USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 29
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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 hoard 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 hody and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomh 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 hody is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may he, 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, 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 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 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 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 teu vi chapier forty-six, tuat 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 forth with 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).
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.
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 board, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . 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 s a deaths only as those of persons who, though disabled by recognized disease unrelated to any formu of injury, have died without recent medical attendance or whose phy. sician is absent from home wben 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 hy 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 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 morhid 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 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 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
t
2-301 A
1
PLACE OF DEATH
Auffach . (County)
Winthrop (City or Towy Winthrop" Hospital No. margine a. Jacobs 2 FULL NAME
The Commonwealth 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 y Registered No.
St. { § (If death occurred in a hospital or institution, {
give its NAME instead of street and nun.ber) )
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(If nonresident, give city or town and State)
In this community
17 yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
april
(Month)
(Day)
20
1946
(Ycar)
19
I HEREBY CERTIFY,
That I attended deceased from
march 1. 1946, to
april 20
1986
I last saw her alive on
april 20, 1976
death is said to
have occurred on the date stated above. at
6:05pm.
Immediate cause of death Cliente Myelogenciono leukemia
Due to
Due to
Other conditions
none
(Include pregnancy within 3 months of death)
Major findings:
Of operations
none
Date of.
Of autopsy
What test confirmed diagno
clinical + lubous
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
(Address) 56Hotel
Date 4/20
21 Hand alta yes hop H. Roferty (City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
am, 23 - 1946 /19
22 NAME OF
FUNERAL DIRECTOR
Benjamin F Solomon
ADDRESS
420 Ataround X Brookline
Received and Filed APR 27 1946
19
(Registrar)
Duration IMPORTANT 7 weeks
IMPORTANT
Physician Underline the cause to which death should be desta- tistically.
M. D.
1946
Sidney L Jacobs ( Relation, if any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Signature of Agent of Board of Health of other
Health affiche 4/22/46 (Date of Issue of Permit)
(Official Designation)
5 SINGLE
(write the word)
Rengle
years
If less than 1 day
Hours
Minutes
chelsea mars
13 NAME OF
FATHER
Sidney L. Jacobs
Bastel Mars.
15 MAIDEN NAME
OF MOTHER
annie Hi tario
Balan Mass
17 Informant (Address 66 Beauty & Vinduop father
100m-9-44-14955
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
RRATH IT
Length of stay: In hospital or institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4
COLOR OR RACE
Female white
MARRIED
WIDOWED
or DIVORCED
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
7 IF STILLBORN, enter that fact here.
8
AGE. 17
Years
Months.
-
Days
Usual
Student
9 Occupation:
11 Social Security No ...
12 BIRTHPLACE (City)
(State or Country)
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or Country)
in nlAin ferme. in that it may he nonfly claimned EXACT STATEMENT Of THE TIPATIEIN I WANT IMPARARE
Industry
10 or Business:
High School
(If deceased is a married, widowed or divorced woman, give also faiden hame)
66 Betaler SX
(a) Residence. No.C
(Usual place of abode)
Hospital
1
months
years
days.
.
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 hy section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or othcer 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 hy section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert iu the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate hoth 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 sections forty-five, forty-six and fortyseven 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, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder 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 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 hoard, from the elerk 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 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 he, 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, 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 physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- eian who is a member of the board of health, or employed hy 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 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 removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section teu ut chapier ivity . sia, wwat ine 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).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the hody lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
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 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 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 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 hy 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 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 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, 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 none.
SPACE FOR ADDITIONAL INFORMATION
-
R-305
PLACE OF DEATH
Middlesex
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
stoneham
(City or town making return)
Registered No.
78
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Warres Mair Dewar
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
speolfy WAR)
(a) Residence. No.
235 Court Rd. Wintrop
St.
(Usual piace of abode)
11
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divoroed
HUSBAND of
Martha .... Anderson
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that fact here.
8
AGE
83
Years
11
Months
11
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Wood Turner ( Retired )
Industry
10 or Business :
Factory
11 Social Security No ..
none
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
13 NAME OF
FATHER
John Dewar
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Nova Scotia
(State or country)
15 MAIDEN NAME
OF MOTHER
Christine Campbell
16 BIRTHPLACE OF
MOTHER (City)
Nova Scotia
.....
(State or country)
17
Informant.Mrs Arthur O'Brien ...
(Address)
235 Court Rd Wintrop
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
21
1946
(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.) Fracture hight Femur
Carcinoma Rectum
20 Acoldent, sulolde, or homlolde:
Aprispecify fsqadertal
Date of ocourrenoe
19
Where did
Injury ocour? Stoneham .... Mass
(City or town and State)
Did Injury oocur In or about the home, on farm, in Industrial place, or in
publio place?
In koom at Rest Home
(Specify type of place)
Manner of Fall from bed on floor
Injury
Nature of
Fracture right Hip
Injury
While at work ?.
no
Was there an autopsy?
21 Was disease or Injury In any way related to ocoupation of deceased ?
If so, speolfyrawRichardson
(Signed)
wakefield Mass
Date.
Apr 23 46
22
Wintrop- Wintrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
April 23 1946
19
23 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Wintrop, Mass
Received and filed.
April 22 1946
19
(Registrar of city Of Po. .......... 1-9.46
where deceased resided)
- - - - - s Bu Is pustiDie after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m (h)-1-41-4667
....
1
Stoneham
(City or Town)
No.
12 .... Denton
St.
(If nonresident, give city or town and State)
40
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
18
DATE FILED
April
22
.
19
46
(Address)
(Give maiden name of wife in full)
)1 A +
1
PLACE OF DEATH
Suffolk. (County)
Winthrop. (City or Town)
No. 158 Winthrop Street
The Commontoralth 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. { {If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Phoebee .Estelle Fernald.
(If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 158 Winthrop Street (Usual place of abode)
St
( If nonresident, give city or town and State)
Length of stay: In nesoltal or Institution
( Before death)
(Specify whether)
.... years
months
days.
In this community 33 yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE!
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
18 DATE DF
DEATH
April
24
1946
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Thet d attended deceased from
august 10
1945, to april
24
1946
...
I last saw h.G ............ allve on
april 24
1916, death Is said to
have occurred on the dete stated above, at.
1
p.
m.
Duration
6 Age of husband or wife if alive yeers
7 IF STILLBORN, enter that fact here.
8 AGE 7.5 Years .4 ... Months 20 Days
If less then 1 day
Hours
Minutes
Right Lowfer Lobe
Usual
9 Occupetion :
At Home
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
Dixmont
( Siate or country)
Maine.
PARENTS
14 BIRTHPLACE OF
FATHER (Clty)
Concord
(State or country)
New Hampshire.
15 MAIDEN NAME
OF MOTHER
Laura Howe
16 BIRTHPLACE OF
MOTHER (City)
Dixmont.
(State or country)
Maine.
17 John Pratt
Relatlon, if any ( Nephew
21
Dixmont Cemetery Dixmont Maine
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL ... April 27,1946.
19
...
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burky transit permit was Issued :
22 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS
174 Winthrop Street Winthrop
&Signature of Agent of Board of Health of other)
Health Official
..... 4/26/46
(Official Designation) ( Date of Those of Permit)
IMPORTANT
Major findIngs :
Of operations
Nc operation
Date of.
Of outopsy.
No autopsy
What test confirmed diagnosis ? physical Examination
IMPORTANT 10 modèles
Due to
Due to
Other conditions.
Carcinoma et liver
8 months
( Include pregnancy within 3 months of death)
Physician Underline the cause to which death should be charged sta. tistically.
20 Was diseese or injury in any way related to occupation of deceesed ?
If so, specify ...
( Signed).
Edmund Di tranger
M. D.
(Address) 200 Washington Art Date 4-25 1946
Received and fled APR 27 1946
19
( Registrar)
100m(i).1-44-13634
Informent
( Address)
Dixmont Maine
13 NAME OF
FATHER
John Fernald.
Immediate cause of death. Carcinoma of Luna
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
NO.
if so specify WAR)
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 helief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired hy section one, where same was contracted, the duration of his last illness, when last seen alive hy 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 helief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert iu 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 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 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.
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