USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 4
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No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he bas 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 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).
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 tbose of persons wbo, tbough disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from bome 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 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 deatb means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, aspbyxia, asthenia, etc. As principal cause name tbe disease causing deatb. 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 important, so that the relative bealthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation bad been given up or cbanged on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired fromn 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, bowever, designate tbe occupation by tbe appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
Suffolk
(County) Winthrop
(City or Town) 106 Ballage are winther Mass No .
The Commonturalth 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. 0
Registered No.
( ( If death occurred In a hospital or Institution, St. ) give its NAME instead of street and number)
albert Sich Richard
(If deceased is a married, widowed or divorced woman, give also maiden game. )
(a) Residence. No. 106 Cottage ave Wireless
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
2
years months days.
In this community 46
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January 16 1944
(Month)
(Day)
(Year)
19 HEREBY CERTIFY, That I attended deceased from
February 101894
......
January 16
19/
4K
I last saw him
.allve on ...
15, 1944, death Is said to
have occurred on the date stated above, at.
2:30 P:
m.
Immediate cause of death.
Cerchial Hemorrhage
1 month
Due to.
artensclerosis
5 years
Due to.
Senility
2 years
Other conditions.
node
(Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findings :
Of operations.
none
Date of
l'uderline the cause to which death
Of autopsy.
none
What test confirmed diagnosis
chemical + lab
charged sta. Fiistically.
20 Was disease or injury in any way related to ocoupation of deceased ?
If so, specify ..
(Signed acor Chances Is. 00)
(Address) 5628 Lucky
Date ...
1/17/48
, M. D.
l'lace of Burial, Crematieg er Removal.
DATE OF BURIAL
Jan 18H Winelink
1944
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed.
JAN 1 8 1940
19
(Registrar)
100m (d)-1-41-4667
1
2 FULL NAME
(Usual place of abode)
3 SEX
4 COLOR OR RACE|
White
make
(or) WIFE of
7 IF STILLBORN. enter that fact here.
8
AGE
80
1
Years
Months
20
Days
Industry
10 or Business :
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
Rowley
16 BIRTHPLACE OF
MOTHER (City)
Rowley
(State or country)
maso
17
grus. H. H Gould
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
PARENTS
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. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
(State or country)
mins
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the wurd)
vordarel
Sa If married, widowed, of divor nettleton Richard
HUSBAND of
Give maiden name of wife in fully
(Ihusband's name in full)
6 Age of husband or wife if alive years
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Retired Salesman
11 Social Security No. .
031-07-2638
Somenile
13 NAME OF
FATHER
George. Albert Richards
15 MAIDEN NAME
OF MOTHER
Sarah. Lambert Smith
Informant
126 John St Each Watered
21 Relation, if any orario
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was Issued: m.S. Children&
(Signature of Agent of Board of Hegith or other)
Health Officer 1/18/44
(Official Designation ) (Date of Issue of Permit)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
(If nonresident, give city or towu and State)
(City or Town)
Duration IMPORTANT
PLACE OF DEATH
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 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 hia 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 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 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 Fehruary fourteenth, eighteen hundred and ninety-eight and July fourth. nineteen hundred and two, and the Mexi- can border service of oineteen 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, fromn 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 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 cootaining 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 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 hy violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a hinman 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 served In the army, navy or marine corps of the I'nited States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall forthwith counter-ign it and transmit it to the clerk of the town for registration. The person to whoin 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 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 huntan hody or the ashes thereof which have been hrought 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 board. from the clerk of the town where the hody is to he buried or the funeral is to be held, or from a person apointed 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 examioers shall make examination upon the view of the dead bodies of outy 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) Attendiog 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 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 .- Cantse of death means the discase, 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, naine earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed inay 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
R.301 A
Auffach (County) München (City or Town)
PLACE OF DEATH No. 20 Suvall are
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or ita Agent.
Registrar's No.
§ (If death occurred in a hospital or institution, St.
{ give its NAME instead of strect and number)
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
20 Juval ave Minutenpost. (a) Residence. No. (Usual place of abode)
years
months
days.
In this community2 5 yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATHI
1949
18 DATE OF
DEATH
(Month)
(Day)
(Ycar)
19 I HEREBY CERTIFY,
That I attended deccascd from
19
to
19
I last saw h
alive on
19
death is said to
have occurred on the date stated above, a . 45PM.
,
Immediate cause of death
IMPORTANT
Due to. Virtual Causes
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of.
Of autopsy.
What test confirmed diagnosis ?.
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify_
(Signed)
(Address)
M. D.
coleman Foto 1-16~ 19
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL Jan 201
19.4.31
22 NAME OF FUNERAL DIRECTOR Manduel Me De human ADDRESS 23 Gary Que Calabria
Received and filed. JAN 2 6 9944
.. 19
(Registrar)
5 SINGLE
(write the word)
MARRIED
WIDOWED
Or DIVORCED Marnie
years
If less than 1 day
Hours.
Minutes,
13 NAME OF
FATHER
Florence . Tobin
Informant (Address) 20 Auwallace Mandaron
was filed with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that a satisfactory standard certificate of death Was. Childress %. (Signature of Agent of Board of Health for other) Health officer 1/19/44 7(Official Designation) (Date of Issue of Permix)
Relation, if any
50m-(e)-3-43-11574
1
2 FULL NAME
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Male Wchili
5a If married, widowed, or divorced
HUSBAND of Flounce M. Ford
(Give maiden nakie of wife in fully
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alivc.
50
7 IF STILLBORN, enter that fact here.
8
AGF 51
Years
Months
Days
Usual
9 Occupation :
Stevedone
10 or Business:
11 Social Security No.
010-09-8913
12 BIRTHPLACE (City)
Madden
(State or country)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Laura Y
16 BIRTHPLACE OF
MOTHER (City)
Topsfield
(State or country)
17
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect.
PARENTS
from the laws on back of certificate.
that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts
Industry
Vanou Companies
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Q. Tafino
(If nonresident, give city or town and State)
17
Duration
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 tbe family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belicf the name of the deccased, his supposed agc, 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 scou alive by the physician or officer and the date of his deatb ... 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 scc- 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 expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eightcen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen bundred and sixteen and nine- teen 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 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 may be, a satisfactory written statement containing the facts required by law to be returned and recordcd, 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- ciau 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 rc- quired of the attending physician. If death is caused by violence, tbe 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 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 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 perinit. 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 aslies thercof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agcut 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 front 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 phy- sician 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 indirectly 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 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 mcans the discase, 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 cmployed 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, how- ever, designate the occupation by the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
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