USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 85
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A physician or registered hospital medical officer shail forthwith, after the death of a person whom he has attended during his last illness, 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 deatii, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he divii, defined as required by section one, where same wss contracted, the duration of his last lineas, when last seen alive by the physiciau or officer and the date of his death ... Gen. Laws, Chap. 16, Sec. 9.
À physician or officer furnishing a certificate of deatir as required by the preceding section or by section forty-Ave ol chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the ariny, navy or marine corps of the United States in any war in which it has been engaged, invert in the certificate & recital to that effect, speci- fying the war, und 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 tiris section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-Ave, forty-six and forty-seven of said chapter one hundred and lourteen, the word "war" shail include the China relief ex- pedition and the i'hilippine insurrection, which shall, for said purposea, be deemed to have taken place between February fourteentir, eighteen hundred and ninety-elglit and Juiy fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen aud nineteen hundred and seventeen. Q. L. Citap. 46, Sec. 10.
No undertaker or other person sisil 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 perinit from the board of heaith, or ita agent appointed to issue such permits, or if there is no such board, from tire clerk of the town where the person died; and no undertaker or other person shali exitume a human body and remove it from s 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 baa received a permit from the board of health or its agent aforesald or from the cierk of the town wirere the body is buried. No such permit shali be issued until there shail have been delivered to such board, agent or cierk, 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 sn original Interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereluafter provided. If there is no attending physician, or If, for sufficient ressons, his certificste cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a nieinber of the board of health, or employed by it or by the selectmen for the purpose, shaii upon application make the certificate re- quired of the attending physician. if death is caused by violence, the medical examiner shali 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 cannot 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 shali constitute a pernilt for suclr removai; provided, that sucir body shall be returned to the town from which It was removed within thirty-six hours after such re- movai, unless s permit in the usual form for the removal of such body has been sooner obtained hereunder. If the desth certificate contains a recitai, as required by section ien of chapter forty-xix, that the deceased served in the army, wavy or marine corps of the United States in any war in which
it has been engaged, such recitai shali appear upon the permit. The board of heulth, or. ils agent, upon receipt of snclr statement and certificate, shati forthwith countersign it ami transmit it to the clerk of the town for regis- tration. The person to whom the permit la 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 manner or cause of the death, which the clerk or registrar may re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
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 boily is to be buried or the funeral is to be held, or from a per son appointed to itave the care of the cenietery or burial ground in which the interment is niade .... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Mericai examiners shaii 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 hla county the body of such a person, fre shisil forthwith go to the place where the body fies sod take charge of the same; ... -- General Laws, Chap. 38, Sec. 6.
. . lle shall in sli cases certify to the town cierk or registrar in the piace where the deceased died his usine and residence, if known; otherwise a description as fuli as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
. .. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fuiffiment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physiolans wili certify to such deaths only as those of persons to whom they have given bedside care during a last iliness from disease unrelated to any forin of injury.
(2) Board of Heaith physioians will certify to auch deatha oniy an those of persons who, though disabled by recognized diaesse unrelated to any form of injury, have died without recent medicai attendance or whose phyaf- cian is absent from hoine when the certificate of death is needed.
(3) Medlcai Examiners will investigate and certify to aii deatha sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatisin (including resulting septicemia), and by the action of chemical (druga or poisons), therinai, or electrical agenta, and deaths following abortion, but also deaths from diseass resulting from injury or infection related to occupation, the sudden deaths of persona not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death wlii state the cause and manner thereof, and wifi specify : (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicenria (gas baciifus) caused by a steam rallway accident." "Pistoi shot wound of the chest with asso- ciated hemorrhage, homicidai." "Asphyxiation by suspension, sulcidai." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of tile skuil with associated internai injury sua- tained under circumstancea unkuown."
if disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumabie nature; and (2) urler manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basai ganglla) (found dead in bed)." "Heart disease, presumably coronary scierosis. (Suilien drath. )"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
ORM R-302 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46. Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
Middlesex (County)
Malden
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Malden
(City or town making return) .
Registered No. 256
Churchill Nursing Home No.
f(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
32 Marshall
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
8
months.
days. In place of residence.
.years
.. months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December 15 1950
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED idowed
4 I HEREBY CERTIFY,
That I attended deceased
from
50
July
19
50 ...
to
Dec ..... 15
19
death is said to
have occurred on the date stated above, at.
2.30 P
m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact, here.
2 day SAGE
Years
Months.
.Days
If under 24 hours
Hours
Minutes
Due To
CEDENT (b)
CAUSES
Diabetes Mellitus
Due To (c)
Arteriosclerotic H
.1. . 6mg
16 BIRTHPLACE (City)
(State or country)
NfId.
17 NAME OF
FATHER
Cannot be learned
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nfld.
19 MAIDEN NAME
OF MOTHER
Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
St . Johns
Nfld.
21 Elizabeth Ward
Informant
(Address)
1655 Parkway Everett
A TRUE COPY.
ATTEST:
(Registrar.of City or Town where death occurred) Dec. 27, 1950
19
...
(Registrar of City or Town where deceased resided)
10a If married, widowed, or divorced
mary
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY L
TO DEATH (a).
Hypostatic Pneumonia
12
77
Painter
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Retired
15 Social Security No.
St. Johns
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
no
5 Was disease or injury in any way related to occupation of deceased? If so, specify .... Edward Cardillo
(Signed)
"534 Broadway
Date. 12/16/50 D.
6
DATE OF BURIAL
Holy Cross Place of Burial or Cremation Dec. 18, 1950 19
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
Frederick J. Magrath E. Boston
ADDRESS
Received and filed.
IAN 1 ~ 8051
19
50
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop
(a) Residence. No.
John Walsh
CERTIFICATE OF DEATH
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
MARVIN RESERVED FOR DINDING
50m-(e)-10-48-24658
What test confirmed diagnosis?
Clin.
PARENTS
St. Johns
(Address) EVere Malden
6 mo.
ANTE
I last saw h im
alive on
Dec. 15
19.50
(write the word)
DATE FILED
ORM R-302 1
PLACE OF DEATH
SUFFOLK (count)STON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
11152 257
Registered No.
(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME EDWARD J BARTLETT (If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
WINTHROP
St.
(If nonresident, give city or town and State)
.months.
5
days. In place of residence
6
.years.
.months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR OR RACE
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
MARRIED
That
A attended deceased from
to
DEC 31
19 ... 50
alive on
DEC 31 19 50death is said to
INTERVAL BE- TWEEN ONSET AND DEATH
TERM.
10a If married, widowed, or divnered HUSBAND of.
ETHEL
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 77 Years 11 Months.
1.7. Days
If under 24 hours
.Hours ....
Minutes
13 Usual
Occupation:
SALESMAN
(Kind of work done during most of working life)
14 Industry
or Business:
AUTOMOBILE
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
BOSTON MAS'S
17 NAME OF
FATHER
EZRA BARTLETT
18 BIRTHPLACE OF
FATHER (City) .N.E.w·HAMP.
(State or country)
19 MAIDEN NAME
OF MOTHER
FLORA MCINTYRE
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
S.C.O.T.L.A.N.D.
WIFE
7 NAME OF
FUNERAL DIRECTOR
A E EATON & SONS
ADDRESS NEEDHAM, MASS
Received and filed. 19
JAN 1 / 1951
(Registrar of City or Town where deceased resided)
PARENTS
M. D.
Date. DEC 31 50
6 WOODLAWN CEM Place of Burial or Cremation (City or Town) JAN 3
51
19.
21
Informant
(Address)
A TRUE COPY
TRUNGLarles H. Mackie
(Registrar of City or Town where death occurred)
DATE FILED JAN 3
19 51
MARDIN NEUENVED POR BINDING
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Due To (c) ART.E.R.I.Q.SCLERO TIC YR
TERM
YRS
Was autopsy performed?
YES
25m-(b)-11-49-900,475
PETER BENT BRIGHAMHOSP.
No.
(a) Residence. No.
103-A SUMMIT AVE
(Usual place of abode)
Length of stay: In place of death.
......
... years.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
DEC 31/50
(Day) WE
(Year)
,WE
(Month)
4/ HEREBY CERTIFY,
DEC 26
50
19
YWE
/ last saw
h
IM
have occurred on the date stated above, at
2:56 ₱
m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
BILATERAL PULMONARY
THROMBATIC EMBOLI FROM
ANTE
Due To
CEDENT (b)
RIGHT AURICLE
CAUSES
HEART DIS. WITH CONGESTIVE FAILURE
OTHER
PULMONARY EDEMA .
SIGNIFICANT
Major findings:
Of operations.
Date of operation
What test confirmed diagnosis ?.
AUTOPSY
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
NA WILHELM.
BOSTON MASS
(Address)
DATE OF BURIAL.
E.V.ER.E.T.T.
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city of town in which the deceased resided as soon as possible
CONDITIONS
CARCINOMA OF PROSTATE
R PERKINS
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