USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 26
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CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
76
¿ give its NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
annie Vel Cornish
( If deceased Is a married, widowed or divorced woman, give alao maiden name.)
(a) Residence. No.
125 Cliff ave
St.
(Usual place of abode)
Paulis Prit Home
days.
In this community
2 yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
anne
12 1947 (Year)
Month)
(Day)
19 | HEREBY CERTIFY,
march 15 1946
That I attendad deosesed from
to
12 ano
1947
I last saw h.
.......... alive on
2
abril. 194, daath is said to
have occurred on the date stated above, at.
8.10 %
.m.
Duration
Immediate cause of death
Cerebral contidas
IMPORTANT 1 days 0
Due to
artino-schule Heart
2yrs.
Desense noti auricular
Due to tabellation auricular
Ofibrillateiro
9 mo.
Other conditions.
Computation - Rt. mid Thigh
( Include pregnancy within 3 months of death)
... ........... IMPORTANT
Major findings:
Of operetions
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was diseasa or injury in any way raletad to occupation of deoaasad ? no
If so, spsolfy.
(Signad).
(Address)
21 Horent Hala
l'lace of Burial, Creniation or Removal.
(City or Town)
Boston
22 NAME OF
FUNER
S. M. Burrougly by Robot Belysa
ADDRESS
2. Virginia St- Doncletta
19
.......
( Registrar)
100M-6 - 2-42-8855
Winthrop
1
(City or Town)
No.
2 FULL NAME
Length of stay: In hospital or Institution ac
( Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
The
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
White
( write the word)
Single
Sa If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
( Husband's name In full)
9 IF STILLBORN. enter that fact here.
8
79 Years
4
Months
25 Days
AGE
Usual
9 Occupation :
Retired
10 or Business :
11 Social Security No.
Exeter
12 BIRTHPLACE (City)
( State or country)
Maine
13 NAME OF
FATHER
Jacob Cornish
14 BIRTHPLACE OF
FATHER (City)
Hampden
maine
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Pease
16 BIRTHPLACE OF
Exeter
PARENTS
MOTHER (City)
(State or country)
maine
george E. B. Paul
125 Cliff aux Window
17
Informant
( Address)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a reoitai 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
Industry
City Missionary and Chuvisitor
I HEREBY CERTIFY that a satisfactory standard certifionle of daath was filed with ma BEFORE the bugabor transit permit was Issued : Prallte A Paper.b
Signature of Ageht of Board nf Health or other) Health Spacet 4/14/47
(Omcial Designation) ( Date of Issue of Pefmity
If less than 1 day
Hours
Minutes
....
Of eutopsy.
What test confirmed diagnosis?
Date of.
Data 1224947
M. D.
Relation, "'>
DATE OF BURIAL.
april
16
1947
Reosived and Alsd
APR 18 1017
PLACE OF DEATH
Paul's Reat Home
St.
( ( If death occurred in a hospital or institution,
(Wes deceased a
U. S. War Veteran,
if to specify WAR)
(If nonresident, give city or town and State)
6 Age of husband or wife if alive yaars
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 whoin 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, furnisb for registration a standard certificate of death, stating to the best of his knowledge and belief the nante of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. where same wss contracted. the duration of his last Illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chiap. 16, 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 four- teen, shall, if the decessed, to the best of his knowledge and helief, aerved in the ariny, navy or marine corps of the I'nited States in any war in which it has been engaged. insert in the certifeste a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediste cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-Ave, forty-six and forty-seven of said chapter one bundred and fourteen, the word "war" shall inchide the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed 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 aud sixteen and nineteen bundred and seventeen. G. L. Chisp. 16, Sec. 10.
No undertaker or other person shall bury or otherwise 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 health, or ita agent appointed to issue sucb permits, or if there is uo such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a buman body and remove it froin a towu. from one cemetery to another, or from one grave or tomb other than the receiving tomb to another In the same cemetery, until be has received a permit from the board of health or its agent aforessid 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 sucb board, agent or clerk, as the case may be, a satisfactory written statenient containing the facts required by law to be returned and recorded, which shall be accompanied. in case of an original Internient, by a satisfactory certificate of the attending physician, if any, as required by law, ot 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 pbysi- cian who is a member of the board of health, or employed by it or by the aelectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If deatb is caused by violence, the medl- cal examiner ahall make such certificate. If such a permit for the removal of a human body, not previously interred, froin one town to another within the commonwealth cannot be obtained esrly enough for the purpose, the certificate of desth made as above provided and in the possession ot tbe 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. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statenient and certificate, shall forthwith countersign it and transniit 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 nece+ sary information which can be obtained as to the deceased, or as to the manner of canse of the death, which the clerk or registrar way require .- Cbap. 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 froni 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 he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Cbap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall make exsminstion upon the view of the dead bodies of ouly such persons ss 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 aud take charge of the same; ... - General Laws, Cbap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending phyalcians will certify to sucb deatba only aa 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 physiolans will certify to such deaths only aa those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose pbyat- cian is ahsent from home when the certificate of death is needed.
(3) Msdloal Examiners will investigate and certify to all deatba aup- 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 dlacasa resulting from Injury or Infection related to occupation, the audden deaths of persons not disablad by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Csuse of death means the disease, or complication which causes desth, 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- portaut, 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 ou account of the disease causing desth, report the ususl occupation prior to illness. If the deceased hsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned an at school or at boine. For a woman wbose only occupatiou wss that of bone bousework. write bousework. For s person engaged in domestic service for wages, however, designste the occupation by the appropriate terms, aa bousekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-303-A +
Sullock (County)
The Commantoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
St. [ { If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divoreed woman, give also, maiden name.)
91 Bartlett Rd, Nutters
(If nonresident, give city or town and State)
months
7
days.
In this community
yra.
5
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE!
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
5a If married, widowed, or dlvoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Sylvanus Chipman Lowell
(Husband's name in full)
6 Age of husband or wife If allve
years
7 IF STILLBORN, enter that fact here.
8
AGE. 8.4 Years.
Q.Months.
2.7 Days
If less than 1 day
Hours ....
....
.. Minutes
Usual
at .... home
Industry
10 or Business :
11 Soolal Security No .....
none
12 BIRTHPLACE (City)
Bucksport
(State or country)
Maine
13 NAME OF
FATHER
Francis Homer
14 BIRTHPLACE OF
FATHER (City)
Bucksport
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Rhoda Stubbs
16 BIRTHPLACE OF
MOTHER (City)
Bucksport
(State or country )
Maine
17 Edwin .... S. Lovell.
( Address)
91 Bartlett Road Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the ballal or Transit permit was Issued :
(Signature of Agent of Board of Health or other) Hallte
4/16/47
(Official Designationy (Date of Issue of Permit)
20 Accident, sulolde, or homlolde
specify).
accidental
Date of ooourrence.
april 10-
1947
Where did
Wuttros 7
Injury ooour ?
(City or town and State)
Did Injury ooour In or about home, on farmy, In Industrial place, or In publio
piace ?
Italantal
Manner
Dell accidentally in fleurs at
(Specify type of place)
Injury
Natur
Hospital on apr-10-1947
Injury
While at work ?!
Was there an autopsy?
21 Was disease or Injury In any way related to oooupation of deceased?
If so, specify
Hattrickles
M. D.
(Signed)
(Address)
22
Riverview ..... Cemetery. Buckspo ..... T.
Place of Burial, Cremation or Removal.
(City or Town)
VIAINSI
23 NAME OF
FUNERAL DIRECTOR
ADDRESS
174 Winthrop st winthrop
19
Received and flied
APR 18 1947
( Registrar )
50m- (f) .6-43-12056
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a reoltal to that effeot extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
0332
1
PLACE OF DEATH No. Envie
Watterin. City or Town) Ventrilo Community Hospital (HOMER) Erne Louise, Lowell
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so spoolfy WAR)
(a) Residenoo. No.
(Usual place of @bode)
Length of stay: In hospital or Institution.hospital
( Before death)
( Specify' whether)
18 DATE OF
DEATH
april-15-1947
( Month)
(Day)
( Year)
female
white
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof fractured iny to involved, stat , fully.)
Brancheofneu menude:
asterio Vclerotic Heart Disease
9 Occupation :
PARENTS
-Lepil -15-
19
Relation, if any
DATE OF BURIAL
April 18 .1948
19
Informant ...
years
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal offioer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an umlertaker or other authorized person or of any meniber 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 required hy 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 wbich 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 atate the same. For neglect to comply with sny 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 l'hilippine insurrection, which shall, for asid purposes, be deemed 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 sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertsker 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 perinit froin 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 exhumre a human body and remove it from a town, from one cemetery to anotlier, or from one grave or tomb otlier thau the receiving tomb to another in the aame cemetery, until he has received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the body is buried. No auch perinit shall be issued until there ahall have been delivered to such hoard, agent or clerk, as the case may be, a aatisfactory written statement containing the facts required by law to be returned and recorded, which ahall 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, hia certificate cannot be obtained early enough for the purpose, or is insufficleut, a physi- cian who is a meinher 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 human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early 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 body shall be returned to the town from which it was removed within thirty-six hours after sucb re- moval, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the desth 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 heen engaged, such recital shall sppear 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 perinit 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 mainer or cause of the death, which the clerk or regiatrar 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 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 huricd or the funeral ia to he held, or from a per- son appointed to have the care of the cenietery or burial ground in which the intermcut ia niade. ... 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 hia county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ...- General Laws, Chap. 38, Sec. 6.
. . He ahall 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 manuer of death .- General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifies the cause and manner of death to the hest of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ohaervance 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 form of injury.
(2) Board of Health physicians will certify to such deaths only an those of persons who, though disabled by recognized disease uurelated to any form of injury, have died without recent medical attendance or wbose physi- ciau ia absent fromn hoine 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 deatha caused directly or In- directly by traumatism (including resulting septicemia), and by the action of chenrical (druga or poisons), 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 daad.
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, tbe mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of tbe femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation hy suspension, auicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated internal injury aus- tained under circunstances unkuown."
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; and (2) umler manner, indicate the circum- stancea 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
+
A R-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
No. 19 Coral Avenue
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.
78
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)
(a) Residence.
No.
Concent Com
(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
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED »
18 DATE OF
DEATH
april
(Month)
16
(Day)
1947 (Ycar)
5a If married, widowed or divorced HUSBAND of ....
irre
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
8 AGE :2. ... Years Months Days
If less than 1 day
.Hours
Minutes
Usual
9 Occupation:
Industry 10 or Business:
11 Social Security No. TAK
12 BIRTHPLACE (City)
(State or Country)
13 NAME OF
FATHER
14 BIRTHPLACE OF FATHER (City) (State or Country}
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or Country)
17 Sydney J.Zetter ( Rg'dir, if any )
(Address! 19 Coral Avenue, Winthrop. I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burgl of transit permit was issued:
[Signature ( hkent of Board of Health or other) Health Office "Official Designation (Date of Issue of Perind)
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