USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 68
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(Year)
19 | HEREBY CERTIFY, That I attandad deoaasad from
0-17
1947, 2010-17-
19
4>
.
I last saw h. com .... allva on.
10-17-
19 % ), death Is aald to
have occurred on the date stated above, a 9:30. p. .m.
Duration
Immedlate cause of death Prematurity-
Due to
Due to
Other conditions
( Include pregnancy within 3 months of death)
Major findings: Of oparations
Date of
Of autopsy
What test confirmed diagnosis ?
IMPORTANT
Physician Underline the cause to which death should be charged st ... ustically
20 Was diseasa or injury in any way related to oooupalion of dacaased? If so, spoolfy
( Signad )
( Ad
18. Princelast EB
a
. M. D.
Date 14-18 1947
(City or Town)
Plsce of Burial, Cremation or Removal. 13 DATE OF BURIAL 1947
22 NAME OF
FUNERAL DIRECTOR Vincer
ADDRESS
9 Chelsea-SV.
U.Satten
19
( Registrar)
100m. (g)-1-45-15510
If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, raquires physiolans to Insert a recital to that effect. 0881
PLACE OF DEATH
County)
1
F ....
( City of Town)
No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) 1
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
( Specify Whether )
3 hrs. 10 min.
17 1947
w+2 lbs1g
IMPORTANT
Reoalved and fled OCT 2717
(Oficial Designation)
21
Relation, IL any
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 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 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 auch 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, 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 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
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop (City or town making return)
Registrar's Number
205
§ (If death occurred in a hospital or institution give its NAME instead of street and number)
2 FULL NAME
Hattie M. Harris
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
10 .. Beacon St.
(Usual place of abode)
St
(If nonresident, give city or town and State)-
Length of stay: In hospital or institution
hospital
years
months
2
days.
In this community 3 7
years
months
days·
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX female
4 COLOR OR RACE
white
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
5a If married. widowed, or divorced
HUSBAND OF
(Give maiden name of wife in full)
(or) WIFE OF
Chester Harris.
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8 AGE 65 Years 0 Months 1 Days
If less than I day
Hours
Minutes
Usual
·9 Occupation:
Book keeper
Industry 10 or Business: First National Stores, Inc.
11 Social Security No.
122-07-2643
12 BIRTHPLACE (City)
(State or country)
Maine
Peru
13 NAME OF
FATHER
Charles Andrews
14 BIRTHPLACE OF
Peru.
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Stella Childs
16 BIRTHPLACE OF MOTHER (City) (State or country)
Canton
Maine
17 Informant Mrs. Bertha L'onnghan sister, (Address) Box 27 E. Sumner Maine
I HEREBY CERTIFY that a satisfactory standard' certificate of death was filed with me BEFORE the burishoy transu permit was issued:
Master
Javier Signature of Agent of Board of Health Or other Thealth Vehicle
(Dator 9/53/47
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
October
27
(Month)
(Day)
1947
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Jan. 26.
. 19
41to Oct .. .. 21
19
4.7.
I last saw h .er.
alive on.
Oct.21
.. 19
4 7death is said to
have occurred on the date stated above, at
2
D .... M.
Immediate cause of death Cerebral Hemorrhage
Due to. Arteriosclerosis
Due to
Uremia
Other conditions none. (Include pregnancy within 3 months of death)
Major findings:
Of operations
none
Date of
Of autopsy
none
What test confirmed diagnosis? clinical &
Duration Important
3. days
6. years
1 day.
Important ..
Physician
Underline the cause to which death should be charged sta- Pistidally.
20 Was disease or injury in any way related to occupation of deceased? If so, specify (Signed) Favore Q. Chiamo (Addre 562 Abuela St Datdo/Es
R.D M.D.
21
Winthro Heter Winthrop
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
Oct 24, 1947
19
22 NAME OF FUNERAL DIRECTOR alfred B. Manche
ADDRESS
174 Winthrop St Winthrop
Received and filed OCT 27 1943 19
(Registrar)
A TRUE COPY ATTEST:
no
on back of certificate.
100m-(+)-3-46-18278
(Official Designation
1 If deceased was a U. S. War Veteran, G. L., Chap. 48, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
1
No. Winthrop Community Hospital
St.
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
(if so specify WAR) . ..
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 meniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed nge. the disease of which he died, defined as required 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 fourteen, 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, specifying 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 section 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 nineteen 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 inter- ment, 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 physician 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 required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a perinit 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 perinit in the usual form for the removal of such body has been sooner obtained bereunder. 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 I'nited 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, shull forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is sofgiven and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the cleceased, or as to the manner or cuuse of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. I ... (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 n 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 sante: . .. - 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 received 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 cure 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 physiclans will certify touch 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 physiclans 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 physician is absent from home when the certificate of death is needed
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatisin (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths front 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, naine 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 ix very in- 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 : person engaged in domestic service for wages, however, 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
1 A
1
PLACE OF DEATH
Suffolk 3 (County) Witterop (City or Town) 72 Main
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be fled for burial permit with Board of Health or its Agent.
206
Registrar's No. § (If death occurred in a hospital or institution, St.
¿ give its NAME instead of street and number)
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
no
(a)
Residence. No.
72 mains
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community / yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
Married
5a If married, widowed, or divorced HUSBAND of
Lucy Cates
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. 65
ycars
7 IF STILLBORN, enter that fact here.
8
AGE
Years.
76
Months
Days
If less than 1 day
Hours ..
Minutes
Usual
9 Occupation :
Ufetured custodian
Industry
10 or Business:
Genere City Hall
11 Social Security No. cone
12 BIRTHPLACE (City)
Story Creek
(State or country)
n.y.
13 NAME OF
FATHER
John Murray
14 BIRTHPLACE OF
FATIIER (City)
(State or country)
n.y.
15 MAIDEN NAME
OF MOTIIER
Jucuida Pickett
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Two Lucy Murray Relation, if any Informar (Address) Za ziquist Viaturato Suggs
was filed with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that asatisfactory standard certificate of death Waltere
-
(Signature of Agent of Board of Health Offother Vealle Oficer 10/23/47 (Official Designation) (Date of Issue of Permit)
18 DATE OF
October 21
1947
DEATH
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,
That I attended deccased from
14 tember
19 46
to ...
I last saw him
alive on
ttouit )1)
death is said to
have occurred on the date stated above, at.
Duration IMPORTANT
2 hours
IMPORTANT Physician
Major findings:
Of operations.
Date of.
Of autopsy
What test confirmed diagnosis?
clinical
Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury in/any way related to occupation of deceased? If so, specify
(Signed)
8Mou Ret Date 10/1 1947
(Address)
21 glenword i Tion
Place of Burial, Cremation or Keine al.
(Cus & Town)
DATE OF BURIAL
October 24
1947
22 NAME OF
FUNERAL DIRECTOR
Cdithe mu Merciin
ADDRESS
505 Beach St, Pane Tier
Received and filed.
OCT 27-1947
19
(Registrar)
50m-(c)-3-43-11574
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
Immediate cause of death
Cerebro vocenter acident
Due to.
generalized arteno-
Due to
Other conditions
Uit. returdes
(Include pregnancy within 3 months of death) trait disease
.. , M. D.
No.
2 FULL NAME
Penas H. Murray
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Usual place of abode)
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 attendcd 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 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 scction or by section forty-five of chapter one hundred and four- teen, shall, if the deccased, to the hest 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 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 bundred and seventeen. G. L. Chap. 46, Sec. 10.
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