USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 63
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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 from the board of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the hody is to he huried 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
Tbe 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 hedside 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 hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy. sician is ahsent 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 hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or 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 .- 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 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 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, how- ever, 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
1 A
-
Suffolk
(County)
Winthrop
(City or Town)
835 Shirley Street
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be flied for burial permit with Board of Health or its Agente
Registrar's No.
f (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Laura
(Francis ) Rogers
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
835 Shirley Street
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community20
yrs.
mes.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William A Rogers
(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
Months.
Days
If less than 1 day
Hours ...
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business:
At Home
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
Prince Edward Island
13 NAME OF
FATHER
George Francis
Major findings:
Of operations
none
.Date of.
Of autopsy
none
What test confirmed diagnosis? Clinical &
20 Was disease or injury in any way related to occupation of deceases
If so, specify
(Signed) Jacob palbraus
1.2.
M. D.
255 562 Smiley St
Sept. 2019/44
21
Winthrop Cento Winthrop
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
September 27,
44
19
22 NAME OF
FUNERAL DIRECTOR
Forward S hunolds
ADDRESS
Winchop phrase
Received and filed
SEP 2-9 1944
19
(Registrar)
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
50m-(e)-3-43-11574
was fled with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that a satisfactory standard certificate of death Www. D. Clickdreng
(Signature of Agent of Board of Health or other) Healthe Office 9/24/44
(Official Designation) V (Date of Issue of/Permit)/
19 H
HEREBY CERTIFY,
That I attended deceased from
June 16, 19.30,
to.
Sept. 25
44
Y last saw h.
en
Lalive on
Sept. 24, 19 44, death is said to
have occurred on the date stated above, at.
2:05 AM
Duration IMPORTANT
Immediate cause of death
Cerebral Hemorrhage
5 days
Due to.
arteriosclerosis
2 years
Due to.
arthurtes
Other conditions
none
(Include pregnancy within 3 months of death)
IMPORTANT
Physician
Underline the cause to which death should be charged sta- ftistically.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Prince Edward Island
15 MAIDEN NAME
OF MOTHER
Jane Macdonal33
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Prince Edward Island
17 InformantWilliam Rogers (Address)035 Shirley St winthrop
HUkaHfany
1
PLACE OF DEATH
No.
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
18 DATE OF
DEATH
Monday Sept. 25/1944
(Month)
(Day)
(Year)
c
generalized astes-
10 years
$
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital incdical 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 deccased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belicf the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section onc, where same was contracted, the duration of his last illness, when last scen 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, servey' in the army, navy or marine corps of the United States in any warin 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 staterviand take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
the same. For neglect to comply with any provision of this section stich physician or oficer shall forfeit ten dollars. For the purposes of this dec 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-sfid; purposes. be deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred 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 net tre huried, until he has received a permit from the board of heallt pr lun agent appointed to issue such permits, or if there is no such board, com the clerk of the town where the person died; and no undertaker or other person shall exhumc a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv 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 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 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 cominonwealth 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 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, Scc. 45, G. I .. , (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes 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 agent appointed to issue such permits, or if there isno 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, Scc. 46, G. L., (Tercentenary Edition).
[ D Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have dicd 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
RULES OF PRACTICE
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 ersons to, whom they have given bedside care during a last illness from disease uhrelated to any form of injury. (3) Board of Health physicians will certify to such deaths only as those got persons who, though disabled by recognized discase unrelated to any form of injury, have died without recent medical attendance or whose phy- Ciao's absent from home when the certificate of death is needed.
₹3 Medical Examiners will investigate and certify to all deaths sup- besably 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 tomb to another in the same cemetery, until he hatte than the rest ofessratewing abortion, but also deaths from disease resulting from
Jury of 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 canse.
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 husiness, 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 wagcs, how- ever, designate the occupation by the appropriate terms, as housekeeper --- private family, cook-hotel, etc. For a person who had no occupation whatever write nonc.
SPACE FOR ADDITIONAL INFORMATION
R-303-A
1
No.
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
(Before death)
4 COLOR OR RACE|
Female White
3 SEX
5 SINGLE
MARRIED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
18 Ye
AGE
.Years
.Months
.Days
Usual
at home
9 Occupation :
11 Social Security No .....
12 BIRTHPLACE (City)
(State or country)
X
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Isabell
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
unknown
(State or country)
XX
17
I Marmaht .
extracts from the laws relative to the return of certificates of death.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to Insert a recital to that effect
so that it may be properly classified under the international Stasstricaitoff of Causes of vedin, ace levelse alue for
Industry
10 or Business :
at home
If less than 1 day
Hours.
.Minutes
Down
7 %
13 NAME OF
FATHER
-
Cornell
50m (g)-1-41-4667
(Signature of 'Agent of Board of Health or other) 10542
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jekt -
26-1944
(Month)
(Day)
(Year)
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, state fully.) Brunchobno Fractured Left Fewer Jenilite
20 Accident, sulcide, or homjolde (specify) ..
accidental
Date of ocourrenoe
JeME 18 -
1944
Where did
Britan
Injury ocour ?
(City or town and State)
Did Injury ocour In or about home, on farm, In Industrial place, or in publis
place?
(Specify type of place)
Manner of Fell accidentally at a revolving down
Injury
Nature of
in Burton on Sept-18-1944
Injury
While at work ?.
Was there an autopsy?
200
21 Was disease or Injury in any way related to occupation of deceased?
If so, specify
Hat Trickley 400
'M. D.
(Signed)
cedar-27
19.
(Address)
tway Providence PO
2 tace of Burial, Cremation or Removal.
Olet-1
-
(City or Town)
23 NAME OF
FUNERAL DIRECTOR ...
Jay O. Dage
ADDRESS
260 Elmwood Que
Received and filed
SEP 20 1944
(Registrar)
11
PLACE OF DEATH
Sullink (County) Wurtteda. (City or Town) Winthrop Comment Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 185
Registered No.
St. { { If death occurred in a hospital or institution, ( give its NAME instead of street aud number)
Fora M. Metcalf
(If deceased is a married, widowed or divorced woman, give also maiden name.D 189 Verudale are Providence IL. Y
years
months days.
in this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
6 Age of husband or wife If allve years
Dr. Richard Mitcall Relation, if any DATE OF BURIAL
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
(Official Designation) = DEPT.
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH RECEIVE
A physician or registered hospital medloal officer, shall forthwith, after the death of a person whom he has attended during his last illness, at tbe request of an undertaker or other authorized person/ or of any member of the family of the deceased, furnish for registration a'atandard 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 onc, 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 dertincate of death as required by the preceding section or by section forty-Ave 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, Bolted Stares in any war in which it has been engaged, insert in the certificate- a rental 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 offieer shall forfeit ten dollars, For the purposes of this sec- tion and of sections forty-five, forty-six Guapoavventofi said chapter one hundred and fourteen. the word "war' Thall metude 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 fourtb, nineteen hundred and two, and the Mexi- can border service of nineteen bundred and sixteen and nineteen hundred and seventeen. G. L. Cbap. 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 recorded, which shall he 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 tbe 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 tbe removal of a buman hody, 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, tbat such body shall be returned to tbe town from which it was removed witbin tbirty-six hours after such re- moval, 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, Ruch recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statetnent and certificate, shall 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 furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the deathi, which the clerk or registrar inay re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition ).
No undertaker or other person shall bury a human body or the asbes 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 he buried or the funeral is to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is inade .... 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, Cbap. 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 manuer of deatb .- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifles 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 wbom they have given bedside care during a last illnesa 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 (druga 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 deatb 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, auieidal." "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- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
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