USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 15
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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 hren 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 manuer or cause of the death, which the clerk or registrar may require .- 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 hoard of health or its agent appointed to issue such perinits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to be held, or front 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).
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.
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 physi- cian is absent from home when the certificate of death is needed.
(3) Medioal Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or Infeotlon 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 tlie 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 yeara or over .. If the occupation had been given up or changed ou account of the discase 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 inay 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
..........
ERM R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effeot. checked with sta. Vorfitil
100m (d)-1-41-4667
BOSTON NOTIFIED 3/9/42
Suffolk (County)
Winthrop (City or Town) Station Hospital, Fort Banks, Mass. No:
The Commonturalth 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.
40
Registered No.
......... f(If death occurred in a hospital or institution, Storgive its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual 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
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCED
Married
5a if married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Lawrence ......... Hällmeyer
(TTusband's name in full)
years
7 IF STILLBORN, enter that fact here.
8 AGE .40 Years
4
Months
25 Days
If less than 1 day
-.... Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
--
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
San Francisco, California
13 NAME OF
FATHER
George Martellie
14 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
15 MAIDEN NAME
OF MOTHER
Elizabeth Huchinson
16 BIRTHPLACE OF
MOTHER (City)
San Francisco, California
(State or country)
17 Lawrence D. Hallmeyer(
Relation, if any ... husband.
Informant
(Address) Hq. Btry. 1st Bn.9th 1.85
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued :
(Signature of Agent Board of Health or other) all Feb. 26/42
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
25,
1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
February 22, 1942
to
February 25,
42
19
1 last saw her
ailve on
February 25, 1942
death Is said to
have occurred on the date stated above, at.
1:25
Pom
Immediate cause of death.
Peritonitis , general
ized,acute ..
Due to ..
Pelvic abscess, subsequent to
chronic salpingitis.
6 months
Due to.
Intestinal obstruction, paralyfteus
Other conditions ...
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations.
As above
Physician
Underline
Of autopsy.
As above
What test confirmed diagnosis ?
Operation
which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.... Q.
If so, specify
(Signed)
Sidney Olano, 1st 25., M.C.
(Address)
Fort Banks, Mass.
Feb 25
M.
Data
19
.......
21
DATE OF BURIAL
72.27.
angeit or Town )
19 42
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
-54
Received and filed
3
1942
19
( Registrar)
extracts from the laws on back of certificate.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
1
PLACE OF DEATH
LILLIAN CARMEL HALLMEYER
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Fort Stro
Lass .
0
years
months
3
days.
In this community
yrs.
mos.
days.
6 Age of husband or wife if alive 34
Duration
IMPORTANT
4 days
PARENTS
Date of Feb 23, 19 the cause to
22
Place of Burial, Cremation or Removal.
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 illnesa, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a atandard certificate of death, stating to the best of his knowledge and belief the nanie 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 aud the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa 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 ariny, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war. and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five. forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition 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 Mexi- can 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 iu 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 sucb 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 exlume 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 internient, 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 meniber of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence. the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body. not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for auch 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 aection ten of chapter forty-aix, that the deceased aerved 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 statenrent 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).
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 sucb 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 froin a person appointed to have the care of the centetery or burial ground in which the interment is made. .. . Chap. 114. Sec. 46. G. L., (Terccuteuary Edition).
Medical examinera 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 ia within bis 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.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persona to whom they have given bedside care during a last illneas 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 physi- cian 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 in- directly by traumatism (including resulting septicemia), and by the action of chemicai (drugs or poisons), thermal, or electrical agents, and deatbs following-abortion, but-also deathis 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 coniplication 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 kuown. 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 honie 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
....
..........
ORM R-303A
PLACE OF DEATH
Swillk · ( County)
Just Baula Hospital No ..
The Commonwealth 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.
41
Registered No
§ (If death occurred in a hospital or institution,
St.
¿ give its NAME instead of street and number)
2 FULL NAME
arroll Delmont Lufkin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Deer Iland maine
St
(a) Residence. No.
(Usual place of abode)
Fort Banks Ductus
years
months
days.
In this community
yrs.
mos.
days.
6 hours
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February-25-1942
(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)
Bullet Wound Miru abdomen
Internal d External Nemosshaga
20 Accident, suicide, or homicide (specify)
accidental
-
24
19 42
Where did
Injury occur ?.
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place? un a fort
(Specify type of place)
Manner of accidentally Short while in duts
Injury ..
Nature of
as a soldier at Winthrop
Injury.
While at work?
Was there an autopsy ?.
yes
21 Was disease or injury in any way relatedto occupation of deceased?
yes
If eo, epecify
Sand Sackler
(Signed)
M. D.
(Address)
Jedan-25 -1082
(State or country)
maine
Relation, if any
22.
Suns
Sunset Wayne
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL ....
Feb. 27
19/2
23 NAME OF fun
FUNERAL DIRECTOR We Jument Frem
ADDRESS.
254 Bear IR Rever
...
Received and filed. 19
(Registrar)
MARGIN RESERVED FOR BINDING
25m-2-'40-D-729-b
1
Northrop
(City or Town)
Length of stay: In hospital or institution .............
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
male
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of ..
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
25
AGE ..
Years ..
8
.Months.
17 Days
Usual
9 Occupation :....
Private qt CAC
11 Social Security No.
12 BIRTHPLACE (City).
(State or country)
14 BIRTHPLACE OF
Sunset
16 BIRTHPLACE OF
PARENTS
MOTHER (City) .....
Sunset
Informant !!
(Address)
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
FATHER (City) ....
(State or country)
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
10 or Business:
US ARMY
Lompechildren
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
Industry
(Signature of Agent of Board of Health or other)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
.......
(Official Designation)
(Date of Issue of Permit)
6 SINGLE
(write the word)
single
.years
If less than 1 day
Hours.
Minutes
Date of occurrence
Hancock
Maine
13 NAME OF
FATHER
Fred F. Lufkin
Maine
15 MAIDEN NAME
OF MOTHER
Arlene G. Small
17
Mrs. Bertha Hards
SISTEX)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
170 Feb 25/42
(If U. S.
War Veteran.
specify WAR).
(If nonresident, give city or town and state)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shaii 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 iliness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
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, untli 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 shail 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 he 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 he 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 physiclan who Is a member of the board of health, or em- ployed by It or hy the selectmen for the purpose, shail upon application make the certificate required of the attending physiclan. 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 another within the commonwealth cannot be obtained cariy 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 shali 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- movai of such hody has been sooner ohtained 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 shali appear upon the permit. The board of heaith, or its agent, upon receipt of such statement and certificate, shail 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 shali thereafter furnish for registration any other necessary Information which can be ohtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chop. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shail bury a human body or the ashes thereof which have been brought into the commonwealth untli 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 cierk 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 burlal ground in which the interment is made. . . . Chap. 114. Sec. 46, G. L., (Tercentenary Edition).
Medical examiners shaii make examination upon the view of the dead bodies of only such persons as are supposed to have died by vlolence. 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 iies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
... He shail in all cases certify to the town cierk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full 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 fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians wiii certify to such deaths only as those of persons to whom they have given bedside care during a iast 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 physician is absent from home when the certificate of death is needed.
(3) Medical Examiners wili investigate and certify to ali deaths supposabiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septlcemla), 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 disahled hy recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will 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 exampie: "Compound fracture of the femur with ensuing septicemia (gas hacilius) caused by a steam railway accident." "Pistoi shot wound of the chest with associated hemorrhage, homicidai." "Asphyxiation by suspension, suicidai." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internai injury sustained under circumstances unknown."
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