USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 5
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it has been engaged, such recital shall appcar 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 deathi 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- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body 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 bealth or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town wbere the body is to be buried or the funeral is to be held, or from a per- sen 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. ff 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 sball in all cases certify to tbc town clerk or registrar in tbe place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
... The medical examiner 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 physiolans will certify to sucb 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 wbo, though disabled by recognized disease unrelated to any forin 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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example : "Com- pound fracture of the fenrur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, bomicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of etber 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) l'uder cause ita known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death. )"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF 100m(h)-1-41-4695 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- PARENTS
PLACE OF DEATH
"County) anthrop 21
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
1.1
...
§ (If death occurred in a hospital or institution, St. \ give its NAME instead of street and number) PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran?
(a) Residence. No. (Usual place of abode) Length of stay: In hospital or institution (Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
.- 3-SEX
Female White
4 COLOR QR RACE
8 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
Ba If married, widowed, or divorced HUSBAND of.
(Give maiden name of wife In full)
(or) WIFE of.
(Husband's name in fuli)
8 Age of husband or wife if alive ..
.. years
7 IF STILLBORN, enter that fact here. FaelltomV 8 AGE Years .Months. Days If less than 1 day
Hours Minutes Due to
Usual 9 Occupation :.
Industry
10 or Business:
-
11 Social Security No.
12 BIRTHPLACE (Cit) Winthrop Mail (State or country)
13 NAME OF
FATHER
ER Gomenie Parello
14 BIRTHPLACE OF FATHER (City) .. (State or country)
15 MAIDEN NAME
OF MOTHER
Jennie Verderico
16 BIRTHPLACE OF MOTHER (City). (State or country)
Dothat, mass.
17
Relation if any
(AddresBy
I HEREBY CERTIFY thet a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Xgent of Board of Health or other) seattle pieve 11/9/46
(Officlai Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
OF Jau. 8
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. X 1976 Jau
That Iattended deceased, from 194-6
Mast saw h. tasslive on. tak 9, 1966, death is said to have occurred on the date stated above, at. Duration m. Important Immediate cause of death ... Stillon
Due to.
Other conditions (Include pregnancy within 3 months of death)
Major findings: Of operations ..
Of autopsy
What test confirmed diagnosis!
20
Was disease of injury in any way related to occupation cl deceased ?.
If so. specify
(Signed)
M. D.
21 it. Makali
(Address) ... 1/9/18/1 5 . .. Place of Burial, Cremation for Removal. ((City of Town)
DATE OF BURIAL ...
5
46 19% ..
22 NAME OF TO Cancel Deltutto ADDRESS 04 Warenel de. 665
Received and filed.
DECTT 1945
19
A TRUE COPY ATTEST:
(Registrar)
1
(City of Town) Winthrop/ Immunity Hoff No.
2 FULL NAME baby Girl Parilla (If deceased is a married, widowed or divorced woman, give also maiden name.)
200 Maverik
St
E. Warten, mais
(If nonresident, give city or town and State)
years
months
days.
In this community
yrs.
mos.
days.
If so. specify WAR)
1946
Important
Date of.
PHYSICIAN Underline tbe cause to which death should be charged sta- tlatically.
ORM R-301 7 Suffolhos
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 tbe name of the deceased, ble supposed age, the disease of which he died, defined as required 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 bundred and fourteen, 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, specifying 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 pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one bundred 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 fourtb, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shall bury or otberwise dispose of a buman 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 bealth. 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 receiv- Ing 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 auch 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 la no attending physician, or If, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by It or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical 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 re- moval of such body bas been sooner obtained hereunder. If the deatb 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, sucb recital sball appear upon the permit. The board of beaitb, 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 tbe physician certifyIng the cause of deatb shall thereafter furnish for registration any other necessary Information which can be obtained as to the deceased, or as to tbe manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examinera shall make examination upon the view of the dead bodies of only such persons as are supposed to bave died by violence. If a medical examiner has notice that there la within bla county the body of such a person, he shall forthwith go to the place where the body lles and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes tbereof which bave been brought Into the commonwealth until be has received a permit so to do from the board of health or Its agent appointed to Issue auch permits, or If there is no such board, from the clerk of the town where the body la to be buried or the funeral la to be held, or from a person appointed to have the care of the cemetery or burial ground in which the Interment la 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 tbe following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persona 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 sucb 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 wbose physician is absent from borne wben the certificate of death la needed.
(3) Medical Examiners will Investigate and certify to all deatha supposably due to injury. These Include not only deatha caused directly or Indirectly by traumatism (Including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agenta, 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 la very Important, 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 Iliness. 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, bowever, 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
Sulfate County>
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.
12
Registered No.
St. § (If death occurred in a hospital or institution, give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
( If nonresident, give clty or town and State)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
months
7
days.
In this community 36 yra. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male White
5 SINGLE
( write the word)
Married
MARRIED
WIDOWED
DIVORCED
Sa If married, widowed, or divorced hamberlin 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.
AGE 89 Years Months Days
If less than 1 dey Hours Minutes
Usual
9 Occupation :
Stereotyper
Industry
10 or Business :
Newspaper.
11 Social Security No.
12 BIRTHPLACE (City)
( State or country )
may
13 NAME OF
FATHER
Tavaly Thompson
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Ruland
15 MAIDEN NAME
OF MOTHER
Huntension
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17
Informent
( Address)
Relation, If any voice
I HEREBY CERTIFY that a satisfactory standard certificate of death was Aled with me BEFORE the bariny ac transit permit was lasued: Nace-D . Children's
Signature Board of Health or other) Health Officer 1/12/46
(Official Designation) ( Date of Immue of/Permil"
18 DATE OF
DEATH
(Month)
(Day)
19 HEREBY CERTIFY, That I attended deceased from
Jan 2
1946
to
Nam co.
1946
I last saw h./ ........ 7 ... allve on I can 10, 1946 desth is said to have occurred on the dato stated above, at 9:4/5Pm. Duration Immediate oeuse of death ... Trancho- Piumone
IMPORTANT
6 days
Due to
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operetions
Date of ........... -
Of autopsy
What test confirmed diegnosis?
Clinical Signs.
IMPORTANT
Physician Underline the cause to which death should be charged sta . tistically.
20 Was diseese or injury in any way fejated to occupation of deoeesed ? If so, specify ........
(Signed) ....
(Address) TOmachine
19/12/1946
21
Price of Burim, Cremation or Removal,
DATE OF BURIAL
(City or Towns
1944
22 NAME OF
CTOR Luby Pros
ADDRESS
Received and Aled.
19
(Registrar)
1
2 FULL NAME
( U deceased Is married, widowed or divorced woman, gire also maiden name.)
817 Shirley SK
(a) Residence. (Usual place of abode Y
No. PLACE OF DEATH r Caseph I Thompson St.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, rsquirss physicians to Insert a recital to that effect. 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 PARENTS
100m-(g)-1-45-15510
MEDICAL CERTIFICATE OF DEATH
10
1946 (Year)
4 COLOR OR RACE
(Give maiden name of wife In full)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, after tbe death of a person whom he has attended during his last illness, at the request of an undertaker or otber 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 bis 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 furnisbing a certificate of death as required by the preceding section or by section forty-five of chapter one bundred 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 iu the certificate a recital to that effect, speci- fying the war, and sball 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 bundred 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 buman 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 be accompanied, in case of an original interment, by a satisfactory certificate of tbe 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 wbo 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, 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 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 bas been sooner obtained bereunder. 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 aud 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 tbe 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 bave 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 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 be buried or the funeral is to be beld, 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 sncb 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 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 by the action of chemical (drugs or poisons), thermal, or electrical agenta, 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.
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