USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 46
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Duration IMPORTANT
IMPORTANT Physician
(Cits or Town) June /28 1943
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so apeolfy WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medioal offioer shall forthwith. after the death of a person whoin he has attended during his last illness, at the request of an undertsker or other authorizeil person or ol ans member of the Ismily of the deceased, furnisb for registration a standard certificate of desth, stating to the best of his knowledge and belief the name of the deceased, bis supposed age, the disesse of which he died. defined as re- quired by section one. where same wss contracted. the duration of his last illness, when Isst seen alive by the physician or officer and the date of bia 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 lorty-five of clispter one hundred and four- teen, shall, il the decessed, to the best of his knowledge and belief, aerved in the army, navy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate a recitsl to that effect, speci- fying the wsr. snd shall slso certily in such certificate both the primary and the secondary or immeiliate cause of death ss nearly as he can state the ssine. For neglect to comply with any provision ol 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 humulred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shsil, for said purposea, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety- eight sud July fourth, nineteen hundred and two, and the Jtexi- can border service of nineteen hundred sud sixtcen and nineteen bundred 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 permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a human body and remove it from a town, from one cenietery to another, or from one grave or tomb other thau the receiving tomb to another In the same cemetery, until he has received a permit from the bosrd of health or its agent aforessid or from the clerk of the town where the body is buried. No such permit shall be issued until there aball 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 internient, 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 ressons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cisn who is a member of the hoard of health, or employed by it or by the aelectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death is caused by violence, the medl- 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 esrly enough for the purpose, the certificate of desth made as above provided and in the possession ot the undertaker desiring to make such removal shall constitute a permit for such removal; provided, thst 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. sucb 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 cirrk of the town for registration. The person to whom the permit is so given and the physician certilying the cause of death shall thereafter furnish for registration any other nece+ sary information which can be obtained as to the deceased, or as to the msuner 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 hunisn 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 sgent affminted 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 interment is made. ... Cbap. 114. Sec. 46. C. L., (Tercentenary Edition).
Medical examiners shall mske examination upon the view of the dead bodies of ouly 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 boily lles aud 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 deatha only aa 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 physlolans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose pbyaf- cian is absent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all (catba 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, aml deatbs following abortion, but also deaths from diseasa 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 .- Canse of death means the disease, or complication which causes death, not the moile of ilying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng death, As relsted causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Ocoupation .- Precise statement of occupation ia very im- portant, so that the relative hesithfulness 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 discase causing death, report the ususl occupation prior to illness. If the deceased bsd retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at home. For a woman wbose only occupatiou wss that of honie bousework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa bousekeeper-private faniily, cook- hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
Suffolk County)
Winthrop
No.
(City or Town) 104 Highland Que
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.
Registered No.
134
ยง ( If death occurred in a hospital or Institution, give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
John Gaughan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
104 Highland ave
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution.
( Before death)
(Specify whether)
Rest 9home years months days.
(If nonresident, give city or town and State)
In this community 1 0
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male White
4 COLOR, OR RACE|
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
58 If married, widowed, or divoroed
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 years
7 IF STILLBORN, enter that fact here.
8
86
AGE ..
Years
14
Days
If less than 1 day Hours. ..... Minutes
Usual
9 Occupation :
Retired
Industry
10 or Business :
Farmer
12 BIRTHPLACE (City)
( State or country)
new York
13 NAME OF
FATHER
Stephen 2 Saugeon
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
Ireland
17 Informant ... ( Address)
I HEREBY CERTIFY that a satisfactory standard oertifloate of death was filed with me BEFORE the burial or transit permit was Issued : Ww D. Childress
...
(Signature of Agent of Board of flealth or other>
4/1/43
Health (Official Designatinn) (Date of lamie of Dermt)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
28 1943
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
gue 25
19 43.
to
que 28
19.5/3 ...
I last saw halive on -28
19.43., death Is sald to
have oocurred on the date stated above, at ....
2.00 A.
.m.
Immedlate oause of death
Inemia
Duration
IMPORTANT
3 days
Due to.
Hypertensive Cardia Ramal
disease
Due to
Other conditions.
Samlity
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations.
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?za .. If so, specify
(Sig
Richard Matery
(Address) 148 Minichamps Ind 5 Date 962
M. D.
19.953
21
Place of Burial, Cremation or Removal.
DATE OF BURIAL
July
(City or Town)
1963
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Received and filed
JUL 2 1943
19
( Registrar)
1
PLACE OF DEATH
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
100m (d) -1-41-4667
Relation if any
Eventi
Of autopsy
Date of.
-
What test confirmed dlagnosis?
chical
....
11 Social Security No.
8
Months.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
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 ar; member of the family of the deceased, furnisb for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, ltis 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 .. Cen. 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 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 inchile the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deeme 1 to have taken place between. February fourteenth, eighteen bummer d 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. O. L. Chap. 46, S.c. 10.
No undertaker or other person cha I bury or otherwise dispose of a human body in a towa, or remove therefrom a human b ds which has not been buried, until he has received a permi from the board of health, or ils 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 exhun a human body and rule it from a tave for one cemetery to another, or from one grave or tomb other than the receiving tamb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or fron the clerk of the town where the hody is huried. No such permit shall be issued until there sha l have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by low 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 thereoi a certificate as heremafter provided. If there is no attending physician, or if, for suficient reasor :. his certificate cannot be obtained early enough for the purpose, or is insulcient, a physi- cian who is a member of the board of health, or employed by it er by the selectinen 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 conunonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided aud in the possession of the undertaker desiring to make such removal shall constitute a permit for ench removal; provided, that such body shall be returned to the town froni 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 heen sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-mix, of the dereand ceased in the army, avy or marve corps of the United States in aby war in which it has been engaged. such recital shail appear upon the permit. The board of health. or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and trausunt it to the cleik of the town for registration. The person to whom the permit is so given and the physician certifying th' cause of death shall thereafter furnish for registration any other neces- vary reformation which can be obtained as to the deceased, or as to the manuel or cause of the death, which the clerk or registrar may require .- Chay. 111, 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- ce vad 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, er from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Cbap. 114, Sec. 46, G. L., (Terecutcuary Edition).
Medical examiners shali mak . 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 fulfillnient 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 whont 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 discase 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 chemical (drugs or poisons), thermal, or electrical agents, and deaths f Mpwing abortion, but also deaths from disease resulting fiore 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 nieana the disease, or complication which causes death, not the mode of dying, e. g., heart failure. asphyxia, asthenia, etc. As principal cause name tbe 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 .-- I'mcase statement of occupation is very im- portaut, so that the relative healthfulness of various pursuits can be known. blake 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 leccased 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 ervice 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
-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
-
No.
(City or Town) 29 Ingleside Ave.
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 LAgest.
Registered No.
S ( If death occurred in a hospital or Inatitution, { give its NAME Instead of street and number)
2 FULL NAME
Gunhilde Christine (Knudsen) Knudsen
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
12 Lincoln St Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
yeara
months
days.
In this community 23 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
1945
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
Poder Pruisen
(or) WIFE of
Peder inud seife in full)
( Husband's name in full)
6 Age of husband or wife if allve years
> IF STILLBORN. enter that fact here.
8
AGE
83 Years 3
Months
.10Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
At Home
11 Social Security No. None
12 BIRTHPLACE (City)
(State or country)
Norway
13 NAME OF
FATHER
Knut Knudsen
14 BIRTHPLACE OF
FATHER (City)
Unable To Obtain
(State or country) Unable To Obtain
15 MAIDEN NAME
OF MOTHER
Unable To Obtain
16 BIRTHPLACE OF
MOTHER (Clty)
(State or country)
Unable To Obatin
17 Anna M Iversen Daughter
Informant
( Address) 12 Lincoln St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificata of death was fled with me.BEFORE the burig of transit permit was Issued :
( Signature of Agent of Board of Health of other) Health fficer 7/2/43 (Omcial Designation) (Date of Issue of Permit)
19 I HEREBY CERTIFY,
That I attended deceased from.
last saw he
Aller 30, 2043
have occurred on the date stated above, at.
Immediate oause of death ...
Myocardehs
Due to
artur Saluons
10 /Eus
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Df operations
IMPORTANT Physician
Underline the cause to which death should ba charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?.
If so, spaolfy.
('Signed)
Date.
7/1
M. D.
195/3
21
Winthrop
Winthrop
l'lace of Burial, Cremation or Removal,
DATE OF BURIAL
July
+
(City or Town)
1943
22 NAME DF
FUNERAL DIRECTOR.
Howard S Reynolds
ADDRESS
....
Winthrop mars
Raoalved and Alad
JUL 2 1943
19
( Registrar)
100M-6 - 2-42-8855
SAulsVis Trum Ine laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot. PARENTS
3 SEX
Female
4 COLOR OR RACE| 5 SINGLE
( write the word)
White
MARRIED
WIDOWED
DIVORCE
Widowed
18 DATE OF
DEATH
pour
30
19.
49
19 Lune 30
.. ,
1943
death Is aald to
38
m.
Duration 8 Manuel IMPORTANT 1.
Date of
Of autopsy.
What test confirmed diagnosis?
( Address)
Hardanger
1
St.
PHYSIC
(Was debeused N - IMPORTANT
U. S. War Veteran,
if so spoolfy WAR)
(Usual place of abode)
(Specify whether)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physioian or registered hospital medical officer shall forthwith, after the death of a person whoin he has attemled 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 atandard 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, wliere same was contracted. the duration of his last illnesa, 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 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 helief, aerved in the army. navy or marine corps of the I'nited States in aus war in which it has been engaged. insert in the certificate a recital to that effect, speci- fylng the wsr. 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 saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humulred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred aud sixtcen 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 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 froin a town, from one cemetery to another, or from one grave or tomb other thau 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 boily 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 internient, by a satisfactory certificate of the attending physician, if any, as required by law. 01 in lieu thereof a certificste as liereinafter 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 physl- cian who is a member 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 attending physician. If death Is caused by violence. the medl- cal examiner shall make such certificate. If such a permit for the removal of a humsu body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of desth made as above provided and in the possession ot the undertaker desiring to make such removal shall constitute a permit for such removsl; 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
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