USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 57
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A physician or officer furnishing a certificate of death as required by the preceding section or hy 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, 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 bundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person sball bury or otherwise dispose of a buman 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 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 its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there sball bave 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 bereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian wbo is a member of the board of health, or employed hy 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- eal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another witbin 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 sball constitute a permit for such removal; provided, that such hody 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 bas 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 forth with 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 registi ir may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died hy 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 hody lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human hody or the ashes thereof which have been brought into the commonwealth until he bas 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 sucb 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 sucb deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, bave died without recent medical attendance or whose pby- 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 hy 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., beart 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 bad heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at bome. 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 bad no occupation whatever write none.
.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
301
from the laws on back of certificate.
100m-(1)-1-45.15510
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter A. Baker
(Signature of Agent of Board of Health or other) Health Officer 8/17/48
(Official Designation)
(Date of Issne of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
15, 1948
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
Timo thfive maiden name of life in full)
(or) WIFE of
(Husband's name in full)
75
years
7 IF STILLBORN, enter that fact here.
8
AGE.68
Years
Months
Dạys
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business:
Own Home
11 Social Security No.
East Boston
12 BIRTHPLACE (City)
(State or country)
Massachusetts
13 NAME OF
FATHER
Thomas Sheffield
Major findings:
Of operations.
Date of.
Of autopsy
What test confirmed diagnosis?
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? 100
If so, specify.
Louis 7 Salerno
(Signed).
M. D.
(Address) 175 Pleasant St. Date Grupp 16 1948.
21
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
August
(City or Town)
18,
48
22 NAME OF
John F. Oftaley
FUNERAL DIRECTOR
ADDRESS
Winthrop Mass.
Received and filed.
AUG 25 1948
_19
A TRUE COPY ATTIST:
If deceased was a U. S. War Veteran, G. L., Chap. 48, Sec. 10, requires physicians to Insert a recital to that effect. PARENTS
PLACE OF DEATH
Suffolk (County) Winthrop
(City or Town)
14 Edgehill Road
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
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)
3 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
14 Edgehill Road
(Usual place of abode)
Length of stay : In hospital or Institution (Before death)
(Specify whether)
years
montha
days.
In this community
50grs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED Married
19 I HEREBY CERTIFY, 7 That I attended deceased from 1948, to august 15, 1948 I last saw h &M alive on Ong, 17, 1942, death is said to have occurred on the date stated above, at 9 AM. Immediate cause of death Coronary Theocharis
Duration IMPORTANT 6 sweets.
Due to.
myocarditis
3 yrs.
Dne to.
Other conditions
(Include pregnancy within 3 months of death)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Massachusetts
East Boston
15 MAIDEN NAME
OF MOTHER
Catherine M. Lang
16 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country)
Massachusetts
17
Timothy J. Mccarthy Mutsbirra
(Address) 14 Edgehill Road Winthrop
Registrar's No.
162
No.
Gertrude B. Mccarthy
( Sheffield)
St.
(If nonresident, give city or town and State)
" Age of husband or wife if alive.
(Registrar)
DATE OF BURIAL
19.
!
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 iu the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate hoth 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 heen 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 hody is buried. No such permit shall be issued until there shall have been delivered to such hoard, 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 he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed hy it or hy 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 hody, 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 ahove 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 herennder. If the death certificate contains a recital, as required
by section ien ot chapier 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 registi ir may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died hy 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 hody 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 he held, or from a person appointed to have the care of the cemetery or burial ground in which the interinent 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 hy 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 hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled hy 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 morhid 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
-
R-303-A
+ Suffer (County)
(City or Town) 15 Court (Pd)
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 Health or Its Agent.
Registered No.
163.
St. { { If death occurred in a hospital or institution, give ite NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced wonjan, give also maiden /name.) 15 Court Rd. Winthrop
(a) Residenoe. No.
(Ueual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
( Before death)
( Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If marrled, widowed, or divorced HUSBAND of
(or) WIFE of
Geor givermaiden name of wife in full)
(Husband's name in full)
42
6 Age of husband or wife If allve
years
7 IF STILLBORN, enter that faot here.
8
39
Years
9
Months.
29 Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Housework
Own Home
11 Soolal Seourity No.
None
12 BIRTHPLACE (City)
(State or country)
Marysville
Ohio
13 NAME OF
Dersea
FATHER
-Stevens
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ohio
15 MAIDEN NAME
OF MOTHER
Mabel .
. _ Drake
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Chio
17 Ma jor George H. Smith (Address) 15 Court Road Winthrop, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was Issued : Walter A. Nakey.8. {Signature of Agent of Board of Health or other) Health Office 8/16/48
/ (Official Designation) (Date of Issue/of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august-15-1948
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death
of the person above-named and that the CAUSE AND MANNER thereof
are as follows:
(If an injury was involved, state fully.)
acule landeac failure:
Protag Corman, leroze
Hypertensive Heart Disease
20 Accident, sulolde, or homlolde (specify)
Date of goourrenoe
19
Where did
Injury oobur ?
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or in publio
place?
(Specify type of place)
Manner of found dead in her bed
Injury
Nature of
Injury
While at work?
Was there an autopsy ?.
200
21 Was disease or Injury In any way related to oooupation of deceased ?
If so, speolfy
Hun. Trickle
M. D.
(Signed)
(Address)
Gusta 15-2048
22
Oak Grove-Dellaware
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
August 19 1918
19
23 NAME OF
FUNERAL DIRECTOR.
J.E.Henderson Company
ADDRESS
517 Broadway Everett, Mass.
Reoelved and filed
AUG 25 1948
19
(Registrar)
50m- (f) -6-43-12056
1 3 SEX Female AGE PARENTS if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10. requires physicians to insert a recital to that effeot extracts from the laws relative to the return of certificates of death. Should be caferdny supplied. MSVTens SAAMINEN, should Siste CAUSE Any MANNER OF ALATT In plain terms, Industry 10 or Business : so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
PLACE OF DEATH
No.
HELEN F.SMITH . Helen 7 Smith
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
St.
"years - months "
days.
In this community - yra. 9
mos.
- days.
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 attendeul during his last illness, at the request of an umulertaker or other authorized person or of any member of the family of the decreased, furnish for registration a standard certificate of death, 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 by section one, where same was contracted, the duration of his last illueas, when last seen alive by the physician or officer and the date of his 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-tive 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 immeiliate 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 thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" aliall include the China relief ex- pedition and the l'hilippine insurrection, which shall, for said purposes, he deentreil to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nlueteen hundred and two, and the Mexi- can boriler service of nineteen hundred aud aixteen 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 heen buried, until he haa received a perinit 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 lruman body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomb to another in the same centretery, until he haa received a permit from the board of health or its agent aforesald or from the clerk of the town where the body is buried. No such permit shall be issued until there ahall 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 physicfan, 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 board of health, or employed by it or by the aelectmen for the purpose, shall upon application make the certificate re- quired of the atterling physician. If death 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 an- other within the commonwealth caunot be obtained early enough for the purpose, the certificate of death made as above provided aud in the pos- session of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall 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-six, that the deceased served in the army, navy or marine corps of the United States in any war in which
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