USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 11
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should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
50m-(f) .6-43-12056
N. D .- WRITE PLAINET, WITHT ONTADINO SLAVA INK TITS IS A PERMANENT ALVORD. Every Tent or mermanon
13 NAME OF
FATHER
John W. O' Connell
(Registrar)
19
23 NAME OF
FUNERAL DIRECTOR.
Fleury & O Donnell x Son'S
ADDRESS
46 Washington St.
Salem Mass
Received and filed
FEB 7 1947
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
2
years
Anythey Colombie Hall-Within One -Newthanh ocurre
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal officer shall forthwith, after the desth of a person whom he has attended during his last illnesa, at the request of au undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of deatlı, stating to the best of hia knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where ssme was contracted, the duration of his last illness, when last seen alive by the physicisu or officer and the date of his death ... Gen. Laws, Chap. 16, Sec. 9.
A physician or officer furnishing a certificate of death as required hy the preceding section or by section forty-tive of chapter one humired and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or misrine 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 secondsry or immediate cause of death as nearly as he can atate the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposea of thia 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 ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemeil to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and aixteen and niueteen hundred and seventeen. G. L. Chup. 16, 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 haa not been buried, until he haa received a perinit from the board of health, or its agent appointed to Issue auch permits, or if there is no such hoard, 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 tomh other than the receiving tomb to another in the same cemetery, until he haa received a permit from the board of health or its agent aforesald or from the clerk of the town where the hody is buried. No auch permit shall be issued uutif there ahall have been delivered to such board, agent or clerk, aa 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 aa hereinafter provided. If there is no attending physician, or if, for suficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a nieinber 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 medical examiner shall make such certificate. If such a permit for the removal of a lruman body, not previously interred, from one town to an- other within the commonwealth cannot be obtained esrly enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody shall he returned to the town from which it was removed within thirty-six hours after such re- moval, 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, 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 rev.al shall appear upon the permit. The board of health, or its agent, ujumu 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 regiatrar may re- quire .- Chap. 114, Sec. 15, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have bren 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 iu which the interment is made. ... Chsp. 114, Sec. 16, G. L., (Tercentenary Edi- tion ).
Medical examiners shall make examination upon the view of the dead bodies of only such persons ss are supposed to have died by violence. If a medical examiner has notice that there is within hia county the body of such a person, he shall forthwith go to the place where the body liea and take charge of the same; ...- General Laws, Chap. 3S, 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 death .- General Laws, Chap. 38, Sec. 7.
.. . The medical examiner certifies 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 physloians will certify to such deaths only as those of persons to whom they have given bedside care during a last illnesa from disease unrelated to any forin of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons who, though disshled by recognized disease unrelated to any form of injury, have died without recent inedical attendance or whoae physi- cian ia absent from home when the certificate of death ia 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 trauinatism (including resulting septicemia), and by the action of chenrical (drugs or poisons), thermal, or electrical agenta, aud deaths following abortion, but also deaths from disease resulting from Injury or Infeotion 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 ita consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicemia (gaa bacillus) caused hy a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, auicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstancea unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause it's known or presumable nature; and (2) uinler manner, indicate the circum- atancea leading to medico-legal inquiry. For example : "Hemorrhage apon- taneous of the brain (hasal ganglia) (found dead in hed)." "Ileart disease, presumably coronary sclerosis. (Sudden death. )"
DESCRIPTION (for unknown person)
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
-
RM R-301 A
Suffolk
(County)
31 Harbor View Ave.
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.
33
Registered No. { (If death occurred in a hospital or institution, "{ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Julia (Beeley) Fletcher
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
31 Harbor View Ave.
St.
(If nonresident, give clty or town and State)
Length of stay: In Anepitel or Institution
( Before death)
( Specify whether )
years
months
days.
In this community
37
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH OF Felmoney 6
(Mfonth )/
(Day)
1944
KYear)
19 I HEREBY CERTIFY,
That I attended deceased from
June 15, 1945.
to .
19 45
I fast saw h ............
Sebring 5, 1947
have occurred on the date stated above, at - 10:15am.
Immediate cause of death
Duration
IMPORTANT'S
Bronchopneumaria
Due to
Due to
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operetions
Date of
Of eutopsy
Whet test confirmed diagnosis?
Physician Underline the cause to which death should be charged st .. tistically.
20 Was disease or injury Pony way related to occupation of deceesed ?. If so, specify ..
( Signed)
J hoo
Stalli
...
. M. D.
(Address Pause, hanne
· dal. 7. 1947
21
woodlawntr
Everett
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Fel
8
(City or Town)
47
19
22 NAME OF
Howard SUingmolto
FUNERAL DIRECTOR
...
ADDRESS
Received and Aled FEB11 1947
...........
19
( Registrar)
100m-(g)-1-45-15510
Winthrop
(City or Town)
No.
(Usual place of abode)
4 COLOR OR RACE
White
5a If married, widowed, or divorced
HUSBAND of
7 IF STILLBORN, enter that fact here.
8
80 Years
1.0Months .. 2.1 Days
At Home
11 Social Security No.
None
13 NAME OF
FATHER
James Beeley
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Mary Johnson
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
England
should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
( State or country)
England
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Widow
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if alive yeers
If less than 1 dey
Hours
Minutes
12 BIRTHPLACE (City)
Manchester
17 Jane W Somerby (Address) 31 Harbor View Ave.
Dataunter Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Dustal or transit permit was Issued ? Watter & Baker
(Signature of Agentcef Board of Health of_other) A=O . att Feb. 8147
(Omdelal Designation) ( Date of Theuse of Permits
1 3 SEX Female AGE Usual 9 Occupetion : PARENTS Informent If deceased was a U. S. War Veteran, G. L. Chap. 46. Seotion 10, requiree physicians to insert a recital to that effect. extracts from the laws on back of certificate. .... N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of information Industry 10 or Business :
+
PLACE OF DEATH
St.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
2 week
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 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 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, he deemed to have taken place between Fehruary 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 hury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not heen 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 hoard, 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 tomh to another in the same cemetery, until he has received a permit from the hoard 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 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, 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 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 hy 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 be 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 been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter torty-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 tbe 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 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 such hoard, from the clerk of the town where the body is to he huried 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 hy recognized disease unrelated to any forum 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 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 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 morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation hy the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
Ł
M R-301 A
+
PLACE OF DEATH
Suffolk (County) Hinthrop
(City or Town) 395 Com) Shirley
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.
31 .....
St. { (If death occurred in a hospital or institution, { give its NAME instead of street and number)
Charlotte L. broway
( If deceased is a married, widowed on divorced woman, give also maiden name.)
(a) Residence.
No.
395 Shipley
St.
(If nonresident, give city or town and State)
months
days.
In this community 3 Oyrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
.
5 SINGLE
MARRIED
WIDOWED
or DIVORCEO
( write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(Cive maiden name of wife in full)
( Husband's neme in rull)
6 Age of husband or wife if alive yeers)
If less than 1 dey
Hours
Minutes
Industry
10 or Business :
Dress maker
12 BIRTHPLACE (City)
( State or country)
Malden Mass
13 NAME OF
FATHER
John Q brown
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Margaret Sullivan
16 BIRTHPLACE OF
MOTHEP. (City)
Ireland
17 Family album. ( Relation, If any
I HEREBY CERTIFY that a satisfactory standard certificata of death was flod with me BEFORE the burial or transit permit was Issued: Tralthe A- Bakers.
(Signature of Areat of Board of Health or other) Walter Officer 2/10 47
(Official Designation) ( Date of Issue of Permity
18 DATE OF
DEATH
Feb.
8
1947
( Mfonth)
(Day)
(Year)
19 1 HEREBY CERTIFY Thet 1 attended deosased from
1947. 4
19
47
I last sawh til alive on ......
xen
19 ... 7 death Is cald to
heve occurred on tha date stated above, at. 1130 A.m.
Immediate cause-of death ...
Connective rent carlu
0
Due to
Rheumatic Feuer
Due to
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operetions
Date of
Of eutopsy
Whet test confirmed diagnosis ?
20 Was diseese or injury in any way releted to gooupallon of deceased ? If so, spaoify
( Signed)
2
. M. D.
(Address) +47
2dniwhileago tel- 10 1947
22
St marys
Malden (City or Town)
Place of Burial, Cremalinn or Removal.
DATE OF BURIAL ...
"Leb.
11
47
19
22 NAME OF
FUNERAL DIRECTOR
Owen P. Doonan Sous
ADDRESS
malden, n.
Received and fled
FEB 11 1947
19
( Registrar)
Duration
IMPORTANT ............
.........
2 years
Physician Underline the cause to which death should be charged st .. uistically.
100m.(g)-1-45.15510
1
No.
2 FULL NAME
(Usual place of abode)
Length of stay: In Ansoltal or Institution
( Before death)
3 SEX
31.
4 COLOR OR RACE
3%.
(or) WIFE of
7 IF STILLBORN, enter that fect here.
Usual
9 Occupallon :
Retired
11 Social Security No.
14 BIRTHPLACE OF
FATHER (City)
PARENTS
(State or country)
Informent
( Address)
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires 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
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
AGE
69 Years
Months
Days
years
...
( Specify whether)
MEDICAL CERTIFICATE OF DEATH
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
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 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 belicf, 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 relicf 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.
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