USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 47
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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, acrved 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 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, he deemed to have taken place hetwecn February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
.. No undertaker or other person shall bury or otherwise dispose of a hunian 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 inay 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. 01 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the hoard 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 hy 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 carly 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 heen 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 perinit 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 lie has re- ceived a permit so to do from the board of health or its agem appointed to issue such permits, 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 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).
Medical examiners shall make examination upon the view of the dead bodies 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, Scc. 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 phyal- 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 septicemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, 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 .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- l'recise 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 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 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, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk
(County)
inthron
(City or Town)
No .. 14 Febble _ve.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
14.2 ..
St.
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
Maill
(If U. S.
War Veteran,
specify WAR)
meri can
St.
(If nonresident, give city or town and state)
In this community 2 7 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
/hite
5 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced ; pain Hement
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of bontmed op wife if alive
years
7 IF STILLBORN, enter that fact here.
ÅGE ..
64
Years
2 .. Months ....... 2 .. Deys
If less than 1 day
Hours
Minutes
9 Occupation :
Retired 2017 47 Postal
Industry
10 or Business :...
. Tocomment
11 Social Security No ......
12 BIRTHPLACE (City).
est roston
ASS.
13 NAME OF
FATHER
Tran- Clement
14 BIRTHPLACE OF
FATHER (City)
Tevant
(State or country)
aine
15 MAIDEN NAME
OF MOTHER
Effie Hay Han
16 BIRTHPLACE OF Tenduskeag
MOTHER (City) ...
(State or country)
Taine
.17
Fladeys .. Clement(
wife
Informant.
(Address)
14 Febble ave.,
inthron
I HEREBY CERTIFY thet a satisfactory standard certificete of death was filed with me BEFORE the burial or transit permit was issued: Mm. D. Childress x. (Signature of Agent of Board of Healthor other)
Healthe Officer 10/10/42
(Official Designation) (Date of Issue of Permit) /
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
8
1942
(Month)
(Day)
(Year)
July 25 CERTIFY. That I attended deceased from
I last saw h Malive on
august 7, 15/2 death is said to
have occurred on the date stated above, at 2:30 a
.. m.
acute Coronary Thrombosis
Duration
IMPORTANT
2 weeks
1year
Due to Chronic Brouchutes
Other conditions.
none
(Include pregnancy within 3 months of death)
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 ?. no
If so. specify
(Signed) Jacob
ahaus byto
........
M. D.
(Address) 562 Sturkey St
Date 8/8/429
Place of Burial, Cremation or Removal,
DATE OF BURIAL ..
ang . 108 Winthrop
1942
22 NAME OF
FUNERAL DIRECTOR
Chao. R.Bensin
ADDRESS Meeting
Received and filed ...
...............
.19
(Registrar)
100m-2-'40-D-729-a
1 3 SEX Male (or) WIFE of. 8 Usual PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. Information should be carefully suppned. AGL should be stated LAAcILI. PHYSICIANS should state (State or country)
PLACE OF DEATH
2 FULL NAME
ugens Trophy Clement
(If deceased is a married, widowed or divorced woman, give also maiden name.)
14 lebble .ve.,
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months % days.
19 42 to.
August F- 1942
Due
angina Pectoris
Major findings:
Of operations.
none
Date of.
Of autopsy.
not done
What test confirmed diagnosis ?.
(City or Town)
Relation, if any
Clerk
48
Registered No
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 hest of his knowledge and helief the name of the deceased, his supposed age. the disease of which he died. defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town. or remove therefrom a human hody which has not been huried, 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 hody and remove it from a town, from one cemetery to another. or from one grave or tomb other than the receiv- ing tomh to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the hody is buried. No such permit shall he issued until there shall have heen delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required hy 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 physician who is a memher of the hoard of health, or em- ployed hy it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy 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 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 re- moval of such hody has been sooner ohtained hereunder. If the death certificate contains a recital, as required hy 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 heen engaged, such recital shall appear upon the permit. The hoard 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 necessary information which can he ohtained 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 heen hrought into the commonwealth until he has received a permit so to do from the hoard 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 he huried 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 interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), therinal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahied by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier 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 important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION.
R-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No.
Winthrop Community Hospital
[ { If death occurred In a hospital or Institution,
St. { give its NAME instead of street aud number)
2 FULL NAME
Baby Boy Petersen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
105 Putnam Street
St.
( If nouresident, give city or towu and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Ilushand's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN. enter that fact here.
8
AGE
Years
Months.
Days
-
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No.
winthrop
12 BIRTHPLACE (('ity)
(State or comtry)
Mass
13 NAME OF
FATHER
Robert Petersen
14 BIRTHPLACE OF
FATHER (City)
Coppenhagen
(State or country)
Denmark
15 MAIDEN NAME
OF MOTHER
Marion B Crocket
16 BIRTHPLACE OF
MOTHER (City)
Raymond
(State or country)
Maine
17 Robert Petersen Informant ..... (Address) 105 Putnam St. Winthrop Mass".
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial dr transit permit was Issued : Man D. Children x ....
(Signature of Agent of Board of Health of otherY 8/11/42 Health Officer
( Official Designation ) (Date of Issue of Permit)
18 DATE OF
DEATH
august 10
1942
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
19
to
-
19
I last saw h
alive on
19
death is sald to
have occurred on the date stated above, at
m.
Duration IMPORTANT
years
immediate cause of death.
Still how (full Lenn)
Due to.
Interia of Pregnancy
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations.
Brech presentation
Date of
Of autopsy
What test confirmed dlagnosis?
Clinical Klab
Physician t'ilerline the cuuse to which death should be charged sta- Tistically.
20 Was disease or injury in any way related to occupation of deceased ? 17
If so, specify .....
M. D.
(Signed) Carol, Chamo Th.D
(Address) 5.62
21
winthrop lowtaip Winthrop
l'lace of Burial, Cremation or Removal.
(City or Town)
42
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed. AUG 12 1542
19
(Registrar)
100m (d) -1-41-4667
if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. extracts from the laws on back of certificate. terms, 30 that ff may be property classified. Exact statement of decorATION is very important. See instructions and PARENTS
123 ...
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
The Commontoralth 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.
Date Una 11 1942
DATE OF BURIAL
August
11
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 stive 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, speci- fying the war. and shall also certify in such certificate both the primary and the secondary or iminediate 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 inelinde the China relief ex- pedition 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 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 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 ita agent appointed to issue such permita, 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 froin a town, from one cemetery to suother. or from one grave or tomb other than the receiving tonib 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 inay 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 lrereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of 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 carly 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 hody has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased aerved in the army, navy or marine corpa of the United States in any war in which it has heen engaged. such recital shall appear upon the perinit. 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 canse 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 ashea 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 hoard, 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).
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