USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 5
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by section ten of chapter forty-six, that the deceased aerved in the army, navy or marine corps of the United States in any war in which it has heen engaged. such recital shall appear upon the permit. The board of health. or its agent, upon receipt of such statement and certificate, shall forthwith countersigu 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 eanse of the death, which the clerk or registrar inay 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 perinit so to do from the board 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 beld, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medieal 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, though disabled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyai- 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 .- Cause of death means the discase, or coniplication 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 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
RM R-301 A
BOSTON NOTIFICE 2.9.43
Suffolk
(County)
The Commontoralth ot AnssarImsetts 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. 12
Registered No.
((If death occurred in a hospital or institution, St. į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR) ..
World
Boston Mass
War .... 2
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
-
years -
months 43
days.
In . this community
0 yrs.
0
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
( IInshand's name in full)
years
If less than 1 day
-
.. Hours.
Minutes
13 NAME OF
FATHER
Robert Remington Borden
(State or country)
Massachusetts
21
Relation, if any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the berlaf or transit permit was Issued :
(Signature of Agent of Board of health orother) Health Officer 1/16 /43
/ (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
16.
1913
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
42
toJanuary 16,
19.
That I attended deceased from
December 4.
43
19
I last saw h ............ alive on
January 16. , 19/13., death Is sald to
have occurred on the date stated above, at.
8:56 a.m.
Immediate cause of death ....... Pneumonia,broncho,
„acute,pyogenic, severe.,bilateral
Duration IMPORTANT 43
days
Due to.
Etiology unkmr.
Due to. 2.Lungs" abscess of acute. Other conditionsright ..... tipper ... lobe ,secondary (Include pregnancy within 3 months of death) to L. 3. Pleurisy with effusion, secondary
Major findIngs :
Of operations
None
Date of.
Of autopsy
Diagnoses 1 2 and 3.
What test confirmed diagnosis?
X-Rays
20 Was disease or Mjury in any way related to ocoupatlon of deceased ?.... ......
(Signed) ...
M. D.
Med. GRIP819 13
Date ...: /
(Address) Lation Ho fafor
.....
Vah Siogs Banks, Hass. Fall Rush Man
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Am- 19, 1943
19
22 NAME OF
Salut Samer
FUNERAL DIRECTOR
ADDRESS
338 Recently Tall Que, mass
Received and filed
19
(Registrar)
IMPORTANT Physician
l'uderline The cause to which death should be charged sta- tistically.
If so, specify ...
Kohlende
100m (d) -1-41-4667
1
Winthrop
(City or Town)
-
3 SEX
4 COLOR OR RACE|
Male
White
Unknown
(or) WIFE of
6 Age of husband or wife if alive
Unknown
7 IF STILLBORN. enter that fact here.
-
8
AGE .
3.0
Years
6
Months.
9
Days
Usual
Officer
9 Occupation :
industry
10 or Business :
U.S. Army
11 Social Security No.
unknown
12 BIRTHPLACE (City)
Fall River,
(State or country)
Massachusetts
14 BIRTHPLACE OF
FATHER (City)
Fall River,
15 MAIDEN NAME
OF MOTHER
Helen Shove
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Fall River
17
U. S. Army
informant.
( Address)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
Mm.D.
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
extracts from the laws on back of certificate.
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
N. D .- WNTETLAINET, WITH UNTADINO OLACA INASTRID D A PERMANENT RECORD. Every freut of Information
(State or country)
Massachusetts
PLACE OF DEATH
No. Station ... Hospital,Fort Banks Mass
2 FULL NAMEROBERT ... REMINGTON BORDEN Jr Captain ( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.1.02 Beacon Street
(Usual place of abode)
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 manaber' 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 drcrasul, his supposed 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 seetion 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 I'nited States in any war in which it has been engaged, insert in the certificate a recital to that effect. sprci- fying the war, and shall also certify in such certificate both the primary all 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. 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 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 hody 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 froin the clerk of the town where the body is buried. 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. o1 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 by the selectmen for the purpose, shall upon application make the certificate re- quired of the attentling 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 commonwealth cannot be obtained carly enough for the purpose, the certificate of deathi 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 hren engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement aml certificate, shall forthwith counter-ign it all 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 manter 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 issne such peunits, 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 hekl, or from a persou 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 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, 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 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 .- Callse of death means the discase, or complication which causes death. not the moile of dying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause naine 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 .- l'recise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be kuown. 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 ouly 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
ORM R-301 A
PLACE OF DEATH
Suffolk (Countz) Winthrop
The Commontoralth of Massacinisetts 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, St. ( give Its NAME Instead of street aud nuniber)
PHYSICIAN - IMPORTANT
2 FULL NAME
( If deceased Is a married, widowed or divorced woman, give alao maiden name.)
(a) Residence. No.
5 Coral
une
St.
(If nonresident, give clty or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months days.
In this community
4 yrs.
mos.
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female white
4 COLOR OR RACE| 5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if alive years
> IF STILLBORN. enter that fact here.
8 66 Years AGE Months Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
10 or Business :
Industry
athome
11 Social Security No.
'2 BIRTHPLACE ( City)
( Siate or country)
Russici
13 NAME OF
FATHER
Morris Bransalt
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
15 MAIDEN NAME,
OF MOTHER
Diver gerenthal
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
.
17 Dorothy Kinsley
Informant
( Address)
Shoal are/ wandlung
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : William D. Childress
(Signature of Agent of Board of Health or other) agent 1/17/43
(Official bealgnation) (Date of (mmue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
( Month)
16
(Day)
( Year)
19 J'ai
HEREBY CERTIFY. That I attended deosased from
19.39
Jan 16
Ło ..
193
I fast saw h & ...... alive on ...
Jan 16. 1943 death is said to
have occurred on the date stated above, at.
16:00 pm.
Immedlate cause of death ....
Cerebral Hemorrhage
1 day
Internal Brancho- Prechac
Due to. hypertension
Due
Diabetes mellitus
Other conditions.
( Include pregnancy within 3 months of death)
Major findIngs:
Of operations
-
Date of.
-
Of autopsy
What test confirmed diagnosis?
clinical
10000
10 yrs. 10 yrs. IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to youpation of deceased ??
If so, speolfy ........
(Signe
ress 26 Wave Way Gove Date 1/16/1943
DATE OF BURIAL.
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Received and Aled
.19
(Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. extracts from the laws on back of certificate.
100M- £ · 2·42-8855
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
1
(City or Town)
5 aral are
.....
No.
Ida Marino
(Was deceased a U. S. War Veteran, if so apeoify WAR)
(Usual place of abode)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of Information
should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
21
Relation, y zo
Place of Burial, Cremation or Removal.
(City or Town)
19 43
Duration IMPORTANT
1943
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal officer shall forthwitb. after the death of a person whoin he has attemled during his last illnesa, 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 died. defined as re- quired by section one. where same was contracted. the duration of his last illneaa, when laat seen alive by the physician or officer and the date of bis 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 deceased, to the best of his knowledge and helief, 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 immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, 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 bundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deeincd to have taken place between February fourteenth, eighteen hundred and ninety eight and July fourth, nineteen hundred and two, and the Mext- can border service of nineteen hundred and sixtcen and nineteen hundred 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 heatth, or its agent appointed to issue such permita, or if there is no such board, from the cterk 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 cenietery to another, or from one grave or tomb other thau the receiving tomb to another in the same cemetery, until he haa received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the body is buried. No such permit ahall be Isaued until there shall have been delivered to sucb board, agent or clerk, as the case inay be, a satisfactory written atatenient 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, o1 in lieu thereof a certificate aa hereinafter provided. If there ia no attending physician, or if, for sutticient reasona, hia certifcate cannot be obtained early enough for the purpose, or is insufficient, a physl. cian who ia a member 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 shall make such certificate. If aucb a permit for the removal of a human borty, 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 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 haa been sooner obtained hereunder. If the death certificate containa 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 heen engaged, such recital shall appear upon the permit. The board of health. or its agent. upon receipt of such stateneot 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 nece+ aary information which can be obtained as to the deceased, or as to the manher or cause of the death, which the clerk or registrar may require .- Chap. It4. 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 permita, 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 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 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 hody 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:
(]) Attending phyalcians will certify to such deaths only as those of persona to whom they have given bedside care during a last illneas from disease unrelated to any form of injury.
(2) Board of Health physlolana 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- cian ia ahsent from home when the certificate of death ta needed.
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