USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 9
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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 counteralgn It and transmit It to the clerk of the town for registration. The person to whom the permit la so given and the physician certifying 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 of registrar may require .- Chop. 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 dled by violence. If a medical examiner has notice that there Is within hls county the body of euch 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 thereof which have been brought Into the commonwealth until he has received a permit 80 to do from the board of health or Its agent appointed to lssue 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 burlal ground In which the Intermert la 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 Heaith 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 physician Is absent from home when the certificate of death Is needed.
(3) Medical Examiners will Investigate and certify to all deaths supposably due to injury. These Include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortlon, 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 fallure, 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 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, however, designate the occupation by the appropriate terms. as housekeeper-private family, cook-hotel, etc. For a person who had to occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
608-10-100
R-301 A 1
Winthrop
(County) 1. Suffolk Kgity or Town)
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. 21
death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
Walter mellen Burnap
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
8 Pleasant St
St.
(Usual place of abode)
hospital
years
months
-days:
( If nonresident, give city or town and State)
in this community 2/ yro.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
( write the word)
Married
5e If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife inmill)
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if elive
74
yeers
7 IF STILLBORN, enter that fact here.
g AGE 74 Years 2 Months 14 Days
If less than 1 dey
Hours
Minutes
Usual
9 Occupetion :
Guard
Industry
10 or Business :
Federal Building administration
11 Social Security No.
026-14-8047
12 BIRTHPLACE (City)
(State or country) marlborough
Mass
13 NAME OF
FATHER
Charles Russell Burnap
14 BIRTHPLACE OF
FATHER (City)
Hopkinton
(State or country)
Mass.
15 MAIDEN NAME
. OF MOTHER
Belinda Elisabeth Serra
16 BIRTHPLACE OF
MOTHER (City)
Waterborough
(State or country)
Maine
17 Aus W.m. Bumap( Relation, if any wife
Informant
( Address)
8 Pleasant It
I HEREBY CERTIFY, that a satisfactory standard certificate of death was filed with me BEFORE the butlet or transit permit was Issued ? Www.D. Juldress
( Signature of Agent of Board of Health or other) Hallte Office
1/38/46
'(Oficial Designation) (Date of Toque of' Permit)/
18 DATE OF
DEATH
San
(Month)
(Day)
(Year)
19 1 HEREBY CERTIFY,
lan17,
...
That I attended deceased from
1946
to
lun 2)
1946
last saw h ............ alive on ...
(2), 1946 death Is said to
have occurred on the dete stated above, at ......
11.20 0
Immedlate gouse of death ... Mescalina Thrombosis
Due to
Chronic hypertension
........... 11 hours 5 years
Other conditions.
( Include pregnancy within 8 months of death)
IMPORTANT
Mejor findIngs :
Of operations
Date of
Of eutopsy
What test confirmed dlegnosis?
Clinical Signs
200
20 Was disease or injury in any way related to oogupation of deceesed ?
If so, specify
( Signed)
Daniel 1. 0/ min
. M. D.
( Address).
Winthrop, Mess Date Janay 1946
21
Winthrop territory Withup Mand
Place of Burial, Oremation er Hemroval.
(City or Town)
DATE OF BURIAL
Jan 30, 1946
19
22 NAME OF
FUNERAL DIRECTOR
alfred B. Manch
ADDRESS
174 Whithrop It Whichrop
Received and filled. JAN 30 1946
19
( Registrar)
Physician Underline the cause to which death should be charged sta- tistically.
PARENTS
100m- (g) - 1.45-15510
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires phyelclans to insert a recital to that effect. extracts from the laws on back of certificate. Terms, so raar ir may be properly classitied. Exact statement of OCCUPATION is very important. See instructions and M
1
PLACE OF DEATH
No.
Winthrop Community Hospital!
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
Length of stay: In hospital or Institution
(Before death)
(Specify whether )
16 hrs
27
1946
Ethel May Lunt
Duration
IMPORTANT
Malborough
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 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 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, 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 hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been huried, 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 tomh other than the receiving tomb tc another in the sanie 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 heen delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to he 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 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 hy 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 he obtained early enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody 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 hody has heen sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, tuat the deceased served in the army, navy or marine corps of the United States in any war in which it has heen 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 body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall hury 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 suchi board, from the clerk of the town where the body is to he 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 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 by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is ahsent 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 agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled hy 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 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301 A 1
Suffolk
(County) Winthrop
(City or Town) 507 ... ShirleySt
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.
22
Registared No. { (If death occurred in a hospital or institution, give its NAME instead of street and numbers
2 FULL NAME.
FlorenceL Evans Ginepra
(If deceased la a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No.
507
Shirley
St
SŁ
(If nonresident, give clty or town and State)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
montha
days.
In this community
18 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS -
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIOOWED
or DIVORCEDMarried
Sa If married, widowed, or divorced HUSBANO of
(or) WIFE of
Frank
faire majrien nom feirafill)
( Husband's name In full)
49
years
7 IF STILLBORN, enter that fact here.
8
AGE+5.
Years
Months
Oays
If lesa than 1 day
Hours
Minutes
Usual
9 Ocoupation :
Housewife
Industry
10 or Business :
Own Home
11 Social Security No. Pittsburg
12 BIRTHPLACE (City)
(Siate or country)
Penn.
13 NAME OF
FATHER
Ellsworth Evans
14 BIRTHPLACE OF
FATHER (Clty)
Pittsburg
(State or country)
Penn.
15 MAIOEN NAME
OF MOTHER
Marie Emmerich
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17 Frank V Ginepra
Informant
( Address )
507 Shirley
st
I HEREBY CERTIFY that a satisfactory standard oartifloata of death was filed with me BEFORE the Mutat or transit parmit was Issued :
(Signature of Agent of Board of Health At other) Health Officer, " 1/30/46
(Oficial Designation) ( Date of Trque of Permit)
18 DATE OF 00 24
DEATH
....
( Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
20
1946
to 1
That I attended deceased from
I last saw h.2.
allva on ...
2 , , 19 f., death Is said to
have occurred on the date stated above, at . 5" m.
Duration
Immedlate cause of death
IMPORTANT .. ..........
1
Due to
1)
Due to
Other conditiona
( Include pregoancy within 8 moutha of death)
IMPORTANT
Physician Underline che cause to which death should be charged sta- tistically.
20 Was disease or injury in any way ralated to occupation of deceased ?
If ao, spaoify.
( Signe
M. D.
(Address) / f
i ...... Oats
19-11
21 Winthrop winthrop
Place of Burial, Cremation or Removal.
1948
or Town)
DATE OF BURIAL
Feb 1
214
19
John DO matel
ADDRESS
Winthrop
Received and Alad
JAN 3: 1345
19
( Registrar)
100m- (g) - 1-45-15510
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to insert a reoltal to that effeot. PARENTS
PLACE OF DEATH
No.
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
Female
White
6 Age of husband or wife if aliva
MEDICAL CERTIFICATE OF DEATH
197%.
Of autopsy
What test confirmed dlagnosla?
Major findings :
Of operations
Oate of
22 NAME OF
FUNERAL DIRECTOR
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive 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 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 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 forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relicf expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place hetwecn 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 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 tomh 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
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 hoard 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 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 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 health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and 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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