USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 86
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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
PLACE OF DEATH -
Suffolk (County)
Winthrop (City or Town)
AVE
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 ita Agent.
260.
No. give its NAME instead of street and numher) Bus Stop Cor Terrace and Shirley Sta { (If death occurred in a hospital or institution, Augustus
2 FULL NAME
William.
Williams
( If deceased is a married, widowed or divorced woman, give also maiden name.)
if so specify WAR) ... yes
(a) Residence. No.
42
.Harbor .... View ... A.ve ...
St.
Winthrop
Mass
(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
days.
In this community30
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
29
19.4.7
( }fonth)
(Day)
(Year)
19 | HEREBY CERTIFY.
That I attended dacaased from
.December .... 26 19.4.6 .... , Ło .... De.c ...... 29,
19
47
saw
.im ..
. allve on .... Dec ....... 28,
19.47. desth Is sald to
have occurred on tha date stated above, at.
2:05A
Immediate cause of death
Coronary Thrombosis
IMPORTANT
......
Immediate
.. dea.th 1
Due to
Due to
3 yrs
11 years
Other conditions.
Diabetic (Berger's disease)
( Include pregnancy within 3 months of death)
IMPORTANT
Physiciao
Underline the cause 10 which death should be charged st .. tistically .
20 Was disease or injury in any way ralated to oooupation of deceasad ? No
If so, apacify.
(Signed).
- . M. D.
(Address)
Winthrop.,""ass ..
Date).A.C ... 2.9. 19 ... 47
21
Place of Bu
. Cremation or Removal.
entombment Winthrop Mass
(City or Town )
DATE OF BURIAL
Dec. 31, 1947
19
22 NAME OF
FUNERA
alfred BB. March
ADDRESS
174 Winthrop St ..... Winthrop
Received and Alad JAN 3 1973
19
"(omDelal Designation)
( Date of Toque of Pepmit)
( Registrar)
1
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, requiree physicians to insert a reoltal to that effect. PARENTS
100m-(g)-1-45-15510
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Finland
15 MAIDEN NAME
OF MOTHER
Mary Dougan
16 BIRTHPLACE OF
MOTHEP. (City)
(State or country)
Ireland
17 Informant Mrs .... W ....... A ...... Williams( If any
( Address) 42 Harbor View Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard oartifloata of daath was fles with me BEFORE the burial Or transit permit was Issued : Vater K. Bakero -
years
7 IF STILLBORN, enter that fact hera.
8
AGE .. 60 Years
.5 ..
Months
.8. Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
shipper
10 or Business:
Industry
L. H. Young Co. Fish Pier
11 Social Security No.
010-10-2060
12 BIRTHPLACE (City)
( Sinte or country)
Mass
East ... Boston
13 NAME OF
FATHER
Augustus Williams
Major findIngs:
Of operations
None
Data of
Of autopsy.
None
What test confirmed diagnosls?
Clinical
Duration
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE
( write the word)
MARRIED married
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced
HUSBAND of
Helen ... Marie ... Robie
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name In rull)
6 Age of husband or wife if alive 5.7
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
Registared No.
(Slefature of gent of Board of health or other) Healle officer 12/31/47
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 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, 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
Inational Guard
DATE OF ENTERING MILITARY SERVICE June 26, 1916
DATE OF DISCHARGE
Ulver 22 1016
RANK, RATING
Dur. 04.13 8th Rea
ORGANIZATION AND OUTFIT
Deficne- Beaded deravec
ave. the Sau. 7.19
SERVICE NUMBER
R-303-A
11+ Suffolk (County)
Beste 1/7/48
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Healthat. or Its Agent.
Registerad No.
261
St. { {If death occurred in a hospital or institution, ( give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No.
94 Buslow
(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 days.
In this community
yrs.
mos.
daya.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEJ
Male White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH
December - 30-1947
(Month)
(Day)
(Year)
Sa If marrled, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If alive / years
7 IF STILLBORN, enter that fact here.
8 AGE 61 Years. Months. Days
If less than 1 day Hours ......... .. Minutes
Usual
9 Occupation :
Industry
10 or Business :
11 Soolal Security No .. 817-18=7278
Costa
12 BIRTHPLACE (City)
(State or country )
Mar
13 NAME OF
FATHER
ADavis
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
F Can't be Learned
15 MAIDEN NAME
OF MOTHER
Mary Baker
16 BIRTHPLACE OF
MOTHER (City)'
(State or country)
17
informant
Mary O Davis
Relation, Ir apy
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : THOMAS .. F ... GOOD 1646
(Signature of Agent of Board of Health or other)
1948
( Official Designation) (Date of Issue of Permit)
20 Accident, suiolde, or homloide (specify) ... Gas ..... poisoning Data of ooourrenoe. Presumablyaccidental:
Whara did
Found dead in gas filled
Injury ooour ?
(City or town and State) kitchen! Did Injury ooour In or about home, on farm, In Industrial place, or In publis
plaoo?
Mannar of
Found dead in a gas filled
Injury
Nature Kitchen at Witterin Der-30-19499 Injury
While at work? Was there an autopsy? yes
21 Was disease or iniuty in any way related to oooupation of deceased ?
If so, speolfy
Trecklen
M. D.
(Signed)
Beste
Dc+30-1947
(Address)
Basta Ma
Place of Burial Cremation or Removal. (City or Town)
DATE OF BURIAL.Knorr.
23 NAME OF
FUNERAL DIRECTOR Los
ADDR
Received and filed
JAN 7 1943
19
( Registrar)
(Registrar of City or town where orreasra resinea)
if deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to insert a recital to that effeot
50m- (f) 6-43-12056
1
Ya. 6 . 7-6767
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
extracts from the laws relative to the return of certificates of death.
PLACE OF DEATH
Wetterob. (City or Town) No. 22 Loving Road Richard & Davis
PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran, if so specify WARD
Butter
19 | HEREBY CERTIFY that I have Invastigated the death of the person above-named and that the CAUSE AND MANNER theraof are as follows: (If an injury was involved, state fully.)
wanner to be determined
(Specify type of place)
22
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 illnesa, at the request of an umlertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of deatlı, stating to the best of hia knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted. the duration of his last illness, when last seen alive by the pliysician or officer and the date of hia death ... Gen. Laws, Chap. 16, Sec. 9.
A physician or officer furnishing a certificate of death as required hy 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 atate the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia Bec- tion snd of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" ahall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eiglit and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred aud aixteen and niueteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body lur a town, or remove therefrom a human body which has not been huried, until he has received a perinit froin the hoard of health, or its agent appointed to Issue such permits, or if there is no such hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomh to another in the same cemetery, until he has received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the tiody is buried. No such perinit shall be issued until there shall have been delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statenrent containing the facts required by law to he 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 meinher of the hoard 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 causedl hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously Interred, froin one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as ahove provided and in the pos- session of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that suchi body sliall he returned to the town from which it was removed within thirty-six hours after such re- moval, 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-xix, 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 appesr 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 regis- tration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manter or cause of the desth, which the clerk or registrar may re- quire .- Chap. 114, Sec. 45, G. L., (Terceutenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until lie 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 he huried or the funeral ia to he hield, or from a per- son appointed to have the care of the cenietery or burial ground in which the intermeut is niade ... . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Medical examincra 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 hia county the hody of such a person, he shall forthwith go to the place where the hody liea and take charge of the sante; ...- General Laws, Chap. 38, Sec. 6.
. . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifles the cause and manner of death to the hest of his knowledge and helief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persona to whom they have given bedside care during a last illness from disease unrelated to any forin of injury.
(2) Board of Health physicians will certify to such deatha only aa those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physi- ciau ia absent from home when the certificate of death ia needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posahly due to Injury. These include not only deaths caused directly or In- directly hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deatha following abortion, hut 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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify : (1) Under cause, the nature of an injury and of ita consequences; and (2) under manner, the mode of ita production together with the circumstances when these are known. For example: "Com- pound fracture of the fentur with ensuing septicemia (gaa bacillus) caused hy a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unkuown."
If disease or injury was related to occupation, specify. If investigation showa the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) umuler manner, indicate the circum- stances leading to medico-legal inquiry. For example: "Hemorrhage spon- taneous of the hrain (hasal ganglia ) ( found dead in hed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-302
1
PLACE OF DEATH
suffolk (County) Chelsea
(City or Town)
No. Soldiers! Home Hospital
St.
(If death occurred in a hospital or institution,
give ite NAME instead of etreet and number)
2 FULL NAME Joseph L.LaFayette
WWI
(If deceased ie a married, widowed or divorced woman, give also maiden name.)
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