USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 16
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it has been engaged, such recital shall sppear upon the permit. The board of health, or its agent, ujmius receipt of such statement and certificate. shall forthwith countersign it aut transmit it to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cet- 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 desth, which the clerk or registrar 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 been brought into the commonwealth until Ire 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 buard, from the clerk of the town where the body is to be huried or the funeral ia to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interimneut is made. . .. Chap. 114, Sec. 46, G. L., (Terceutenary 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 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 sanie; ... - 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 ss tsy 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 calla for the observance of the 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 illnesa from disease unrelated to any forin of injury.
(2) Board of Health physiolans will certify to such deaths only aa those of persons wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent inedical attendance or wbose 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 poisous), thermal, or electrical agents, aud 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 femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the cbest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether adininistered 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) Under cause it's known or presumahle nature; aml (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (hasal 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, Q. L. Chap. 46, Section 10. requires physiofans 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
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 12 Emerson Road
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.
46
Registered Ko. § (If death occurred in a hospital or institution, St.
¿give its NAME instead of street and number)
Laura M. Haslam
2 FULL NAME
( Il deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
12 Emerson Raod
......
St.
(If nonresident, give city or town and State)
Length of stay: In howaltel or Institution
( Before death)
( Specify whether)
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED.
WIDOWED
or DIVORCED
Vidowed
5a If married, widowed, or divorced
HUSBAND of
Toire meden nejne of Mite glum
(or) WIFE of
( Husband's name In rull)
6 Age of husband or wife if alive yaers
7 IF STILLBORN, enter that fect here.
86
8
AGE
Yeers
Months
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Housewife.
Industry
10 or Business :
Own Home
11 Social Security No.
Baltimore
12 BIRTHPLACE (City)
( State of country)
Marylana
13 NAME OF
FATHER
William W. Spence
PARENTS
14 BIRTHPLACE OF
FATHER (Clty)
Scotland
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary J. Marriott
16 BIRTHPLACE OF
MOTHEP. (City)
( State or country )
Alabama
17 Cathryn Haslam
Informent
( Address)
12 Emerson Road
Relati ( Daughter)
I HEREBY CERTIFY that a satisfactory standard certificate of death wes Aled with me BEFORE the burial of transit permit was Issued ? Viate
(Sknature of agent of Board of Health or other)
Much
Y
ifalta (Official Dealgnation) ( Date of Ismugol Permit!
( Registrar)
2 years
Due to.
generalized arteriosclerosis
3 years
Due to
con
amputated left leg
( Include pregnancy within 3 months of death)
Mejor findIngs:
Of oparetions
amputation of left leg for
ganquereducto arti Dote or May 1946
What test confirmed dlegnosis
Clinical Laboratory
IMPORTANT
Physician Underline the cause to which death should be charged v .. tistically. Ko ...
20 Was disease or injury in ony way rsleted to oooupation of deocesed ?
If so, spaolfy
Maurice Trouvetrin IT.
( Signed)
M. D.
5) 562 Shelly St Winthrop Date: Feb 21
1947
Winthrop
(City or Town)
Place of Burial, Cremation or Remnval.
DATE OF BURIAL ..
February.
2,4
19.47
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
....
Winthrop Mass
Received and flad
MAR 1 1947
19
100m. (8)-1-45 15510
18 DATE OF
DEATH
February
21
1947
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That i attended deceased from
may 26
46, to February 21
1947
I last saw her
.allve on ..
February 20, 1947, death Is said to
have occurred on the date stated above, at 10 45
A.m.
Duration
Immediate ceuse of death
IMPORTANT
arterioscleratic Heart Disease
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
years
months
days.
In this community -30 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
No.
I R-301 A X
21
inthrop
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired hy section one, where same was contracted, the duration of his last illness, when last scen 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 helicf, 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, he decmed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not heen 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 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 & town, from oue cemetery to another, or from one grave or tomb other than the receiving tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall be issued until there sball 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 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 he 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- quircd 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 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 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 body has heen 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 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 hy 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 body or the asbes 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 where the hody 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 forin 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 ahortion, 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 healtbfulness 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 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 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
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 If deceased was a U. S. War Veteran. Q. L. Chap. 46. Section 10, requires physicians to insert a recital to that effect. PARENTS
PLACE OF DEATH
Suffolk. (County)
QUILT
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 47
{ (If death occurred in a hospital or institution, St & give its NAME instead of street and number)
2 FULL NAME
Mary .... R.i.t.a .... Verd.i
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No.
179 Winthrop Street
(Usual place of abode)
( If nonresident, give city or town and State)
Length of stay : In hospital or Institution
( Before death)
( Specify whether)
years
months days.
In this community
1
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEİ
5 SINGLE
( write the word)
MARRIED
WIOOWED
or DIVORCEDmarried
female' white
5a If married. widowed, or divorced HUSBANO of
(or) WIFE of
Ralph wirriam a)
( Husband's name in full)
29
yaars
7 IF STILLBORN, enter that fact here.
8
AGE 27 Years
0
Months
9. Oays
if less than 1 day Hours Minutes
Usual
9 Occupation :
housewife
Industry
10 or Business :
athome
11 Social Security No.
none
011-16 - 7801
Malden
12 BIRTHPLACE (City)
( State or country)
Mass
13 NAME OF
FATHER
Thomas Francis Fallon
14 BIRTHPLACE OF
FATHER (City)
Cambridge.
( State or country) Mass
15 MAIDEN NAME
OF MOTHER
Mary Ellen Collins
16 BIRTHPLACE OF
MOTHER (City)
Brighton
(State or country) Mass
17 Informant Ralph W. Verdi
Reiation, If any
( Address) 179 Winthrop St husband
I HEREBY CERTIFY that a satisfactory standard oartifloata of death was fled with me BEFORE the Burial ar trangt parmit was larued : Walter A. Makesx
( Signature of Agents of Board of Health no other )
Komcial Designation) ( Date of Inmue of Permit) 2/25/47
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
23. ...... 1947
(Monthy
(Day)
(Year)
19 KHEREBY CERTIFY,
Feb. 20
1947
That attendad deosesed from
Leb.
23
1947
i last saw her
alive on.
Feb. 23
, 1947.
death is said to
have occurred on tha date stated above, at.
5:40 P
.m.
Immediate cause of death.
Pulmonary Edema
IMPORTANT
12 hrs
Oue to Multiple Sclerosis
Due to
Other conditiona
( Include pregoancy within 3 months of death)
Major findings:
Of operations
none
Oate of.
Of eutopsy
none
What test confirmed diagnosis ?.
Clinical
IMPORTANT
Physician Underline the cause to which death should he charged sta. tistically
20 Was disease or injury in any way ralatad to occupailon of deceased ?
If so, spaolfy.
( Signed)
(Address) Winthrop, mass Data 24 Feb 1947
21
St. Pauls Cemetery, Arlington
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Feb. 26,1947
19
22 NAME OF
FUNERAL DIRECTOR
alfred BB. March
........
ADORESS
... 174 Winthrop St Winthrop
19
Received and Alad
MART 1947
( Registrar)
X
100m(+)-1.44-13634
1
Winthrop. (City or Town)
No. 179 ..... Winthrop ..... Street ..
......
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
St.
PHYSICIAN . IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) NO.
Duration
6 Age of husband or wife if alive
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 hy 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 buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such hoard, from the 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 he 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 ahove 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 hody 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 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 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 hoard, 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.
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