Town of Winthrop : Record of Deaths 1947, Part 39

Author: Winthrop (Mass.)
Publication date: 1947
Publisher:
Number of Pages: 544


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 39


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RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


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


DATE OF ENTERING MILITARY SERVICE


.


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


R-301 A


1


Winthrop (City or Town)


No.


Winthrop Community Hospital


{ (If death occurred in a hospital or institution,


St. [.give its NAME instead of street and number)


PHYSICIAN - IMPORTANT (Was deceased a Spaneel if so specify WAR)' am Har


( If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


44 Shirley Avenue


St.


Revere


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution


( Before death)


( Specify whether)


years


months


3


days.


In this community4. 5


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Male


White


4 COLOR OR RACE


5 SINGLE


( write the word)


MARRIED


WIDOWEO


or DIVORCED


Widowed


5a If married, widowed, or divoroed


HUSBAND of


... Emma .....


Fitzgerald


(Give maiden name of wite 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 6.7. Years


Monthe


Days


If less than 1 dey


Hours.


Minutes


Usual


9 Occupetion :


Retired


10 or Business :


Industry


Stationary ..... Fireman


11 Social Security No.


013-01-1882


12 BIRTHPLACE (City)


( State or country)


England


13 NAME OF


FATHERJohn Waldron


14 BIRTHPLACE OF


FATHER (Clty)


(State or country)


Ireland


15 MAIDEN NAME


OF MOTHER


Mary Judge


16 BIRTHPLACE OF


MOTHEP. (City)


(State or country)


England


17 John Waldron


Relation, If any ...... Son ... ..


Informent


( Address)


44 Shirley Ave. Revert


I HEREBY CERTIFY that a satisfactory standard certinoate of death was Aled, with me BEFORE the burial of transit permit was Issued ?


(Signature of' Agent, of Board of Health or other) 6/9/4


( Date of Issue of Peymits


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


June


7


1947


(Month)


(Day)


(Year)


19 ~ HEREBY CERTIFY,


May 29


Thet I attended deceased from


19


42.


to .


June


7


19


47


I last saw him


.allve on ....


1947


death Is sald to


have occurred on the date stated above, at


6.50 P


m.


Duration


Immediate, oeuse of death Internal Hemorrhage


Gastro Intestinal Religiany


Months


Due to Anational L


1


Other conditions


( Include pregnancy within 3 months of death)


Mejor findings :


Of operations


June


Date of.


Of autopsy


Whet test confirmed dlegnosis?


IMPORTANT Physician


Underline the cause to which death should be charged st .. tistically.


20 Was disease of injury in any way related to occupation of deceased ? Ho


If so, spsolfy ..........


Del


( Signed)


. M. D.


(Address) Chevere hass Date un 7 194)


Maldea


2Holy AAP ation or Removal.


(City or Town )


DATE OF BURIAL ..


June 11. 1947


19


22 NAME OF


FUNERAL DIRECTOR Michael e Vorcella


ADORESS 1.0 No ..... Bennett St., Boston


Received and filled


-....


JUN 9 1947


19


( Registrar)


100m. (8).1.45-15510


Sp 2430 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, G. L. Chap. 46, Section 10, requires physiolans to insert a recital to that effeot. PARENTS


T


PLACE OF DEATH


Suffolk (County)


·Revere 1/4/47


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.


119


2 FULL NAME


Thomas J. Waldron


(Usual place of abode)


(Oficial Designation)


IMPORTANT .......... 2 Hours 2


5


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 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 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 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 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 body in a town, or remove therefrom a human hody which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving 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 be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall he accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the hoard 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 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 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 been sooner obtained hereunder. If the death certificate contains a recital, as required


by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The hoard of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given 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 bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.


No undertaker or other person shall bury a human 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 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 hy recognized disease unrelated to any form 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 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 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 be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation by the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE June 28, 1896


DATE OF DISCHARGE June 29


1$99


RANK, RATING Private


ORGANIZATION AND OUTFIT Artillery


SERVICE NUMBER


01 A


Suffolk


(County)


(City or Town)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filled for burial permit with Board of Health or its Agent.


120


St.


§ (If death occurred in a hospital or institution, ( give its NAME instead of street and number) PHYSICIAN-IMPORTANT


2 FULL NAME


dirige 2


(If deceased is a 'married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


(Usual place of abodé)


(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 Jrs.


DIOS.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


mai


4 COLOR OR RACE


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


18 DATE OF


DEATH


ifere 3'


(Month)


(Day)


19491


(Year)


19 I HEREBY CERTIFY,


2/24


19


to.


That I attended deccascd from france 12


I last saw h


alive on


June 8


19


death is said to


have occurred on the date stated above, at. 11


Immediate cause of death ..


2


Duration IMPORTANT -2 hours


Due to_y


antonio relevolig and


7-8 4x2M


Due to.


Other conditions.


(Include pregnancy within 3 months of death)


Major findings:


Of operations


Date of.


Of autopsy


What test confirmed diagnosis?


Clinical


IMPORTANT Physician Underline the cause to which death should be charged sta- tistically.


20 Was discase or injury in any way, related to occupation of deccased?


If so, specify


il weinas vert


(Signed)


(Address)


21 Place of Burial, Cremation or Removal. DATE OF BURIAL A- 1% ISEU


(City or Town)


19


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


Received and filed JUN 1 11947


(Registrar)


.


was filed with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that a Satisfactors standard certificate of death


(Sigpathre of Agent of Board of Heath or other) Health Care 6/10/4/ "Official Designation) (Date of Issue of Pormit)


Relation, if any


17 Informant (Address)


50m - (e)-3-43-11574


from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L., Chap. 48, Sec. 10, requires physicians to insert a recital to that effect. PARENTS


13 NAME OF


FATHER


Daniel Shea


14 BIRTHPLACE OF


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


If less than 1 day


Hours.


Minutes


Usual 9 Occupation :


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


53


years


6 Age of husband or wife if alive


7 IF STILLBORN, enter that fact here.


8 AGE 5 Years. Months. Days


Industry 10 or Business:


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


16 BIRTHPLACE OF MOTHIER (City) (State or country)


Date


418


19.4.2.


M. D.


· 19


thut It muy De Propos, 415easy


PLACE OF DEATH No.


1


Registrar's No.


(Was deceased a U. S. War Veteran, if so specify WAR)


St.


5a If married, widowed, or divorced HUSBAND of


05


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 nanie of the deceased, his supposed age, the disease of which he died, defined as re- quired by section onc, where same was contracted, the duration of his last illness, when last scen 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- tecn, shall, if the deceased, to the best of his knowledge and belief, served in the armny, 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 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 huried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or 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 be returned and recorded, which shall be 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 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 carly enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required


by section ten of chapter forty-six, that the deceased served 111 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 thercafter 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).


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 perinit 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).


Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


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


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, G. L. Chap. 46, Section 10, requires physiolans to insert a reoltal to that effect.


1


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH




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