USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 54
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by section ten oi chapier ioriy-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 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 hy 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-301
Suffolk
The Commonmealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
(City or town making return)
154 .......
[ (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,
""inthronspecify WAR)
St
(If nonresident, give city or town and State)
Length of stay: In hospital or institution ..
(Before death)
3 wonka-
years
months
15
days.
In this community 56 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
fem.
4 COLOR OR RACE
T.Jhs to
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
Sa If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
albert N. Coff.
(Husband's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8 87
AGE
Years
6
Months
16 Days
If less than 1 day
Hours
Minutes
Usual
9 Ocoupation :
Howwork.
Industry
10 or Business :......
Quan Home.
11 Social Security No ...
Portland
12 BIRTHPLACE (City)
(State or country)
mane
PARENTS
14 BIRTHPLACE OF
FATHER (City) ...
amsterdam
(State or country)
dollard
15 MAIDEN NAME
OF MOTHER
Josette Van Wechsel
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
I dollard
17 Relation, if any Rosales M. Colt. (Daugliter)
Informant
(Address)
39 Charmant are new York nig
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with in6 BEFORE the burial or transit permit was issued: Walter & Bakes
(Signature of Agent of Board of Health or other) Realthe Miar 8/4/48 7 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
41.+h
8701
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I Attended deceased from
19
to.
19
I last saw her
alive on
7.7 . ...
19
death is said to
have occurred on the date stated above, at 7
.. m.
Immediate cause of death
T
ft homingaria
Duration
Important
5
days
Due to ............ a.
Antor
Due to
2 TYS
Other conditions.
Faninnen iit pony
Important
(Include pregnancy within 3 months of death)
Major findings: Of operations.
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 ?.
If wo. specify
and
0
(Signed)
238 Shore, Druk
8%
., M. D.
(Address)
·WINTHROP M Date
21
Creutt mans. Woodlawn
Place of Burial.'Cremation or Removal.
aug. 7
DATE OF BURIAL
19.5.p
22 NAME OF
FUNERAL DIRECTOR,
ADDRESS.
30 Laurel St.
nature Har
Received and filed.
AUG-5 1948
19.
A TRUE COPY ATTEST:
(Registrar)
August 23. 1948 If deceased was a . U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- Grank S. Chutney 100m(h)-1-41-4695
PLACE OF DEATH
(County) Wedeltrop
1
No ....
(City or Towa) 46 Washington Live, BESSIE SCORE/non SAhnenTon
2 FULL NAME.
(Ir deceased is a married, widowed or divorced wofnan, give also maiden name.)
730 2710f vonne
(a) Residence. No.
(Usual place of abode)
(Specify whether)
STANDARD CERTIFICATE OF DEATH Quithop
Registered No.
LBULUTLU
What test confirmed diagnosis ?.
Date of
Of autopsy
Munch S. Whitney
(City or Town)
1948
amsterdam
13 NAME OF
FATHER
S. Schreven
Aur. 4
(or) WIFE of
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwitb, 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 tbe name of the deceased, bis supposed age, the disease of which he dled, defined as required by section one, wbere same was contracted, the duration of hla last Illness, when last seen alive by tbe physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by tbe preceding sectlon or by section forty-five of chapter one hundred and fourteen, shall, if tbe 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 pro- vision 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 tbe 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 bundred and two, and the Mexican border service of nineteen bundred and sixteen and nineteen hundred and seventeen .- General Laws, Chop. 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 bealth, 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 receiv- Ing 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 in- sufficient, a physician wbo is a member of the board of health, or em- ployed by It or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If deatb is caused by violence, the medical 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 sucb 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 re- moval of such body has been sooner obtained hereunder. If the deatb certificate contains a recital, as required by section ten of chapter forty-
mix, that the deceased served In the army, navy or marine corps of tbe United States In any war In which It has been engaged, such recital shall appear upon the permlt. The board of health, or Its agent, upon receipt of such statement and certificate, shall forthwith counterslgn it and transmit it to tbe clerk of the town for registration. The person to whom the permit is so given and tbe physician certifying the cause of deatb shall thereafter furnish for registration any otber necessary information which can be obtained as to the deceased, or as to tbe manner or cause of the deatb, which tbe clerk or registrar may require .- Chop. 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 hls county the body of such a person, he shall forthwith go to the place where the body lles 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 tbereof wbicb 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 care of the cemetery or burial ground In which the interment la made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for tbe observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as thoss of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Heaith physicians will certify to such deatbs only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or wbose 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 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 tbe principal cause.
Statement of Occupation .- Precise statement of occupation Is very Important, 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, 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
+
R-301 A
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) No.
75 Summit 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 its Agent.
Registered No.
155
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) world #1
2 FULL NAME
George
L. Cusick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
75 Summit Ave 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
48 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4
COLOR OR RACE
White
5 SINGLE
(write the word)
18 DATE OF
DEATH
7Month)
(Day)
1948 (Year)
5a If married, widowed Mtivraga ret
HUSBAND of .
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
38
yea
7 IF STILLBORN, enter that fact here.
8
AGE
Years
Months
Days
If less than 1 day
. Hours
Minutes mejorardet.
Usual President Boston Corp Co.
9 Occupation.
Industry
Steamship s
10 or Business:
11 Social Security No.
025 -- 05 -- 8798
Winthrop
12 BIRTHPLACE (City)
(State or Country)
Mass
13 NAME OF
FATHER
John F. Cusick
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Mass
15 MAIDEN NAME
OF MOTHER
Mary Haris
16 BIRTHPLACE OF
MOTHER (City).
Quincy
(State or Country)
Mass
(Address)
21
Holyhood
Brookline
Place of Burial, Cremation or Removal.
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
John F. O'malley Winthrop
Received and Filed
AUG 9
...
1948
(Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. WHAT Is plast this, DO that it May be properly Classified. Menatt statement Of Uvedl alla is very Important. PARENTS See instructions and extracts from the laws on back of certificate.
100M-7-46-19068
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with/me BEFORE the burial gr transit permit was issued:
Walter & Bakes (Signature of Agent of Board of Health or other) 1 Health officer (Official Designation) ( Date of Issue of Permet)
8/4/48
...
, 1948.
to
6
48
Mast saw h
W alive on
que
have occurred on the date stated above. at
m.
Immediate cause of death
Duration IMPORTANT
1
Other
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis?
laboratory
no
20 Was disease or imury in any way related to occupation of deceased? If so, specify
(Signed)
of mentees For
Ces/ 8/1948
17 InformanMargaret Cusick RWife any ) DATE OF BURIAL Aug 9. 1948 19
(Address)
75 Summit Ave Sanitop
Due to
.
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
19
.. , 19
2001928
, death is said to
6 Age of husband or wife if alive
en "1/8/45
MARRIED
WIDOWED
or DIVOREE rried
Barter
imacy HEREBY CERTIFY, That I attended deceased from
6
Male
48
Due to
Boston
r
1
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer sball forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or otber authorized person or of any member of the family of the deceased, furnisb for registration a standard certificate of death, stating to the best of his knowledge and helief the name of the deceased, his supposed age, tbe 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 hy tbe 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 bas 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, sucb physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian 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 tbe 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 sucb 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 sball 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 bis county the body of such a person, he shall forthwith go to the place where the hody lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the asbes 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 deatbs 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.
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