USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 70
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... 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 hest 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 such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, cr electrical agents, and deaths following abortion, hut 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 etlier administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify : (1) Under cause its known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example: "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
--
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec, 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
FORM R-301
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- MARGIN RESERVED FOR BINDING
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
203
Registered No.
[ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number) PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran? If 89/7 toposfly WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
years
months
days.
(If nonresident, give city .or town and State)
In this community SU
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Yamaha
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
September
14
1943.
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give malden name of wife in full)
William. H. mirick
(or) WIFE of
(Husband's name In full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
AGE.
8 8992 Years 10 Months 2 .. Days
If less than 1 day
Hours
Minutes
Due to.
9 Oocupetion : at Home
Industry
10 or Business:
11 Social Security No.
cambridge
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Joseph . M. adams
PARENTS
14 BIRTHPLACE OF new london -
FATHER (City)
(State or country) new Nafolhahun
18 MAIDEN NAME
OF MOTHER
abfall A . TWEEd
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country) new Hampshire
Relatlon, If any
17
Roselth Woodward niece
Informant ...
(Address) 36- Standon Road Brookelens My
....
I HEREBY CERTIFY that a satisfactory standard certificate of death wau filed with me. BEFORE the burial er traneit permit was issusd: William D. Childress (Signature of Agent of Board of Health or other) agent Sylt-15/43
(Official Designation) (Date of Issue of Permit
19 I HEREBY CERTIFY. That I attended deceased from
Sept 14
19.45, to ..
Sixt 14
19 43
I last saw her alive on Sept 14 1943 death is said to
have occurred on the date stated above, at 12.50 p.m.
Duration Important
Immediate cause of death Cancer Date Colon
about 8 months
Due to ..
Other conditions none
(Include pregnancy within 3 months of death)
Important
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20
W'as disease or injury in any way related to occupatien el deceased?
If .o, specify ..
(Signad).
Syrole w. pickmysoul
M. D. (Address) Winthrop Man Date Sept 14 1043
21. Bramatin of it. auburn Build Candy Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR Sha. R. Bernador
ADDRESS.
440
Received end filed S.E.L. 16 1343
19
A TRUE COPY ATTEST:
(Registrar)
100m (h)-1-41-4695
1
(City or Town)
20 Clinwood No. Laura Merick
ave Wurdeof .. St.
adams
2 FULL NAME
(If deceased is a married, widowed or divorced woman give also maiden name.)
20 Elmwood ave
SP.
.....
the her Children
Major findings:
Of operations
name
Date of.
Of autopay
none
What test confirmed diagnosis ?.
Clinical
East Unity
MEDICAL CERTIFICATE OF DEATH
Usual
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last Illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and bellef the name of the deceased, hls supposed age, the dlsease of which he dled, defined as required hy sectlon one, where same was contracted, the duration of his last illness, when last seen ailve by the physiclan or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physiclan or officer furnishing a certificate of death as required by the preceding sectlon or by section forty-five of chapter one hundred and fourteen, shall, If the deceased, to the hest of his knowledge and belief, served In the army, navy or marine corps of the United States in any war in which it has heen engaged, insert In the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or Immedlate cause of death as nearly as he can state the same. For neglect to comply with any pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section 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 expedition and the Philippine Insurrection, which shall, for said purposes, he deemed to have taken place between Fehruary fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws. Chap. 46, Sec. 10.
No undertaker or other person shali bury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been huried, until he has received a permit from the hoard 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 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 receiv- Ing tomh to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the hody Is huried. No such permit shall he issued until there shall have been delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall he accompanied, in case of an original interment, hy 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 physiclan, or If, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or ls in- sufficient, a physician who is a member of the hoard of health, or em- ployed hy it or hy the selectnien for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the inedical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 he 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 re- moval of such body has been sooner ohtained hereunder. If the death certificate contains a recital, as required hy 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 recltai 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 physiclan certifyIng the cause of death shail thereafter furnish for registration any other necessary Information which can he obtained as to the deceased, or as to the manner or cause of the death, which the cierk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shail make examination upon the view of the dead bodles of only such persons as are supposed to have dled by vlolence. If a medical examiner has notice that there Is within hls county the body of such a person, he shall forthwith go to the place where the body lles and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received 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 cierk of the town where the body is to be buried or the funeral ls to he held, or from a person appointed to have the care of the cemetery or hurlal ground in which the Interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calis 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 fast 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 disahled hy recognized dlsease unrelated to any form of Injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortlon, hut 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 fallure, asphyxia, asthenia, etc. As principal cause name the dlsease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principai cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfuiness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to iliness. If the deceased had retired from husiness, report the usual occupation prior to retirement. Children not gainfully employed may he 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
Suffolk (County) Winthrop
The Commonforall 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.
204
S ( If death occurred in a hospital or institution, St. give its NAME instead of street and number)
O'Brien
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(write the word) Married
Sa If married, widowg & orive G. Gomore HUSBAND of
6 Age of husband or wife if alive GCo ..... years
If less than 1 day Hours Minutes
13 NAME OF
FATHER
William O'Brien
15 MAIDEN NAME
OF MOTHER
Mary Carroll
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Wird. Catherine G. O'Brien Relstion g any (Address) 6/ Read Str. Win
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with ma BEFORE the burial or, transit parmit was Issued ?
Childrens
(Signature of Agent bt Board of Health or other)
Ho.
Sept 23/43
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept.
21-1943
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deoaased from
1943 to.
Sept. 21
1943
I last saw h .... Im alive on
Senf.28
1943
death Is said to
have occurred on the date stated above, at.
6 %
.m.
Immediate oause of death
IMPORTANT
Cammina of liver È metratas
Due to
Due to.
Other conditions
( Include pregnancy within 3 months of death)
....
IMPORTANT
Major findIngs:
Of operations.
Quemathmit metachares
Physician
Underline the cause to which death should ba charged sta- listically.
20 Was disease or injury In any way related to oooupation of deceased ? no
If so, specify.
(Signed)
305 Hame S. EBarth Date Sept 22 19 43
M. D.
(Address)
21 Winterot ............. Winthrop
l'lace of Burial, Cremation or Bemoval.
(City or Town)
DATE OF BURIAL.
September
2%
19 43
22 NAME OF
FUNERAL DIRECTOR
Kelly
ADDRESS
11 Mariakan St.02.13.
Received and Aled. .19
( Registrar)
E
100M-G - 2-42-8855
1
(City of Town)
61 Tread
...
No.
2 FULL NAME
6/ Head
(a) Residenca. No.
(Usual place of abode)
Died at home
Length of stay : In hospital or Institution
(Before death)
(Sperify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Male White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED?
(or) WIFE of
(Give maiden name of wife in full)
( Husband's name in full)
" IF STILLBORN. enter that fact here.
8
AGE
70 Years
-. Months
Days
Usual
Retired Captain
9 Occupation :
10 or Business :
11 Social Security No.
021-14-1117
12 BIRTHPLACE (City)
Dublere
( State or country)
Ireland
14 BIRTHPLACE OF
FATHER (Clty)
Dublu
Ireland
(State, or country)
PARENTS
Dublin
Informant
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physicians to insert a recital to that effeot.
extracts from the laws on back of certificate.
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
Industry
Bor. R. B.Y Lyun R.R. Ferry
years
months
days.
In this community
16 yrs.
mos.
dayı.
Duration
.......
3 months
Date of.
que 1943
Of autopsy
What test confirmed diagnosis ?...
Let + clinical
...
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so Meolfy WAR)
St.
Winthrop0
(If nonresident, give city or town and State)
PLACE OF DEATH r Michael
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medical 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 sny meoiber of the family of the deceased, furnisb 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 was contracted. the duration of his last illness, when last 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 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, aerved in the army. navy or marine corps of the I'nited Ststes In any war in which It has been engaged, insert in the certificate a recital to that elect, speci- fying the war. sud 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 purposes. he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Jiexi- can horder 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 budy which has not been buried, until he haa 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 ahall exhume a human body and remove it from a town, from one cenietery to suother, or from one grave or tomb other thau 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 aball bave been delivered to sucb board, agent or clerk. as the case inay be, a satisfactory written atutenient 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. ot 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 hoard of health, or employed by it or by the selectmen for the purpose, shall upon application niake 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 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 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 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 aerved 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 sgent. upon receipt of such stateoient 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 .- Cbap. 114. Sec. 45, G. L., (Tercentenary Edition ).
No undertaker or other person shall bury a human body or the ashea 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 appuiluted 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 held, or from a person apointed to have the care of the cemetery or burial ground in which the interment is made. ... Cbap. 114. Sec. 16. G. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies 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 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 rulea 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 illneaa from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths 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 phyaf- cian is absent from home when the certificate of death is needed.
(3) Medioal Examiners will investigate and certify to sil deaths sup- posably due to injury. These include oot 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 deaths from diseasa 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. Aa principal cause name the disease caualng 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 ia very im- 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 disease 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 hoine. For a woman whose only occupatiou waa that of home bousework. write bouxework. 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.
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