USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 5
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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 tomh 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 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 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 disahled 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 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 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 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
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requiree physicians to insert a reoltal to that effect. extracts from the laws on back of certificate. terms. so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
1
Winthrop. (City or Town)
No.
125 Cliff Avenue § (If death occurred in a hospital or institution, st. { give its NAME instead of street and number)
2 FULL NAME
Adelia Montaire
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No.
125 Cliff Avenue
....... St.
(If nonresident, give city or town and State)
Length of stay: In hospital nr Institution
R.e.s.t ..... home4 years
months
days.
( Before death)
( Specify whether)
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEI
5 SINGLE
( write the word)
MARRIED
WIDOWEO
or DIVORCED
single
female
white
Sa If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if aliva
years
7 IF STILLBORN, enter that fact here.
8
AGE 9.3 ... Years
2 Months
1.4 Days
If less than 1 day
Hours
. Minutas
Usual
9 Occupation :
retired
Industry
10 or Business :
11 Social Security No.
none
Bath
12 BIRTHPLACE ( City)
( Siste or country)
Maine
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Valdoboro
(State or country)
Maine.
15 MAIOEN NAME
OF MOTHER
unable to obtain
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
Maine
17 Katherine Roval
Informant
Relation, If any (Address) O Orlando ave
I HEREBY CERTIFY that a satisfactory standard, certifioats of death was fled with me BEFORE the burial er transit parmit was Issued :
Walter A. Makers
(Signature of Agent of Board of Health or other)
Health Office 1/17/47
( Date of Irque of Permit)
18 OATE OF
DEATH
January
15
1947
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Thet i attended deosasad from
Jane 9
1947. to Jan. 14
1947
I last saw her alive on
Jan.
14. 19 47, death Is said to
have occurred on tha date stated above, at ..
6.400
Immediata cause of death Chronic myocardete
Senalizad anticia Salescio
Duration 4 years IMPORTANT years.
Que to
Due to.
Other conditions.
non
( Include pregnancy within 8 months of death)
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? no if so, spaoify
( Signad ).
Hy die w. Dickinson
(Address) Weiterof Maso Oste 1/16
M. D.
19.47.
21
Woodlawn ..... Cemetery ..... EverettLass
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL January 17, 1947
19
22 NAME OF
alfred 3 March.
FUNERAL DIRECTOR
ADDRESS
174
Winthrop St. Winthrop
Reosived and Alad IAN 20 13+/ 19
( Registrar)
100m. (g)-1-45-15510
PLACE OF DEATH
Suffolk. (County)
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.
....
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
no
(Usual place of abode)
In this community 35 yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
(Official Designation) U
Major findIngs :
Of operalions
none
Data of
Of autopsy.
What test confirmad diagnosis?
Clinical.
13 NAME OF
FATHER
Alexander Montaire
ngice
arraige
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .. . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or 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 exhumne 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, 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 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 forum 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
ORM R-302
1
PLACE OF DEATH
(County) Danvers (City or Town) No anvers State Hospital -
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
15
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
2
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
140 A Shirley
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
3 years 6 months3 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE|
Female Colored!
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Endowed
18 DATE OF
DEATH
January
15'
1947
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
amos
(Give maiden name of wife in full)
cuando
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that faot here.
8 AGE 65 Years Months Days
If less than 1 day
.Hours
Minutes
Usual
9 Ocoupation :
Housework
Industry 10 or Business :
11 Soolal Seourlty No ...
none
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
should be charged sta- tistically.
What test confirmed diagnosis? Clinical
20 Was disease or Injury In any way related to oooupation of deceased ?.
If so, specify. - X Sullivan M. D.
(Signed) Lancia
(Address)atthorne Maso, Date 124 1947
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Carosellville, alabama
DATE OF BURIAL
(City or Town)
(Cemetery)
tan: 26
1946
22 NAME OF
FUNERAL DIRECTOR
Florence P. Lyons
ADDRESS
Loanvers.
masal
Received and filled
FEB 7 1947
.19
(Registrar of City or Town where deceased resided)
50m. (b)-6-44-14607
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
15 MAIDEN NAME
OF MOTHER annat be learned
16 BIRTHPLACE OF
MOTHER
iwannot be learned
(State or country)
17 Informant Mary K. Mc Phile Relation, if any (Address) Halthorner maso.
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Fet.3
1947
19 IHEREBY CERTIFY, ter. 4
That I attended deosased from
1946 ... to Jan. 15
1947 9 ...... I last saw her alive on Van 15, 194, death is said to have ooourred on the date stated above, at. 11.20 p. .m.
Immedlate cause of death. erebral Hemorrhage
9 moo.
Generalized arteriosclerosis
Due to.
12 BIRTHPLACE (City)
(State or country)
alabama
13 NAME OF
FATHER
Cannot be learned
14 BIRTHPLACE OF
FATHER
(irannot be learned
(State or country)
Of autopsy
Physician Underline the cause to which death
no
(If U. S.
War Veteran,
ppeolfy WAR)
(a) Residence. No.
(Usual place of abode)
Mary Williams
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Duration
ORM R-302
1
PLACE OF DEATH
Suffolk (County)
Boston (City or Town), Mass .Veneral Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
570 16
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Nellie Belcher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
77 Cottage Ave.
Winthrop Mass.
(a) Residence. No.
(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
2
days.
In this community
yra.
mos.
2
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE
W
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
(Month)
Jan 17/47
(Year)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at.
11;2.0AMm.
Duration
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that faot here.
8 85 AGP Years Months Days
If less than 1 day .Hours .Minutes
Usual
9 Ocoupation :
At Home
Industry
10 or Business :
Housework
11 Soolal Seourity No ..
None
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
13 NAME OF
FATHER
John Rafuse
Major findings:
Of operations
None
Physician Underline the cause to
which death
Date of
should be
charged sta-
tistically.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
Of autopsy
What test confirmed diagnosis?
autopsy
20 Was disease or Injury in any way related to oooupation of deceased ?..
If so, spoolfy.
(Signed)
J S Lichty
M.
(Address)
Mass .General .Hospt Date
1-17 19
27
21 PLACE OF BURIAL,
CREMATION OR REMOWinthrop Com-Winthrop Mass.
(Cemetery)
(City or Town)
Jan 21/47
19
17 informant. (Address)
M.r.s ... D .. Ming6
Relation, if any GranddaughtoATE OF BURIAL ......
22 NAME OF
FUNERAL DIRECTOR
A A Duncan
ADDRESS
Somerville Hass.
Received and filed JAN 31 1947
19
DATE FILED
A TRUE COPY.
ATTEST :
Michael Flammen
(Registrar of city or town where death occurred)
Jan.20/47
19
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
50m-(b).6.44.14607
Immedlate cause of death
Carcinoma ... of .... gallbladder
5 Weeks ....
Due to.
Rupture of gall bladder
24 Hrs
Due to
Peritonitis, generalized
24 Hrs
Hypertensive heart disease
Other conditions
(Include pregnancy within 3 months of death)
(Day)
That I attended deceased from
19 I HEREBY CERTIFY,
Jan/15/47
19
to
Jan/17/47
19
I last saw h.
er
„ailve on.
Jan .17.497 ....... , death Is sald to
(Registrar of City or Town where deceased resided)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
St.
(If U. S.
War Veteran,
spoolfy WAR)
.. ....
RM R-301 A
Suffolk B
Boston tified
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, 18
Registered No.
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 W'AR)
no
(a) Residence. No.
(Usual place of abode)
Hospital
years
Length of stay: In hospital or Institution
( Before death)
( Specify /whether )
months
days.
in this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
Female White
5 SINGLE
MARRIED
WIDOWED
( write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(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. Stillborn
8
AGE
Yeers
Months
Days
If less than 1 dey Hours Minutes
none
11 Social Security No.
Mone
12 BIRTHPLACE (City)
( State or country)
Winthrop
13 NAME OF
FATHER
Joseph F. Fielding
14 BIRTHPLACE OF
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