USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 66
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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 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 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 held, 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).
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 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 pliysl- 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 dircetly or in- directly by traumatism (including resulting septicemia), and by the actlon 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 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 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 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
Suffolk
The Commontucalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
STON (City or town making return) 193 8181
Registered No.
(If death occurred in a hospital or institution, St. ¿ give ite NAME instead of street and number)
2 FULL NAME
Artemas Brockway Poor
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
115 ..... Circuit .... Road
st. Winthrop .... Center ...... Mass ..
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years 8
months days.
In this community
угs. 8
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a 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
7 IF STILLBORN, enter that fact here.
8
AGE 64 Years
4
Months.
13 Days
If less than 1 day
Hours
Minutes
Usual
9 Dccupatlon :
Vice President
Industry
Employer's Insurance Co.
10 or Business :
11 Social Security No ..
012-03-4808
12 BIRTHPLACE (City)
(State or country)
Chelsea, Mass.
13 NAME OF
FATHER
Joseph Lincoln Poor
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Robbinston
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Harriette A. Wyman
16 BIRTHPLACE OF
MOTHER (City)
Calais
(State or country)
Maine
17
Informant iss Gladys P. Phippin
( Address)
Relatimetėny
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED Sept. 819 43
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
3
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
to
January 6
19
43
Sept 3 19 43
I last saw h ..
im
... allve on
Sept 3
1943
death Is sald to
have occurred on the date stated above, at ..
10. P
m
Duration
Immediate cause of death Bronchopneumonia
cardiac failure
Due to. Coronary arteriosclerosis
Due to.
1 to
2 yrs
Dther conditions.
(Include pregnancy within 3 months of death)
Major findings : Of operations
Date of
Physician Underline the cause to which death should be charged sta-
What test confirmed diagnosis?
Electrocardiagramistically.
20 Was disease or Injury in any way related to oooupation of deceased ?...... 11Q If so, specify
(Signed)
D, F. Mahoney
M. D.
(Address)
The Copley Plaza
Date
9-4
19
43
21 PLACE OF BURIAL, Woodlawn Cem. Everett, Mass.
19
CREMATION OR REMOVAL
(Cemetery)
(City or Towp)
7
DATE DF BURIAL
Sept ...
43
22 NAME DF
FUNERAL DIRECTOR
J. S. Waterman
ADDRESS
Boston Lass.
Received and filed.
Str
1943
19
(Registrar of City or Town where deceased resided)
.... .. . ...
PLACE OF DEATH
(County)
1
Boston
(City or Town)
No.
Copley Plaza Hotel
.....
(If U. S.
War Veteran,
specify WAR)
1943
That I attended deceased from
36 hrs
Of autopsy
302
1
PLACE OF DE Suppria (County )
(City or Town) Fast Banka Hospital No.
MEDICAL EXAMINER'S CERTIFICATE OF DEATH Il Notifie
To be filed for burial permit RegWieled Epard of Health or its Agent.
St. [ {If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Romuald O. Wagner (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
Stewart are
Elgin Ill
St.
(Usual place of abode)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL. AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jeff
3 -
1943
(Month)
(Day)
(Year)
5a ff married, widowed, or dixproed Evelyn
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
6 Age of husband or wife If allve
7 IF STILLBORN, enter that fact here.
8 AGE32 Years .Months. Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Soldier
Industry
10 or Business :
US army
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
11/12019
13 NAME OF
FATHER
C/BIL
PARENTS
(State or country)
15 MAIDEN NAME
DF MOTHER
C/O/L
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
C/BIL
60m (g)-1-41-4667
I HEREBY CERTIFY that a satisfactory sandard certificate of death was filed Alth me BEFORE Huy burlafor transit permit was Issued : . Mas. Children
nature 9 Ment of Board cidfealty or other) 1 healthe officer 9/6/43
(Official Designation ) (Date of leghe of Permit)
20 Accident, suloide, or homicide (specify)
Presimins accidente
Date of ooourrenoe.
Jeff-3-
1943
Where did
Boston
Injury ooour ?
(City or town and State)
Did Injury ocour In or about home, on farm, In Industrial place, or In publio
place?
School
(Specify type of place)
Manner of
Tell him a window at
Injury
Nature of
Burton on Sept-3-1943
Injury
While at work?
?
Was there an autopsy ?.
yes
21 Was disease or Injury in any way related to ocoupation of deceased ?.
If so, specify.
(Signed)
'M. D.
(Address)
Sophto- 4-
1943
22
Elgin
111/2013
Place of Burial, Cremation or Removal.
(City or Town)
23 NAME OF
FUNERAL DIRECTO Murray Murray
ADDRESS
254
Beau et Ravel
Received and flied.
SEP 1 1943
19
(Registrar)
4TH
.......
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY
×
.......................
el
(Was deceased a U. S. War Veteran, If so specify WAR). PHYSICIAN-IMPORTANT
42
(If nonresident, give city or town and State)
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
2
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, etatefully.) heltible Inferior including Fractured Pelvis +
years Ruptured Lens
ww. a ... J. war veteran, G. L. Chap. 46, Seotion 10, requires physloians to insert a recital to that effeot
17
Fort Bank
(
Relation, if
Informant.
DATE OF BURIAL
Sept 8
19
43
14 BIRTHPLACE OF
FATHER (City)
CIBIL
21000
Elegant 0/9/43
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, furnisb 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 required 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 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 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 and 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 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, be deemed to have taken place between February fourteenth, eigbteen 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 permit from the board of bealth or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to 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, 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 medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session 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 re- moval, unless a permit in the usual form for the removal of such body has been sooner obtained hereundet. 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 permit. The board of health, or its agent, upon receipt of such statement and certificate, shail 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 furnisb for registration any other necessary 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 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 bas 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 beld, 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 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.
. . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .-- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 much deatbs 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) Medioal 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 (gas 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 ether 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- tancous 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
A
Suffolk
(County)
Winthrop
(City or Town)
Winthrop Community Hospital
( If death occurred in a hospital or institution, St.
give ita NAME instead of atreet aud number)
2 FULL NAME
Ellsworth Burrill
( If deceased is a married, widowed or divorced woman, give also maiden name.)
46 Thornton Park
(a) Rasidenca. No.
St.
(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 Male
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
Sa If married, widowed, or divorced
Annie Cobb
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if aliva yaars
> IF STILLBORN. enter that fact here.
8 AGE .8.0. Years
Months .25 .. Days
f less than 1 day Hours Minutas
Usual
9 Occupation :
Chief of Police (Retired)
industry
Winthrop Police Dept.
10 or Business :
11 Social Security No.
None
Winthrop
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Ebben Burrill
14 BIRTHPLACE OF
FATHER (City)
Revere
( State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Lucy E Chase
16 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country)
Mass.
17 Laura Burrill
informent (Address) 46 Thornton Park"
Relation, If any baughter
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with ma BEFORE the burial of transit permit was issued t Nu.D- Childress. 0 (Signature of Agent of Board of Health of other)
He after apluche 9/7 /43
I (oficial Designation) (Date of Frque 'of Permit)/
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September 4
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That } attended deosased from
august 15 1943,
Ło.
September 4 1943
I last saw him
alive on.
September 4 1943 death is said to
have occurred on tha data statad ahova, at
2:30 Am.
Immediata cause ofdeath ..
Chuonic Interstitial Replanter
Duration 1 year "IMPORTANT
Due to ...
Uremia
3 days
Due to
Senility
6mois
Other conditions.
none
( Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findings :
Of operations
none
Data of
Of autopsy
none
What test confirmed diegnosis climal + lab
Underlina the cause to which death should ba charged sta- listically.
20 Was disease or injury in eny wey raleted to oooupation of deosesad ?..
If so, spaoify ..............
(Sig
(Address) 372 Sunday S
We had Maro Data Sept. 4'
21 .Winthrop
l'lace of Burial, Cremation or Removal.
DATE OF BURIAL
Sept. 7,
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winshop
19
( Registrar)
PARENTS
SCRA.74.7.
-
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. 5
Ragistared No.
PHYSICIAN - IMPORTANT
(Wat deobased
U. S. War Vateren,
if so spoolfy WAR)
(Usual place of abode)
Hospital
yeara
months
5 days.
In this community
yrs.
mos.
dayı.
1943
...
M, D.
1963
winthrop
Raoeivad and Aled
SEP 2 1943"
1
PLACE OF DEATH
...
No.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physioien or registered hospital medioel offioer shall forthwith, after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other authorized person or of ans mentber of the family of the deceased, furniab 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 asme was contracted. the duration of his last filnesa, when lest seen alive by the physician or officer and the date of bis death ... Gen. Lawa, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by acction forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, aerved 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, such physician or officer shall forfeit ten dollars. For the purposes of thia aec- 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 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 aud sixtcen and nineteen hundred and seventeen. G. L. Clap. 46, Sec. 10.
No undarteker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which haa not been buried, until he has received a permit from the board of health, or ita agent appointed to lasue such permita, or if there is no such board, from the clerk of the town where the person dled; and no undertaker or otber person shali exhume a human body and remove it froin a town. from one cemetery 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 issued until there shali 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 ettending physician, if any, as required by law. 01 in lieu thereof a certificate aa hereinafter provided, If there is no attending physician, or if, for sufficient ressous, hia certificate caimot be obtained early enough for the purpose, or ia insufficient, a pbysi- cian who ia e member of the board of health, or employed by It or by the aelectmen for the purpose, shall upon application miske the certificate re- quired of the attending physician, If death Is caused by violence. the medi- cai examiner chall 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 early enough for the purpose, the certificate of death made aa above provided and in the possession ot the undertaker desiring to make such renroval 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 hae been sooner obtained hereunder. If the death certificate containa a recitai, as required
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