USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 87
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2 FULL NAME
China 6 ( Carlson) nilson
(If deceased is a married, widowed or divorced /woman, give also maiden name.) 87 21 pland PPd.
St.
Marthaok
(If nonresident, give gily of town and state)
(Specify whether)
15
death is said
years
8 AGE SE 58 You Usual 9 Occupation:
ottenberg
Due to
Date of ...
21
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 regis- tratlon 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 scen 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, 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 cxhume 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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 licu 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 pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner 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 registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish 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.)
No undertaker or other person 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 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)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance 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 ill- ness from disease unrelated to any form of injury.
(2) Board of Ilealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related 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 resulting septice- mla), 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 occupa- tion, 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 carlier morbid con- ditions, 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 busi- ness, 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, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
01 A
1
Suffolk (County)
Winthrop
-
No.
(City or Town)
97 Grovers 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 Agent.
Registered No.
{ { If death occurred in a hospital or institution, give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAMEGeorge E Hazel
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
97
Grovers
Ave
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Male
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEMarried
5a If merried, widowed gr
Mary forced Mooney
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's neme in full)
6 Age of husband or wife if ative 50
years
> IF STILLBORN. enter that fect here.
8
AGE
67 Years
........ Months
Days
If less then 1 dey Hours. Minutes
Usual
Salesman
9 Occuoetlon :
Industry
Leather
10 or Business:
11 Social Security No.
030-16-0894
12 BIRTHPLACE (City)
(Siate or country)
Mass
13 NAME OF
FATHER
William
Hazel
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Ellen Harrington
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Informant Mary E
( Address)
97 Grovera
Ave
..... Ha.z.e.l Relation, if any ED
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with Du BEFORE the burjal or transit bermit was Issued :
m.D.Childress.D (Signature of Agent of Board of Health or other)
Health Officer 11/18/43
(Omcial Designation) (Date of Issue of Vermit)
18 DATE OF
DEATH
(Month)
(Day)
( Year)
19 | HEREBY CERTIFY,
www. 15
19/3
.....
to
That I attended deosesed from
19
19
2.3 death Is said to
have occurred on the date stated above, at.
1.500
m.
Immediate cause of death.
Duration IMPORTANT
day
...
Due to.
Due to
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
Mejor findings:
Of operations
Date of
Of eutopsy.
What test confirmed dlegnosis ?.
Underline the cause to which death should be charged sta- tistically.
20 Wes diseese or injury in any way related to oooupation of deceesed ?.
if so, specify
......
('Signed)
M. D
(Address)
*2 Date W/1)
.. 19
......
21
Winthrop , Winthrop
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL.
Nov . 20
1943
............
19
22 NAME OF
FUNERAL DIRECTOR
form Ji Umaies
ADDRESS
Winthrop
Rsosived and Alsd
19
( Registrar)
if deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physiolans to insert a recital to that effect. PARENTS
100M-6 -2.42-8855
PLACE OF DEATH
1
St.
(Was deosased a
U. S. War Veteren,
if so specify WAR)
, St.
(If nonresident, give city or town and State)
35
1)
1947
MEDICAL CERTIFICATE OF DEATH
I last saw h.
welive on.
Cambridge
Physician
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 attemled during his last Illuesa, at the request of an undertaker or other authorizeil person or of any member of the family of the deceased, furnisb for registration a atandard certifcate 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, wlirre ssme 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 I'nited States in any war In which it has been engaged, insert in the certificate a recital to that effect, speci- fylng the war. snd shall also certify in such certificate both the primary and the secondary or iinmediate 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 thla sec- tlon and of sections forty-five, forty-six and forty-seven of said chapter one humired 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 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 buman 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 lasue 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 ahall exhume a buinan 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 bave been delivered to sucb 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 ia 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. froin 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 ot tbe undertaker desiring to make such removal shall constitute a permit for such removai; 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 recitai, 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. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statenient 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 of cause of the death, which the clerk or registrar may require .- Cbap. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to Issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person apiminted 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 ouly such persons as are supposed to have died by violence. If a medical examiner has notice that there is within hils county the body of such a person, he shall forthwith go to the place where the loudly lies aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws caiis for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatba oniy aa those of persons to whom they have given bedside care during a fast iliness from disease unrelated to any form of injury.
(2) Board of Health physiolana will certify to such deaths only as those of persons who, though disahled hy recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyel- clan is ahsent from home when the certificate of death Is needed.
(3) Medioal Examiners will Investigate and certify to all deatha aup- posabiy 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, aml deaths following abortion, but also deaths from diseasa reauiting from injury or Infection related to occupation, the audden deaths of persons not disablad hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death, not the mode of dying, e. g., heart fallure, asphyxia, asthenia, etc. As principal cause name tbe disease caualng death. As related causes, name earlier morbid conditions, If any, related to the principal cause and any important complication of the principai cause.
Statement of Occupation .- Precise statement of occupation ia 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 on account of the disease causing death, report the usual occupation prior to Illness. If the deceased bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned aa at school or at boine. For a woman wbose only occupatiou was that of home housework. write bousework. 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
-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 49 Prospect 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 Agent.
St.
( If death occurred in a hospital or institution, give its NAME instead of street aud number)
2 FULL NAME.
Charles Calvin Cook
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
49 Prospect Ave .
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
years
months
days.
in this community
22yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
Or DIVORCED Married
5a If married, widowed, or divorced Lydia Stone
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 84
years
> IF STILLBORN. enter that fact here.
8
83
Years
8
AGE
Months
10
Days
If less than 1 day Hours Minutes
Usual
9 Occuoatlon :
Salesman (Retired)
Industry
10 or Business :
Hardware
11 Social Security No.
None
East Northfield
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
George Cook
14 BIRTHPLACE OF
FATHER (City)
Unable To Obtain
(State or country)
15 MAIDEN NAME
OF MOTHER
Martha
?
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable To Obtain
17 Martha S Ridley
Rotation Hunter
Informant
( Address)
47 Prospect Ave" Winthrop
DATE OF BURIAL
NOV.
22
1943
22 NAME OF
Howard S Maismoldo
FUNERAL DIRECTOR
ADDRESS
Winthrop Mano
19
......... (Omcial Designation) ( Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
nor 18
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
nor 8
19 43, $0.
2200 18
1943
i last saw h ...
... alive on
220018
19 43, death is said to
have occurred on the date stated above, at. 3.45 P. m.
Duration
Immediate oause of death.
Coronen Thantous
Branche pneumonia
.. IMPORTANT 7 days
Due to
Due to.
Other conditions ..
Servlets + Hypoten H. cheese no
( Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findIngs :
Of operations
Date of
Of autopsy.
What test confirmed diagnosis?
Chacal
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?
If so, speolfy ........................
M. D.
(Signed).
(Address) 148 Withus St Date 2019 1943
21
Woodlawn Crematory
Place of Burial, Cremation or Removal.
(City or Town)
Everett
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with ma BEFORE the burial or transit permit was issued : Um.A. Children-
(Signature of thefat of Board of Health or other) nov. 20/43
Received and filed.
NOV 2 2 1943
( Registrar)
100M-6 -2-42-8855
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to Insert a recital to that effect. PARENTS
No.
-
Registered No.
(Was dedosBAY - IMPORTANT
U. S. War Veteran,
if so spoolfy WAR)
St.
(If nonresident, give city or town and State)
(Specify whether)
1943
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwith, after the death of a person whoin he has attended during his Isst illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnisb for registration a standard certificate of desth, ststing 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 ssme wss contracted. the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chiap. 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 sriny, navy or marine corps of the I'nited 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 csuse of death as nearly as he can state the saine. For neglect to comply with any provision of this section, sucb 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 inchule 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 buman body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the bosrd of health, or ita agent appointed to lesue such permits, or if there is no such board, from the clerk of the town where the person dled; and no undertaker or otber person shall exhume a human body and remove it froin 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 board of health or its agent sforesaid 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 hiereinafter provided. If there Is no sttending physician, or If, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient. a pbysi- 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, tbe medl- cal examiner shall make such certificate. If auch 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 desth made as above provided and in the possession ot tbe 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 obtalued hereunder. If the desth 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 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 registrer may require .- Cbap. 114. Sec. 46, G. L., ( Tercentenary Edition).
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