USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 59
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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. sucb 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 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 of 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 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 is made ... . Cbap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examinera shall make examination upon the view of the dead bodies of ouly such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the kody of such a person, he shall forthwith go to the place where the hody liea aud 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 deatha 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 deaths only aa those of persons who, though disabled by recognized disease unrelated to any form of injury. have died withrout recent medical attendance or whose phyal- cian ia ahsent from home when the certificate of death ia needed.
(3) Medloal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not ooly deaths csused directly or in- directly by traumatism (Including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following abortion, but also deatha from dlaeasa resulting from injury or Infeotlon related to oooupation, the sudden deaths of persons not disabled hy recognized dlaease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease causing death. Aa 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 ia 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 bad retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at home. For a woman whose only occupatiou waa that of honie housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa bousekeeper-private family. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1 A
9/9/43
Suffolk (County)
.iinthron (City or Town)
No. StationHospital,Fort Banks ... 1955
( ( lf death occurred in a hospital or institutinn, St. [ give its NAME instead of street and number)
2 FULL NAME
JOSEPH J. WORKLAN
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
Still River Village
St.
Harvard, Mass.
(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
Liale
4 COLOR OR RACEI
white
5 SINGLE
( write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
Hazel VattEs
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive 28 year
7 IF STILLBORN. enter that fact here.
8
AGE
38 Years
4
Months
27
Days
If less than 1 day
Hours
Minutes
Usual
9 Dccupation :
Soldier
Industry
10 or Business :
Army of the U.S.
11 Social Security No.
unknown
Spencerville, Ohio
13 NAME OF
FATHER
Unknown
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Unknown
15 MAIDEN NAME
DF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unknown
17 Informant First Service Commeatt Relation, If any (Aikdress) US Army Bertin
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued ;
(Bigniture of Agent of Board of health or other) health Office 8/16/43
(Date of Issue of Permit) /
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
1L
()Innth)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
-
19
...
to.
19
....
I last saw h.
--
.alive on
19
death Is sald to
have occurred on the date stated above, at.
AUmust
1. 19437:20
a
m.
Duration
IMPORTANT
Immediate cause of death.
Spasm of coronary artery
Due to
Due to.
Other conditions
Pulmonary .... tuberculosis.
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of.
Of autopsy .....
Damaged aortic valve
Pulmonary 1. 3.
What test confirmed diagnosis?
None
20 Was disease or injury in any way related to occupation of deceased ?..... Q.
If so, specify
aveteyour
(Signed) .... marcan ......
( Aodress) Fort .B.l.
Bat 37 ; Cap
It| 19 36.
21
Camp
DErens
Ayer.
l'lace of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Aug. 17. 1943
19
22 NAME DF
EC murray o Zurra
ADDRESS
259 Beach et Reme
Received and filed
19
( Registrar)
il uuceased was & U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoital to that eneot. PARENTS
100m (d)-1-41-4667
1
PLACE OF DEATH
The Commonforalth ot MassarImsetts 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.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
# 2
(Usual place of abode)
0
years
months
days.
In this community
yrs.
mos.
days.
( Official Designation)
IMPORTANT Physician
l'oderline the canse to which death should be charged sta.
M. - D.
12 BIRTHPLACE (City)
(State or country)
(Give maiden name of wife in full)
1943
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 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 drceased. his supposed agr, the discase of which he died. deffiud as re- quired hy section one, where same was contracted, the iluration of his last illness, when last seen alive by the physician or officer and the date of his death ... Cen. 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 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, aml shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can stale 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- peilition and the Philippine insurrection, which shall, for said purposes, he dermed 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 theretrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town. from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is 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 he 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 hy 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 limmnan 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 form for the ‘renioval 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 engagent, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement atul 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 mees- sary information which can be obtained as to the decrased, or as to the miamier 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 hody or the ashes thereof which have bren brought into the commonwealth until he has re- ceiveil a permit so to do from the hoard of health or its agent appointed to issue such prunits, 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 be held, or from a personl appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114. Sec. 46. G. L., (Tereentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have ilied 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 liea 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 physi- cian is absent from home when the certificate of death is needeil.
(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 reaulting aepticemla), and by the action of clipmieal (drugs or poisons), therival, 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 .- Canse of death means the disease, or complication which causes death, not the mode of dying. e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbul 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 ou account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of 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 occupatiou whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1
>
PLACE OF DEATH
Surtolk (County)
Winthrop-
(City or Town)
No.
15 Thornton Park
The Commonforalil of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. ....
S ( If deoth occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
( If deceased is a morried. widowed or divorced woman, give also meiden nome.)
(a) Residence. No.
15
Thorton Park
St.
( If nonresident, give city or town and State)
50 yrs.
In this community
mos.
deys.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEJ
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
Emma L Ashley
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive years
> IF STILLBORN. enter that fact here.
8
AGE
92Years
9 Months
LO Days
If less than 1 day
Hours
Minutes
Usual
Printer (Retirea)
9 Occupation :
Industry
General
10 or Business :
11 Social Security No.
None
12 BIRTHPLACE (City)
New Buff.Low
(State or country)
Mich
13 NAME OF
FATHER
Lsaac Adams
14 BIRTHPLACE OF
FATHER (City)
Unable to obtain
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Moore
16 BIRTHPLACE OF
MOTHER (City)
Unable to optain
(State or counley)
17 Kate S Payne ( Daughter
Informant ( Address) 15 Thornton Park
I HEREBY CERTIFY thet . satisfactory stendard certifioste of death was fled with me BEFORE the burlal or tensit permit wes Issued : Childress
(Signature of Agent of Board of Health or other
8/17/43
(Omcial Designation) ( Date of Fate of Permit)/
MEDICAL CERTIFICATE OF DEATH
18 DATE OF arejust
DEATH
(Afonth)
16.
1943
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended daocased from
19
.. ,
Ło
19
I last sew h .....
.. allve on
19
., deeth Is sold to
have occurred on the date stated above, at
5:30 am.
Immedlete cause of death ...
generalized atiio sclerosis
Duration 10 years
...
Due to
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findIngs :
Of operations
none
Date of.
Of autopsy
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way releted to oooupetlon of deceased ?.
......
If so, spaolfy.
(Signed) ...
.A., M. D.
(Address) Boarde) Health Dat Aug 16
19 ..... 3.
21
Winthrop
Winthrop
l'lece of Burial, Creniation or Removal.
(City or Town)
22 NAME OF
FUNERAL DIRECTOR .....
Howard S Purnolds
DATE OF BURIAL
August 18
....
ADDRESS
Winthrop maso
Reosived and Aled 19 ......
Tieto ( Registrar)
100M-6 - 2.42-8855
1
Sidney Charles S. adams
St.
PHYSICIAN - IMPORTANT
U. S. War Veteran,
if so spoolfy WAR)
r
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
yeera
months
days.
Male White
...
IMPORTANT Physician
PARENTS
...
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal offioer shail 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, furnish for registration a ataudard 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 illness, when last seen alive by the physician or officer and the date of his death ... Ceur. Laws, Chiap. 16, 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, aerved in the armny, 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 shsil 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 thia 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 tire Philippine insurrection, which shall, for said purposea, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety.eiglit 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. Chisp. 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 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 shail exhume a huinan body and remove it from a town. from one cenietery to another, or from oue 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 sınl 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 ressons, 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 niske the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner ahall make such certificate. If such a permit for the removal of a liumst body, not previously interred, from one town to another within the cominorwealth cannot be obtained early enough for the purpose, the certificate of desth 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, unless a permit In the usual form for the removal of such body has been sooner obtalked hereunder. If the death certificate contains a recitai, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States In any war In which It has been engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall 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 be obtained as to the deceased, or as to the manner of 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 hody or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do froni the board of heaith or its agem appointed to issue such permits, or if there is no such board, front 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 tire cemetery or burial groundi in which the interment is made .... Cbap. 114. Sec. 16. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies 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 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 calla for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persons to whour tlicy have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health phyalolans will certify to such deaths only as those of persons who, though disshled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is absent from home when the certificate of death ia needed.
(3) Medioal Examiners will investigate and certify to ali deaths sup- posably due to Injury. These include not only deaths caused directly or in- directly hy traumatism (including resulting septicemia), and by the action of chenicai (drugs or poisons), thermal, or electrical agents, and dealbs 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 meana the disease, or complication which causes death, not the mode of dylug. e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any Important compliestion of the principal cause.
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