USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 28
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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 hest 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 sball also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen 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 bealth, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the 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 hoard, 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 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 been sooner obtained hereunder. If the death certificate contains a recital, as required
by section teu of chapter 1only-six, tuat 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 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 fortbwith 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 deathis 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 by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation 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
R-301 A
1
PLACE OF DEATH
Suffolk fCounty) Winthrop (City or Town)
Brator Mistifica 5/10/49
The Commonforall 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.
Ragistarad No.
81.
§ ( If death occurred in a hospital or institution, ( give its NAME instead of street aud nuniber)
PHYSICIAN - IMPORTANT
2 FULL NAME
anna
Lawley
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No.
60 n Street
(Usual place of ahode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution Leat Home
years
6
months
days.
In this community
yrs.
mos
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
He
4 COLOR OR RACE|
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Willowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
· (Give maiden name of wife in full)
Edwin Ainge Lawley
( Husband's name in full)
6 Age of husband or wife if alive line
yaars
IF STILLBORN. enter that fact hera.
8
AGE
75 Years 2
9
Months
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Industry
10 or Business :
formerly housewife
11 Social Security No.
Pleasant Harbor
12 BIRTHPLACE (City)
(Siste or country)
Nova Scotia
13 NAME OF
FATHER
John Beaver
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
15 MAIDEN NAME
OF MOTHER
Silvia Snyder
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
nova Scotia
17 Informant
Relation, If any (Address) 405 Buray Enteret
I HEREBY CERTIFY that a satisfactory standard partificata of death was filed with me BEFORE tha Nurlal or transit permit was Issued : haber A Mallux-
(Signature of Agent of Board of Health or other) Health fficer (Omcial DesignationY
4/23/47
(Date of Teque of Permit}
18 DATE OF
DEATH
april
23
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That i attendad daosased from
I last sawhen allva on.
april 20
, 1947
daath Is said to
hava oocurred on tha data statad abova, at
7 A
.m.
Immadlate causa of daath.
Dacute Coronary Thrombosis
IMPORTANT
Dua
2 Carterno selvotac Hent
ouruse with amicaltion
Due to
Fibrillation
Other conditions ..
Senile psychosis due
( Include pregnancy within 3 Months of death)
IMPORTANT
Major findings : Of operations
Data of
Of autopsy.
What test confirmed dlagnosis?
Physician Uuderlina the cause to which death should be charged sta- tistically.
20 Was diseasa or injury in any way ralated to ogoupation of daoaasad ? la.
If so, spsolfy ..
('Signad)
S!
M. D.
(Addrass)
5/2 Schule St.
Data april 23 1947
21 Woodlawn Wanthoy Escrett Place of Burial, Cremation or Removal, (City or Town)
DATE OF BURIAL
april 26
19.4.17
22 NAME DF
FUNERAL DIRECTOR
J.M. Burroughs by Robert f. Belyca
ADDRESS
Dascheater 5 6
Raoalvad and Alsd APR-30-1947 .19
( Registrar)
100M-6 - 2-42- 8855
en Paul's Kest Come
If deceased was a U. S. War Veteran, G. 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
No.
Paul's Rest Home
St.
8. Boston
(Was deoaased a
U. S. War Veteran,
if so spacify WAR)
1947
1947
to
april 25
19.47
......
Duration
John Chattenburg (nephew
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 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 iilneas, when laat seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 16, Sec. 9.
A physician or officer furnishing a certificate of death aa required by the preceding section or by section forty-five of chapter one bundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, aerved in the army, navy or marine corps of the I'nited States in any war in which it has heen engaged, insert in the certifieste 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, auch physician or officer shall forfeit ten dollars. For the purposes of this aec- 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 deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety-eight and July fourth. nineteen hundred and two, and the Stexi- can border service of nineteen hundred and sixteen and nineteen bundred and seventeen. C. L. Chiap. 46, 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 haa received a permit from the board of health, or ita agent appointed to issue such permita, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a human body and remove it fromn a town, from one cenietery to another, or from one grave or tomb other than the receiving tomb to another In the same cemetery, until he haa received a permit from the board of health or ita agent sforesaid 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 inay be, a satisfactory written statement containing the facta required by iaw 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, aa required by law, 01 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasona, hia certificate cannot be obtained early enough for the purpose, or ia insufficient, a pbysi- cian who is a meniber of the board of health, or employed by it or by tbe aelectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence. the medl- cal examiner shall make such certificate. If such a permit for the removal of a humsu 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 ot 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 containa a recital, aa required
by section ten of chapter forty-six, that the deceased aerved in the army, navy or marine corps of the United States in any war In which It has heen 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 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 niece+ aary information which can be obtained as to the deceased, or wa to the manner of cause of the death, which the clerk or registrar may require .- Cbap. 1t4. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashea thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do froni the hoard of health or its agent appointed to issue such permita, 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 tbe care of the cemetery or burial ground in which the interment ia made .... Cbap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examinera shall make examination upon the view of the dead bodiea of only such persons as are supposed to have died hy violence. If s 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.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calis for the observance of the following rules of practice :
(1) Attending physicians will certify to sucb deatha 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 wili certify to such deatha only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose pbyaf- cian ia ahsent from home when the certificate of death ia needed.
(3) Medical Examinera will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths csused directly or in- directly by traumatism (including resuiting septicemla), and by the actlon of clientical (drugs or poisons), thermal, or electrical agents, aml deatbs following abortion, but also deatha from dlacasa 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 .- Callse of deathı meana the disease, or complication which causea death, not the mode of dying. e. g., heart failure, asphyxia, astbenia, etc. Aa principai cause name tbe 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 Oooupatlon .- Precise statement of occupation ia very im- portant, so that the relative bealthfulness of various pursuits can be known. Make some entry in this section for every person aged to yeara or over. If the occupation had been given up or changed on account of the discase causing death, report the usual occupation prior to ilhiess. if the deceased bad retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at boine. For a woman wbose only occupation was that of home bousework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa bousekeeper-private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
+
R-301 A
1
PLACE OF DEATH
Suffolk (County) ..... Winthrop (City or Town) 46 Washington No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH are
To be filed for burial permit with Board of Health or its Agent.
82
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
46 Catherine
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
101 Summit
que
SŁ
(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
yra.
mos.
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
Female \ White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Husband's name in fulf)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
AGE
8 23.73 ears Months Days
If less than 1 day
Hours ...
Minutos
Usual
9 Occupation :
Houseburger
10 or Business :
Industry
Domestic Services
.11 Social Security Co. concannon
12 BIRTHPLACE (City ) V. Rozgonyi
( Siste or country)
13 NAME OF
FATHER
Soha Mullen
14 BIRTHPLACE OF
FATHER (Chy)
...
(State or country)
15 MAIDEN NAME
OF MOTHER
Margaret Freely.
16 BIRTHPLACE OF
MOTHER (City) / ....
(State or country)
17 Mro, Margret Weda
Informant ( Address) 26 Dally Bl mille
Relstion, If any niece
I HEREBY CERTIFY that a satisfactory standard oartifiosla of death was fled with me BEFORE the Jurlalyst transit parmit was Issued : Ballag
(Slognature of Agent of Board of Health or other) 4/30/47
f Date of True of Permit)
18 DATE OF
DEATH
Cermil
26 1947
( Month)
(Day)
(Year)
19 +HEREBY CERTIFY,
That I attended deosased from
Lef 15, 1947.
to .
Gemil 26
19 47
I last saw het aliva on
Cemil 26, 1947, death Is said to
have occurred on tha dato stated above, at.
12 43 pm.
Duration
Immediato osuse of death.
Chronic miocarditis
IMPORTANT
2 years
Due to
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major AndIngs:
Of operations
200ml
Data of.
Of autopsy
nome
What test confirmed diagnosis ?
Cheil Segno
IMPORTANT
Physician
Underline the cause to which death should be charged st .. tistically.
20 Was disease or injury in any way rslatad to gooupation of deceased ? 420
If so, spaoify
(Signed) .....
(Address) Windrad
. M. D.
21
Wandred baron
Place of Burial, Cremation or Removal.
BURIAL april 203
( City or Town)
19%2
22 NAME OF
FUNERAL DIRECTOR
...
ADDRESS
Received and fled MAYO 19
(Registrar)
per unie vater v
extracts from the laws on back of certificate. If deceased was a U. S. War Vetsran, Q. L. Chap. 46, Section 10, requires physiolans to insert a reoltal to that effeot.
100m-(g)-1-45-15510
(Offcisi Designation)
St.
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
(Give maiden name of wife in hilf)
PARENTS
....
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 hy 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 belief, served in the army, navy or inarine 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 relief expedition and the Philippine insurrection, which shall, for said purposes, he 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 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 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 board 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 he 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 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 body, 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 body has heen sooner obtained hereunder. If the death certificate contains a recital, as required
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