USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 96
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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 regis- tration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- 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 such permits, or if there is no such board, from the clerk of the town where the body is to be huried or the funeral is to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
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.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise 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 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 abortion, but also deaths from disease resulting from Injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
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 example: "Com- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT ·
2-301 A
PLACE OF DEATH
Suffolk County)
The Commonforall 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, St. ( give ita NAME instead of street and nuniber)
2 FULL NAME.
( If deceased is a married, widowed or divorced woman, give also maiden name.)
61 Ingleside avr Writing St.
(a) Residence. No.
(Usual place of abode)
Length of stay: in hospital or Institution
(Refore death)
years
months days.
(If nonresident, give city or town and State) In this community 30 yrs. X mos. dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE|
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
married
5a If married, widowed. HUSBAND of Dorothy (For Kins) Para dikemeiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive- 48 years
9 IF STILLBORN. enter that fact here.
AGE
8 62 Years 3 Months 18 Days
if less than 1 day
Hours
Minutes
Usual
9 Occupation :
Passenger Trainsman
industry
10 or Business :
n.Y. U.N. V.H. R.R.
11 Social Security No. 506-03-0658-
12 BIRTHPLACE (City)
( State or country)
mami
13 NAME OF
FATHER
Charles. Para
14 BIRTHPLACE OF
unable to obtain
FATHER (City)
(State or country)
k
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
4
17 Informent fred R. Para
Relation If any (Address) 630 Waldermar avr Winthey
I HEREBY CERTIFY that a satisfactory standard certificate of death wes Ned with me BEFORE the burial er trangit permit was issued :
(Signature of Agents of Board of Health or other) He althe officer 12/281×3
(Official Designation) ( Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Dec.
24, 1940
· DEATH
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY, That I attended deceased from
Fel.
15,
......
1936
to
Dans 18,
1947
I last saw h ............. alive on ..
Dec. 18,
. 19 4, death is said to
have occurred on the date stated above, at 2A. m.
Immediate cause of death. Cerebral Hemanadası
Pulmonary Eden
Due to
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findings: Of operations
Dete of.
Of eutopsy
What test confirmed diegnosis?
Duration
IMPORTANT I day
... 10 mts. 10 mm
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
. M. D.
20 Was disease or injury in eny wey related to oooupation of deceased ?.
If so, specify .....
(Signed) Jamies. Sheberg
(Address) 270 Stily St.
Date ....
: 2/25/ 1942
21
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
2cc
19 KJ
......
22 NAME OF
FUNERAL DIRECTOR Chunks R. Mennica.
ADDRESS
Winthis quand
Received and Alied
19
( Registrar) 1
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
100M-6 - 2-42-8855
1
No.
(City or Town) 620 Shirley Sh Winthro Maso
Edward. Edmond Para
(Specify whether)
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 regiatered hospital medioal officer shall forthwith, after the death of a person whoin he has attemled during his last illnesa, at the request of an undertaker or other authorizeil person or of any member of the faniily 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. where same was contracted. the duration of his last ilinesa, when last seen alive by the physician or officer and the date of his death ... Cen. Laws, Chap. 16, 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, 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 recital to that effect, speci- fying the war. snd 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 hundred and fourteen, the word "war" shall incimle the China relief ex- pedition and the Phillppine insurrection, which shall, for said purposes, he deemed to have taken place hetween February fourteenth, eigliteen hundred and ninety- eiglit 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. Chiap. 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 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 ahall 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 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 sucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facta 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, o1 in lieu thereof a certifleste 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 pbysi- cian who is a meniber of the board of health. or employed by it or by the aelectinen for the purpose, shall upon application niske 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 desth made as above provided and in the possession of the undertaker desiring to make such renioval 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 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 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 aa to the maliber 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 permits, or if there is no such hosrd, 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. 16. 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, Suc. 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 phyalolans will certify to such deaths only aa those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attemlance or whose pbyaf- cian is ahsent from home when the certificate of death is needed.
(8) Medloal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only desths cansed directly or in- directly hy traumatism (Including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, ami deaths following abortion, but also deaths from dlacasa resulting from injury or Infection related to occupation, the sudden deaths of persons not disablad by 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 dylug, e. g., heart failure, asphyxia, astbenla, etc. Aa principal cause name the disease causing death. Aa related causes, name earlier morbid conditions, If any, related to the principal cause and any important complication of tbe principai cause.
Statement of Oooupatlon .- Precise statement of occupation ia very im- portant, so that the relative bealthfulness 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 usual occupation prior to illness. if the deceased bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned an at school or at boine. For a woman wbose only occupatiou was that of bonie bousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, aa housekeeper-private faniily, cook-hotei, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
-301 A
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physicians to insert a recital to that effect.
100M-G - 2-42-8855
PLACE OF DEATH
Suffolk (County)
iinthron ..........
(City or Town)
No.
7 Laurel Path, Winthrop
$ { If death occurred in a hospital or Institution, St. [ give its NAME instead of street aud nuniber)
PHYSICIAN - IMPORTANT
2 FULL NAME.
williamH .... Pitzold
( if deceased is a married, widowed or divorced woman, give aiso maiden name.)
(a) Rasidence. No ..
7 Laurel Path, Winthrop
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community 6
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
18 DATE OF
DEATH
December 24 1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
19
to
19
{ last saw h.
.alive on
19 ........ , daath Is sald to
have occurred on tha data statad above, at.
11.50 PM
Immedlate oausa of death.
Duration
IMPORTANT
9 IF STILLBORN. enter that fact here.
8
AGE 66 Years
Monthe
Days
If less than 1 day Hours Minutas
Usual
9 Occupation :
Lotorman
Industry
10 or Business :
Retired
11 Social Security No.
None
12 BIRTHPLACE (City)
( State or country)
Gloucester, mass.
13 NAME OF
FATHER
John Fitzold
14 BIRTHPLACE OF
FATHER (City)
Germany
(State or country)
15 MAIDEN NAME
OF MOTHER
Catherine #rench
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland.
17 Mrs. Lena itzold
Reiation, if any
Informant.
.......... I .. e.
( Address)
( Laure] Path, winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of daath was filled with me BEFORE the bustal or transit parmit was Issued ? Childressx
(Signature of Agent of Board of Health ar other)
Health Hucke 12/27/43
(Omciai Designation) ( Date of Issue of/Permity
20 Was disease or injury in any way ralated to oooupation of daoeased ?.
If so, speolfy.
M. D.
('Signad ).
3) Yw shoppen Date 12/2/1945
(Address)
21 HolyCross Halden
Place of Burial, Cremation or Removai.
(City or Town)
DATE OF BURIAL .......
December 28, 1943 19
22 NAME OF
FUNERAL DIRECTOR
· ADDRESS
54Roxbury Street, Rox
Received and Alsd. DEC 27 1943 19
( Registrar)
IMPORTANT
Other conditions
(Include pregnancy within 3 months of death)
Major findIngs : Of operations
Data of
Of autopsy
What test confirmed diagnosis?
Physician Underlina the cause to which death should b & charged sta- tistically.
PARENTS
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if alive years
65
The Commontoralth of MassacInisetts 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.
Registared No.
Brayrey
(Was deceased a
U. S. War Veteran,
Spanish
if so spaolfy WAR) ... Amer .......
..... ... St.
Married
5a If married, widowed, or divorced
HUSBAND of
Lena .... Benner ...
(Give maiden name of wife in full)
Due to Luk, mand
Due to.
1
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 whoin he has attemled during his last illuesa, at the request of an undertaker or other authorizeil person or of ans meniber of tbe 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 aame was contracted. the duration of his last illneas, when laat seen alive by the physician or officer and the date of his death ... Geu. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa required by the preceding section or by acction forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, served In the army. navy or marine corps of the I'nited States in auy 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 saine. For neglect to comply with any provision of this section, auch physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-Ave, forty-six and forty-seven of said chapter one buntired 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 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 sixtcen and nineteen bundred and seventeen. G. L. Chap. 46, Sec. 10.
No undorteker or other person shall hury or otherwise dispoae of a buman body in a town, or remove therefrom a human body which has not been buried, until he haa received a permit from the board of health, or its agent appointed to issue such permita, or if there is no such board, from the clerk of the town where the person died; aud no undertaker or other person shall exhume a human body and remove it from a town, from oue cenietery 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 ita agent aforesaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there aball have been delivered to sucb board, agent or clerk, as the case inay be. a satisfactory written atatenient containing the facta 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, aa required by law. 01 in lieu thereof a certificate aa hereinafter provided. If there is no attending physician, or If, for sufficient reasona, hia certificate cannot be obtained early enough for the purpose, or is insufficient, a pbysi- cian who ia a meniber of the board of health, or employed by It or by the selectmen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death ia caused by violence. the medl- cal examluer 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 cominouwealth 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 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 containa a recital, aa 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 statement and certificate, shall forthwith countersign it and transniit It to the clerk of the town for registration. The person to whom the permit la 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 aa to the manner or canse of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, C. L., ( Tercentenary Edition).
No undertaker or other person shall bury a huntan body or the ashea thereof which have been brought Into the conimonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permita, or if there is no such hoard, from the clerk of the town where the boily 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 ia made. ... Cbap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodiea of only such persona 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 aud take cburge 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 deatba only as those of persona to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Heelth physiolans will certify to such deatha 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 pbsaf- cian ia ahsent from home when the certificate of death ia needed.
(8) Medloal Examiners will Investigate and certify to all dcatba sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the actlon of chemical (drugs or poisons), thermal, or electrical agents, amt deatbs following abortion, but also deatha from diseasa resulting from injury or Infeotion related to occupetion, the sudden deatha of persons not disabled by recognized disease, and those of persons found dead.
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