USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 46
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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 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 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
RM R-305 7
2 FULL NAME 3 SEX M (or) WIFE of 8 AGE 69 Industry 10 or Business : PARENTS WRITE PLAINLY, WITH UNFADING BLACK INK " THIS IS A PERMANENT RECORD (State or country) of the city or town in which the deceased resided as soon as possible after the close of the month in which the death resided in another city or town at the time of death should be made forthwith and transmitted on Form R-805 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased occurred. (See Chap. 46, Sec. 12, G. L.)
25m-(d)-6-43-12056
A TRUE COPY. Total Manning
(Registrar of eity or town where death occurred)
DATE FILED ..... ......
0 July 9 19.48
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 6/48
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that ! have Investigated the death of the parson above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, etate fully.) Acute cardiac failure probably
coronary sclerosis chronic myocarditis
20 Aooldent, sulolda, or homloide (specify)
Date of ocourrenoe
19
Where did Injury occur?
(City or town and State)
Did Injury oocur In or about the home, on farm, In Industrial place, or In publio place?
(Specify type of place)
Manner of
Collapsed and died quickly
InJury
Nature of Injury
While at work?
?
Was there an autopsy ?..... No.
21 Was disease or Injury In any way related to occupation of deoeasad?
If so, specify
(Signed)
W J Brickley
M. D.
(Address)
Boston .. Mass
Date ..
7-6 19 48
22
Winthrop Cem-Winthrop Mass.
Place of Burial, Cremation or Removal,
(City or Town)
E E Merrill
(
Relationcić any
DATE OF BURIAL
July 8/48
19
23 NAME OF
FUNERAL DIRECTOR
H-S Reynold's
ADDRESS
Winthrop Mass:
Racelved and filad
JUL 19 1948
19
...
(City or Town)
No.
183 Porter St
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
60331
(If death occurred in a hospital or institution, give its NAME instead of street and number)
George H Merrill
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residance. No.
201 Winthrop St
St.
(If nonresident, give city or town and State)
(Usual place of abode)
Length of stay: In hospital or Institution.
(Before death)
years
months days.
In this community30
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Aga of husband or wife If allva 58
year&
7 IF STILLBORN, enter that fact hera.
Years .. Months. .. Days
.....
If less than 1 day .. Hours. Minutas
Usual
9 Occupation :
Electrical .. Engineer
Building Maintenance
11 Soolal Security No.
·021-09-1248
12 BIRTHPLACE (City)
Moncton New Brunswick
13 NAME OF
FATHER
John N Merrill
14 BIRTHPLACE OF
FATHER (City)
New Brunswick
(State or country)
15 MAIDEN NAME
OF MOTHER
Anabella Bray
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Brunswick
17
Informant.
(Address)
1
PLACE OF DEATH
SUFFOLK| BOSTON
St.
(if U. S.
War Veteran,
specify WAR)
Winthrop Mass.
(Specify whether)
Ellen E Swimm
(Registrar of City or Town where deceased resided)
JUL 1 ..
R-301 A
1
PLACE OF DEATH
Suffo k (County) Winthrop (City or Town) No. 151 Cottage Pk. Rd.
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. ..
132
St. 3
(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 WAR)
2 FULL NAME
Thomas M. Barry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
151 Cottare Pr
RO
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
"(If nonresident, give city or town and State)
In this community
5
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4
COLOR OR RACE
Jhite
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
S
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.
8
52
AGE
Years
Months
Days
If less than 1 day
.Hours
Minutes
Usual
9 Occupationalegman
Industry
10 or Business:
Automobile
11 Social Security No.
12 BIRTHPLACE (City)
(State or Country)
East
Boston
Mass
PARENTS
14 BIRTHPLACE OF
Boston
FATHER (City)
(State or Country)
Mass
15 MAIDEN NAME
OF MOTHER
Annie L. Norton
16 BIRTHPLACE OF
Boston
MOTHER (City)
(State or Country)
Mass
17 Edmund Barry
Informant (Address)
BBRebothbry )
Adams
St. Henttrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial/or transit permit was issued: Walter &. Baker& (Signature of Agent of Board of Health or other) Health Officer 7/13/48 (Official Designation) (Date of Issue of Permit)
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
200 Pleabut
G. M. D. Date 1209/1948
21
Winthrop
Winthrop
(City_or Town)
14
1948
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Place of Burial, Cremation or Removal.
DATE OF BURIAL
July
John F. O'malley
Winthrop
Received and Filed JUL 1.5.1948
19
(Registrar)
Duration IMPORTANT 10 Tags 3
Due to
Due to Sistrophy
Other conditions
(Include pregnancy within months of death)
Exostophy of Blackile
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis?
45
I last Saw h Lie alive on.
11 July . 194. death is said to
have occurred on the date stated above, at
12 mary
Immediate cause of death Cerebral Harmonlige
MEDICAL CERTIFICATE OF DEATH
1
19 I HEREBY CERTIFY, apune .. 19 8 . to
That I attended deceased from
11 July
...
19
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
100M-7-46-19068
18 DATE OF
DEATH
July
(Month)
11
(Day)
4 (Year)
See instructions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
13 NAME OF
FATHER
Patrick
Barry
(Address)
St.
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 hy 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 iu 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 tomh 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 or chapter ioriy-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)
No.
4 Belcher Street
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 WAR)
2 FULL NAME
William Doig
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
4. Belcher Street
(Usual place of abode)
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 26 years
months
days·
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
white
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED widowed
5a If married, widowed, or divorced
HUSBAND OF
Margaret Archibald
(Give maiden hame 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.
8
AGE
50 Years
0
Months
23Days
-
If less than 1 day
Hours
.Minutes
Usual
·9 Occupation:
Machinest
10 or Business:
Charlestown Navy Yard
11 Social Security No. .
010-03-7535
12 BIRTHPLACE (City)
(State or country)
Aberdeen
Scotland
13 NAME OF
FATHER
Andrew Doig
14 BIRTHPLACE OF
Aberdeen
FATHER (City).
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Jane Gray
16 BIRTHPLACE OF
MOTHER (City).
Dundee
(State or country)
Scotland
17 Informant Thomas Doig ( ... brother ...... )
(Address) 103 Highland Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial ortransit permit was issued: Walter & Baklig (Signature of Agent of Board of Health or dthef) Health Officer 7/15/48 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 13
Month)
1948
(Day)
(Year)
.. 19 18
19 I HEREBY CERTIFY, That I attended deceased from
april 24, 198, to July 12
I last saw him.
alive on
July 12
1948, death is said to
have occurred on the date stated above, at 500 AM.
Immediate cause of death
OCORONARY OCCLUSION
...
Due
Coronary sclerosis
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
Of autopsy .
What test confirmed diagnosis?
5Kg.
Duration Important 12 hours
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, specify
(Signed)
M.D.
(Address) 447 Shirley St Whichop Date 7-14 1948
Relation, if any
21
Forrest Dale Cemetery, Malden
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
July 16,1948
19
22 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS
174 Winthrop St. Winthrop
Received and filed .19
A TRUE COPY ATTEST:
JUL 1-9 1948
(Registrar)
100m-(c)-3-46-18278
1 3 SEX male If deceased was a U. S. War Veteran, G. L., Chap. 48, Sec. 10, requires physicians to insert a recital to that effect. PARENTS it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws Industry on back of certificate.
301
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop, Mass. (City or town making return)
Registrar's Number
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