USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 49
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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 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 by 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 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 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
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, raquiras physicians to insert a recitai to that effeot. PARENTS
1
PLACE OF DEATH
Suffolk ( County)
Winthrop (City or Town)
No.
249 Pleasant Street
St.
§ (If death occurred in a hospital or institution.
give its NAME instead nf street and numher)
2 FULL NAME
Ellie Roy Jones
( If deceased is a married, widowed or divorced woman, give alao maiden name.)
(a) Residence. No.
249 Pleasant Street
(Usual place of abode)
St.
( If nonresident, give city or town and State)
Length of stay: In hospital or Institution ( Before death)
years
months days.
In this community
5
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in fuft)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if aliva
years
7 IF STILLBORN, enter that fact here.
AGE
8
18Years
4
Montha
6
Days
If less than 1 day
Hours
Minutas
Usual
9 Occupation :
Student
Industry
10 or Business :
11 Social Security No. 010-22-8113
12 BIRTHPLACE (City)
Honolulu
( State or country)
Hawaii
13 NAME OF
FATHER
Ellie C Jones
14 BIRTHPLACE OF
FATHER (Clty)
London
(State or country)
Kentucky
15 MAIDEN NAME
OF MOTHER
Ann J Stevens
16 BIRTHPLACE OF
Sommerville
MOTHER (City)
(State or country )
South Carolina
17 Ann J Jones Mother Reistlon, If any Informant ( Address) 249 Pleasant St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death waa filed with me BEFORE the burial og transit parmit was larued: Walter 2; Baker
(Signature of Agent of Board of Health or other) 7/22/17
( Date of Issue of Permit)
18 DATE OF DEATH July
20
1947
( Month)
(Day)
(YearY
19 | HEREBY CERTIFY,
May 30, 1947. to.
July 20
1947
i last sawh iam alive on.
July 19, 1947, death Is said to
have occurred on the data stated above, at 10:45 A.
m.
Immediate cause of daath
Osteogenic sarcoma (leftte)
16 mo
Due to
with pulmonar
metástases
Dua to
Other conditiona
( Include pregnancy within 3 months of death)
Mary 2 41946
Major findings:
Of operations
Mid thigh amputation (left)
Left lower lobectomy Date of april 1947
Of autopsy
What test confirmed diagnosis?
X-ray + biopsy
IMPORTANT Physician Underline the cause to which de.ith should be charged v .. tistically
20 Was disease or injury in any way ralated' to oooupallon of decerved ? 0.
If so, specify arthur Murray
. M. D.
(Address) Winthrop Mass Date July 201947
21
Winthrop
Winthrop
l'lace nf Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL ..
July
24
1947
22 NAME OF
FUNERAL DIRECTOR
Howard S hunolds
ADDRESS
Winthrop mais
Received and Aled
19
( Registrar)
Y
147
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
( Specify whether)
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.
100m-(g)- 1-45-15510
(Oficial Designation)
MEDICAL CERTIFICATE OF DEATH
5 SINGLE
£
( write the word)
Male
That i attended deosased from
Duration
IMPORTANT
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 saine 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, sball, 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 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 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 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, 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 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 teu of chapter forty-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 aud 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 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 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 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
extracts from the laws on back of certificate. If deceased wes a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to insert a recital to that effect. PARENTS
PLACE OF DEATH
Suffolk: (County)
Winthrop (City or Town) No. Winthrop .... Community ..... Hospital
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 Agents 148
Registered No.
§ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Theodore .... Roland ..... Gardner
(Il deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
154 Circuit Road
(Usual piace of abode)
Nursing Home 2 months
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
months
Ildays.
In this community 48 yrs.
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
married
Sa If married, widowed, o
HUSBAND of
Marguerite A. Holmes
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if aliva yaars
7 IF STILLBORN, enter that fact hera.
8 AGE 66 Years 9 Months 30 Days
If less than 1 day
Hours
Minutas
Usual
9 Occupation :
retired
Industry
10 or Business : engineer ..... B.,.R. ,& .... L .... R.R.
11 Social Security No.
023-10- 6837A.
Worcester
12 BIRTHPLACE (City)
(Siste or country )
Mass.
13 NAME DF
FATHER
Roland Coffin Gardner
14 BIRTHPLACE OF
FATHER (City)
Nantucket Island
(State or country) Mass,
15 MAIDEN NAME
OF MOTHER
Annie Wallace
16 BIRTHPLACE DF
MOTHER (City)
(Stete or country )
Nova Scotia
17 Mrs. T.R.Gardner
Hetatinos & any
informant ( Address) 154 Circuit Rd Winthrop
I HEREBY CERTIFY that a satisfactory standard oartifloats of dasth waa filled with me BEFORE the fughi or transit permit was Issued:
Walter A- Maker
- (Bignature of Agente Board of Health nr othe 7/22/47
Really Milch
(Omelal Designation)
( Date of Fame of Permit)
18 DATE OF
DEATH
July
21
1947
( Mfonth)
(Day)
(Year)
19 | HEREBY CERTIFY.
That I attended daoaased from
July 3, 1947.
to
Only 21.
19
47
I last saw & lime a live on.
July 201947, death Is said to
have occurred on the data stated above, at 8:34 a.
m.
Immadiate cause of death.
Broncho- pneumonia
acute Nephritis
Dua to
Due to Cerebral hemorrhage
Other conditiona.
( Inciude pregnancy within 3 months of death)
IMPORTANT
Major findings :
Df operations
NONE
Data of
Of autopsy
NONE
What test confirmed diagnosis ?
Clinical
20 Was disease or injury in any way ralstad to oooupation of dacaasad ? No.
if so, apaoify
( Signed)
M. D.
(Address) Werethrop, Mass. Data 7-21 1947
21
Winthrop Cemetery
Place of Burial, Cremation or Removal.
( City or Town}
DATE OF BURIAL July 24. 1947
19
Winthrop, Mas.s.
22 NAME DF
Called B. Marek
FUNERAL DIRECTOR
ADDRESS
147 Winthrop St. - inthrop. .. Mass.
Received and Alied
JUL 23 1947
19
( Registrar)
6 Days
2 300.
Physician Underline the cause to which death should be charged st .. tisticafly.
100m(t).1.44-13634
1
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR) ...
N.O.
St.
Hospital
male
white
58
Duration 10 Days IMPORTANT
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 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 tbe 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 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 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 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 he, 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 wbo 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 buman 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 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, 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 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 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 sncb 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 pby- 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-botel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A Suffolk (County)
1
Winthrop
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