USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 33
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it has been engaged, such recitar snail 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 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 death, which the clerk or registrar may re quirc .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashce 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 per son appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edi tion).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of deatb .- General Laws, Chap. 38, Sec. 7.
. .. The medical examiner certifies the cause and manner of death to the best of bis knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance o the following rules of practice :
(1) Attending physicians will certify to such deaths only as those o persons to whom they have given bedside care during a last illness fron disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deatbs only as thos of persons who, though disabled by recognized disease unrelated to an form of injury, have died without recent medical attendance or whose phys 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 death following abortion, hut also deaths from disease resulting from Injury o Infection related to occupation, the sudden deaths of persons not disable 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 an manner thereof, and will specify: (1) Under cause, the nature of an injur and of its consequences; and (2) under manner, the mode of its productio together with the circumstances when these are known. For example: "Com pound fracture of the femur with ensuing septicemia (gas bacillus) cause by a steam railway accident." "Pistol shot wound of the chest with ass ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal. "Syncope while under the influence of ethier administered as a surgica anaesthetic." "Fracture of the skull with associated internal injury su tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigatio shows the death to have been due to disease, specify : (1) Under cause it known or presumable nature; and (2) under manner, indicate the circun stances Icading to medico-legal inquiry. For example : "Hemorrhage spor taneous of the brain (basal ganglia) (found dead iu bed)." "Heart disease presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person) Date entered service discharge bank & Organization Deriar Cumber
1
1
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
-
FI R-302
Suffolk
(County)
1
Boston
(City or Town)
No.
Mass .Gener al Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
4236
Registered No.
S (If death occurred in a hospital or institution,
St.
give ite NAME instead of street and number)
2 FULL NAME
Mary Monica King
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
249 Shore Drive
St.
Winthrop Mess.
(Usual place of ahode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
months
7
da y s.
In this community
yre.
mos.
7
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
F
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Giye maiden name of wife in full)
(or) WIFE of
John ... King.
(Husband'e name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that fact here.
8
AGE
60 Years
Months.
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
At Home
Industry
10 or Business:
Housework
11 Soolal Security No ....
12 BIRTHPLACE (City)
(State or country)
.South .... Boston .. Mas.s ..
13 NAME OF
FATHER
John King
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
South Boston Mass.
17
Informant
(Addrese)
L Daffiy "Daughter)
A TRUE COPY .*
ATTEST :
(Registrar of city or town where death occurred) May 8
19
46
MEDICAL CERTIFICATE OF DEATH
May 4/46
(Day)
(Year)
19 | HEREBY CERTIFY,
That J attended deceased
From
19.
.46, to.
May 4
19
I last saw h ............ allve on
May 4
19.46
death Is sald to
have ooourred on the date stated above, at ....
3 .: 05AM
.m.
Immedlate cause of death
Anemia
Duration 2 Yrs
Unknown
Due toCarcinoma of cecum
Due to.
Rheumatic heart disease with
mitral and aortic stenosis; hydrothorax
chronic glomerulo nephritis
Other conditions.
(Include pregnancy within 3 months of death)
Major findinge:
None
Of operatione
Date of
Of autopsy
Carcinoma of cecum
What test confirmed diagnosis ?.
autopsy
20 Was disease or injury in any way related to occupation of deceased ?.. No ...
If so, epeolfy
T S Hamilton
(Signed)
M. D.
(Addrese)
Mass General HosptDate
5-4 19
21 PLACE OF BURIAL, Milton Cem-Milton Mass.
CREMATION OR REMOVAL
Cemetery)
Hay 7/46
(City or Town)
19
22 NAME OF
R J DeNeill
FUNERAL DIRECTOR
ADDRESS
Rovere ... Mass.
19
DATE FILED
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
15 MAIDEN NAME
OF MOTHER
Catherine King
50m-(b) -6-44-14607
1
Received and filed
(Registrar of City or Town where deceased resided)
...
DATE OF BURIAL
Physician Underline the cause to
which death should be
charged sta- tistically.
18 DATE OF
DEATH
(Month)
(If U. S.
war Veteran,
speolfy WAR)
PLACE OF DEATH
-301 A Suffolk (County)
1
Winthank
(City or Town) 52 Jours & No.
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.
Registered No. 89 ....
St& (If death occurred in a hospital or institution, { give its NAME instead of street and number)
أو Ollen For Selling Shelling
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
52 tomat Dr.
(Usual place of abode) }
Length of stay: In hospital or Institution
( Before death)
( Specify whether )
years
months
days.
In this community (0 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Finale
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
Predimed.
5a If married, widowed, or divorced HUSBAND of. ....
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE 70 Yours
1
Months
Days
if less than 1 day
Hours
Minutes
Usual
9 Oooupetlon :
at time
Industry
10 or Business :
une
11 Social Security No. zame
12 BIRTHPLACE (City)
(Sinte or country)
Cambridge
13 NAME OF
FATHER
South & Tilley
14 BIRTHPLACE OF
FATHER (City)
(State or country)
cheland
Clare
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
Many Si Din
(State or country)
Cambiare In. 20
47
Informant
( Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with ow BEFORE the bucket or transit permit was issued :
Dlades C. DEar-
(Signature of Agent of Board of Health or other)
irting
5/4 /46
(Official Designation) ( Date of Issue of Permity
18 DATE OF
DEATH
(Month)
5 1946
(Day)
(fedr)
19 | HEREBY CERTIFY,
That i attended deosased from
may 4,.
19 ..
may 5, 1946
i last saw h.
en
may 5, 19 /6 death is said to
have occurred on the date stated above, at.
4:30 Pm.
Immediate cause of death
Cardiar decompensali
IMPORTANT
Due to ....
In feitemine Meut disease
Due to.
artemis cheurri
Other conditions.
( Inciude 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 ony way related to occupation of deceased ?.......
If so, spoolfy.
ar Caplan
('Signed)
M. D.
(Address) 1SB Pincele ST, E3 Date 5 -
-7 1946
21
Canview
hyde Park .
Piace of Buriai, Cremation or Removal.
May 8
1946
(City or Town)
DATE OF BURIAL.
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
336 Bindway Cambridge
.19
Received and Ated MAY 9 9946
(Registrar)
100m-(g)-1-45-15510
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, Q. L. Chap. 45, Seotlon 10, requires physiolans to insert a recital to that effeot. 350
PARENTS
PLACE OF DEATH
.....
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
St.
(If nonresident, give city or town and State)
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 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 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 thc 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, 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 bundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or otber person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been huried, until be 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 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 he 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 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 buman body, not previously interred, from one town to another within the commonwealth cannot he 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 sucb removal; provided, that such hody shall he returned to the town from which it was removed within thirty-six hours after sucb 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 reeital, 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 he 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 by violence. If a medical examiner has notice that there is within his county the hody 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 hoard, from the clerk of the town where the hody 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 sucb 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 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 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 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 hoine. For a woman whose only occupation was that of home bousework, 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) ENii Community
Lo notifies 6/00/8
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for buriat permit with Board of Health or its Agent.
Registered No.
00
St. f (If death occurred in a hospital or institution, { } give its NAME instead of street and number) }
PHYSICIAN - IMPORTANT no ( Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
93
Beach
Length of stay: In hospital or institution (Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
temale
4 COLOR OR RACE
white
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCEBUT duseres
5a If married, widowed or divorced HUSBAND of .
(or) WIFE of
(Give maiden name of wife in full)
Charles A. Bradley
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8 AGE. 7 / Years 7 Months Days
If less than I day
Hours .
Minutes
Usual 9 Occupation:
housewith
Industry
10 or Business:
at home
11 Social Security No.
12 BIRTHPLACE (City).
(State or Country)
none
kalish mann
13 NAME OF
FATHER
Thomas R. H halen
14 BIRTHPLACE OF
FATHER (City)
beland
(State or Country)
15 MAIDEN NAME
OF MOTHER
Ellen Someddy
16 BIRTHPLACE OF MOTHER (City) (State or Country)
Ireland
Informant (Address! 93 Beach St Revenue
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the torial or transit permit was issued: GladysDean
(Signature of Agent of Board of Health or other)
May 12/19+6:
..... ........
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
may
11
(Month)
(Day)
(Ycar)
19
I HEREBY CERTIFY.
That I attended deceased from
May
8
1946
, to
may !
, 19
46
I last saw h -
en
alive on
may 11
6.55 Am.
Duration
Immediate cause of death
IMPORTANT 3 days
6 years
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings:
Of operations
June
Date of
Of autopsy
Line
What test confirmed diagnosis?
20
20 Was disease or injury in any way related to occupation of deceased?
If so, specity
John F. Colline
(Signed)
(Address) 125 hours Rd Withany Way 19 4.6
, M. D.
21
St. Josepho
Lyny
Place of Burial, Cremation or Removal.
ity or Town)
1946
22 NAME OF
FUNERAL DIRECTOR
Murray + Murray
ADDRESS
Rovere
man
Received and Filed MAY 1 1 1 (Registrar)
19
>
2 FULL NAME
Alice T. Bradley
(If deceased is a married, widowed or divorced woman, giy
also maiden name.)
St.
Rerere
(If nonresident, give city or town and State)
years
months
2
days.
In this community
yrs.
mos.
days.
1946
. 19 % C
death is said to
have occurred on the date stated above. at
arterial Hypertension
1
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
17 Eleanor Bradley Relation, if any ) laughter DATE OF BURIAL May 18
100m-9-44-14955
1
OCCUPATION is very important.
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 UCd If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to insert a recital to that effect. PARENTS
Revere.
Hospital
Whaley
EXTRACTO 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 his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of 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, 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 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 10 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 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 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
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