USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 82
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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, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate 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 section 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 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 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 inter- ment, 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 physician 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 required of the attending 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 another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by, section ten of chapter forty-six, 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 registra- tion. The person to whom the permit is so given and the physician certifying 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 require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which 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 derk 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 follow- ing 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 Ærtify to such deaths only as those of persons who, though disabled by recopi
enized checase unrelated to any form of injury, have died without recent medical attendance or whose 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 resultingasentireria), and by the action of chemical (drugs or poisons) thermal, or eledrie 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
X
PLACE OF DEATH
REVERE 2-7-54 Suffolk (County) Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial ·permit with Board of Health or its Agent.
245
Winthrop amm Hospital No. ...
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Baby Boy Schaffen
(If deceased 'is a married, widowed or divorced woman, give also maiden name.)
24 yeaman St.
St.
(Was deceased a U. S. War Veteran. if so specify WAR) Rivere Mars
(a) Residence. No. (Usual place of abode) Length of stay: In place of death .. years. .. months. .days. In place of residence .years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR OR RACE white
10 SINGLE
(write the word)
MARRIED WIDOWED or DIVORCED
Single
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
TREMATURITY
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
284%
AGE
.Years
Months
Days
If under 24 hours
.Hours
/5 Minutes
ANTE
MULTIPLE CONGENITAL
CEDENT (b)
CAUSES
ANOMÁLIES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation.
Was autopsy performed?
What test confirmed diagnosis?
C/IN 2X AM.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
(Address)
M. D.
Date 11/2 4 1954
6 Beth israil
Place of Burial or Cremation
DATE OF BURIAL
nov 24
1957
Everett (City or Town)
V 21
th a Schaffen
Informant
(Address)
24 Veannen St Kever
I HEREBY CERTIFY that a satisfactory standard/certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter A. Waller x-
(Signature of Agent of Board of Health or other)
Health Officer
11/24/54
(Registrar)
28 ub
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No. 22
16 BIRTHPLACE (City)
(State or country)
Northrop Mass.
17 NAME OF
FATHER
Kenneth ü Schaffen
18 BIRTHPLACE OF FATHER (City) *(State or country)
Winthrop Dass
19 MAIDEN NAME
OF MOTHER :'
Ruth Weiner
20 BIRTHPLACE OF MOTHER (City) (State or country) mars
Boston
7 NAME OF FUNERAL DIRECTOR Washington Tive Chelsea ADDRESS
Received and filed
(NOV 26 1944,
.......... 19.
PHYSICIAN - IMPORTANT
2 FULL NAME ...
3 DATE OF
DEATH
NOV
24 14 5 4/
(Month)
(Daf)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from Nov 23 19
.54
to
Nov 24
19
54
I last saw h / Malive on
have occurred on the date stated above, at. 5% S/ Am.
nav 24 5% deat /. death is said to INTERVAL BE-
IR-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
does not mean of dying, such lure, asthenia, ns the disease, ations which h.
d conditions. ing rise to the e (a) stating lying cause
ions contrib- death but not he disease or ausing death.
50M-(D)-6-51-904917
NO
PARENTS
Registered No.
(If nonresident, give city or town and State)
(Official Designation)
(Date of Issue of/Permit)
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 required 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 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 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 imme- diate 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 section 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 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 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 inter- ment, 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 physician 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 required of the attending 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 another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by, section ten of chapter forty-six, 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 registra- tion. The person to whom the permit is so given and the physician certifying 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 require .- Chap. 114, Sec. 45, G. L .. (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
RECEIVED
No undertaker or other persons shall hury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health onits parent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be huried or the funeral is to be held, or from es person appointed to have the care of the cemetery or burial ground in which the interment is made.
. . Chap. 114, Sec. 46, G,L- telvienenary, Edition). 2°
RULES, DE PRACTICE The fulfillment of the perfns of these laws's call's-for the observance of the follow-
ing rules of practice : (1) Attending physiciansy to such deaths only as those of persons to whom they have given bedelle cefe during a last illness from disease unrelated to any forın of injury.
(2) Board of Health physicianswill certify to such deathsonly as those of persons who, though disabled by irecognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiner fyll investigate and certify to all deaths supposably due to injury. These inek (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, hut 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING. ORGANIZATION AND OUTFIT
SERVICE NUMBER
X
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
No.
11 Lewis Terrace LECKEY John Licky Anderson
[(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
11 Lewis Terrace St.
(a) Residence. No. (Usual place of abode)
10
Length of stay: In place of death .years months. days. In place of residence
19ears
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November25
(Month)
(Day)
1954
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
to
19
10a If married, widowed,or divorced
HUSBAND of
Laura Dumlio
Daniles
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
68
AGE
Years
7
.Months
7
Days
If under 24 hours
Hours. ... . Minutes
13 Usual
Occupation:
Machinist
(Kind of work done during most of working life)
14 Industry
or Business:
Ship building
15 Social Security No
024-07-2704
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
Unable to obtain
Anderson
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Sarah Reilly
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Informant (Address)
Laura C Anderson 11 Lewis Terr, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Matter . Hojees.
(Signature of Agent of Board of Health or othet)
61/26/54
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEarried
I last saw h ......
alive on
19
death is said to
have occurred on the date stated above, at
8 A
m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Natural Causes
Due
o Presumably
ANTE
CEDENT (b)
CAUSES
Coronary
Due To
Occlusion
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? no If so, specify lothar @ norran
DHealth
M. D.
(Signed)Winthrop Board Date 2.5 NOV.1954
Forrest Hills
6
Boston (City or Town)
Place of Burial or Cremation
Nov .
27
19.54
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Forward 5 avenoldo
ADDRESS
Received and filed NOV 2 9 1954
19
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial ·permit with Board of Health or its Agent.
246
Registered No.
R-301A 160
UCTIONS OR CERTIFICATE iving OF DEATH t enter han one For each ) and (c)
oes not mean f dying, such ure. asthenia, s the disease, ations which
conditions, ig rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
Chapter 137. 954, requires s to print or ause or causes on death
50M-3-54-911887
MS.
3
1
2 FULL NAME
(Was deceased a
U. S. War Veteran,
if so specify WAR)
None
(If nonresident, give city or town and State)
Belfast
(Official Designation)
(Date of Issue of Permit)
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 required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section "forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate 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 section 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 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 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 inter- ment, 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 physician 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 required of the attending 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 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
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