE
( write the word )
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowte or divorced Becariale
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's nome in fuli)
6 Age of husband or wife if alive 55 years
> IF STILLBORN. enter that fact here.
8
AGE 54 Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Dccupation :
accountant.
Industry
10 or Business :
11 Social Security No.
·2 BIRTHPLACE (City)
( State or country)
Burton
mark
13 NAME OF
FATHER
Joseph Jahre
14 BIRTHPLACE DE Celenci Lorraine
.FATHER
(State or country)
15 MAIDEN NAME
OF MOTHER
Maria I Vollmer
16 BIRTHPLACE OF
MDTHER (City)
(State or country)
Jeumami
17 Informent ( Address ) 43 France que
Relation, thuny ( wife
I HEREBY CERTIFY that a satisfactory standerd certificata of death wos filed with me BEFORE the Dudlal or trapsit permit was Issued ? Wi. D. Childrens
...
(Signature of Agent of Board nf Lenth # other) Health Officer 6/18/43
... (DMciel Deelgnationy ( Date of Issue of Permit)
18 DATE OF
DEATH
(Jfonth)
17
(Day)
1943
(Year)
19 I HEREBY CERTIFY,
That ! attended deosased from
19:47
to Arme 17, 1943
last saw him
allve on.
. 19 ... 3., death Is cald to
have occurred on the date stated above, at 5.3 0A m.
Immedlate cause of death. Cormay infant
Due to
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findings :
Df operations
Date of.
Of outopsy
What test confirmed dlegnosis?
IMPORTANT Physician
Uuilerlino the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?.
If so, spoolfy.
. M. D.
(Signed)
(Address) With M Date 617- 1943
21 Cedar hore besin
l'lace of Burial, Creniation or Removal.
(City or Town)
DATE OF BURIAL.
1943
22 NAME DF
FUNERAL DIRECTOR.
R. Jury Mas
ADDRESS
Reoalved and Aled
JUN 2 1 1943
19
( Registrar)
Duration IMPORTANT
6 dias
If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physiolans to Insert a recital to that offoot. PARENTS
100M-4 -2-42-8855
2 FULL NAME
(Was deceased a
U. S. Wer Veteran,
if so epeolfy WAR)
MEDICAL CERTIFICATE OF DEATH
Amal 16
Boston Mash
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal 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 ans meniber of the family of the deceased, furnish for registration a standard certificate of desth, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. where same wss contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of hia death ... Gen. Laws, Chap. 46, Src. 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 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 a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immeiliste 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 hundred and fourteen, the word "war" shall inchule the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemcd 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 sixtcen and nineteen hundred and seventeen. G. L. Chsp. 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 lesue 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 fromn 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 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 attending physician, if any, as required by law. o1 in lieu thereof a certificate as hereinafter provided. If there is no sttending physician, or if, for sufficient reasons, his certificate cammot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the hoard of health, or employed by it or by the aelectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death is csused by violence, the medl- cal examiner ahall make such certificate. If such a permit for the removal of a humsu body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unlesa 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
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