USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 74
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by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has 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 furnish for registration any other neces- sary information which can be obtained as to the deccased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue 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, Scc. 46, G. L., (Tercentenary Edition).
Medical cxaminers shall make examination upon the view of the dead bodies of only such persons as are supposed to have dicd by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician 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 indirectly 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 .- 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 .- Precisc 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 on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, 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
R-301 A
+ Female and
1
Winthrop
(City or Town)
No.
20Shirley
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.
222
N ....
S ( If death occurred in a hospital or institution, give its NAME Instead of street aud nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME.
Konstancvia Dobek
( Wietecka).
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
20 .... Shirley
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In nosoltal or Institution ..
(Before death)
(Specify whether)
yeara
months
days.
In this community 3
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEJ
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
.
(or) WIFE of
John ... Dobek
( Husband's name in full)
6 Age of husband or wife if alive years
> IF STILLBORN. enter that fact here.
8
AGE 56 .... Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occuoation :
Housekeeper
......
Industry
10 or Business :
At .... Home
11 Social Security No. Mone
12 BIRTHPLACE (City)
( State or country)
Poland
13 NAME OF
FATHER
Pitao Writecki()
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
15 MAIDEN NAME
OF MOTHER
unable to for
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 (Address) 201mehrWu Source
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William 2. Childress
(Signature of Agent of Board of Health or other)
agent Nov. 11/44
(Officia(Designation) (Date of Issue of/Permit)
18 DATE OF
DEATH
November
10
1944
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deosased from
nov. 8
1944,
Ło.
Kówamber 10
19 44
1 last saw h ...........
.. alive on
November 9, 1944 death is said to
have occurred on the date stated above, at
8'00
Am
Immedlate cause of death
Anguia
PEctoria
Due to.
Due to
anterioralergia
2yrs.
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
Major findIngs :
Of operations
hove
Date of
Of autopsy
What test confirmed diagnosis? Clinical
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 ? Ko
If so, specify ........
(Signed) Manure Traunstein NT.
(Address) 562 Shul
Date Hot. 10, 1944
21
St., Michael ... s.
Rdsindale
l'lace of Burial, Creniation or Removal.
(City or Town)
DATE OF BURIAL ..... No.v ... 13
1914
22 NAME OF
FUNERAL
ADDRESS
Joseph Polakinvia
Examendas Mas
Received and fled NOV 1 4 1044
( Registrar)
-
.......
100M-6 - 2-42-8855
PLACE OF DEATH
Suffolk
(County)
r
per tel onte 12/3/ that offoot. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital, to extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and 1
Duration IMPORTANT 24M.
6 days. ....
PARENTS
Relation, If any
St.
(Was deceased
U. S. War Veteran,
if so specify WAR)
No
-
Female
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail forthwith, after the death of a person whoin 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 seme was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of bis 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- fying the war, and shall siso certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the seine. For neglect to comply with any provision of this section, sucb physician or officer shali forfeit ten dollars. For the purposes of thie aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humulred and fourteen, the word "war" shail inchinle the China relief ex- pedition and tite Philippine insurrection, which shall, for said purposes, 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 and sixteen and nineteen bundred and seventeen. G. L. Cliap. 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 lasue 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 fromn a towu, from one 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 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 aud 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 board of health, or employed by it or by the selectinen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner chall make such certificate. If such a permit for the removal of a human body, not previously interred, froin one town to another within the cominonweaith cennot 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 shail 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-eix, that the deceased served in the army, Davy or marine corps of the United States in any war In which it has heen engaged. sucb recital shail appear upon the permit. The board of health, or its agent. upon receipt of such statenient and certificete, 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 veces sary information which can be obtained as to the deceased. or as to the manter or canse of the death, which the clerk or registrar viay require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shail bury a human body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the board of health or its sgent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the boris is to be buried or the funeral is to he heid, or from a person apjointed to have the care of the cemetery or burial ground in which the internient is made. ... Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the hody of such a person, he shall forthwith go to the place witere the body liea aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persons to whom tilcy have given bedside care during a last illness from disease uurelated 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 phyaf- cian is absent from home when the certificate of death ie needed.
(3) Medioal Examiners will investigate end certify to all deatha sup- posably due to injury. These include not only deaths canved directly or in- directly by traumatism (including resulting septicemia), and by the action of cieniicai (drugs or poisons), thermal, or electrical agents, andi deatbs following abortion, but also deaths from diseasa reauiting 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 more of ilying. e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation 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 ou account of the discase causing death, report the usual occupation prior to iliness. If the deceased had retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at hoine. For a woman wbose only occupatiou was that of honie bousework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as bousekeeper-private fanily, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffolk (County)
reity or Town)
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.
223
10 Prospect any efforttud, 200
2 FULL NAME
Carls anderson
§ (If death occurred in a hospital or institution,
St.
¿ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
(If deceased is à married, widowed or divorced woman, give also maiden name.) 10 Porhectare Houthersh St
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
X
years
months
days.
In this community 2 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) married
Sa If married, widowed, or divorced HUSBAND of WILHELMINA LAURITZEN (Give maiden name of wife in full) andersme
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. 62
years
7 IF STILLBORN, enter that fact here.
AGE
8 62% Bars 4 Months ............. Days
If less than 1 day
Hours
Minutes
9 Occupation :
Painter
Industry
10 or Business :.
11 Social Security No ...
011-30-8496
12 BIRTHPLACE (City)
(State or country)
sweden
13 NAME OF
FATHER
Carl. anderson
PARENTS
15 MAIDEN NAME
OF MOTH
R Emma, Lost daughter
16 BIRTHPLACE OF MOTHER (City) .. (State or country)
17 Carl. W. anderson ( Son
Relation, if any
Informant (Address) (U Prospect are wardens
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
....
(Signature of Agent of Board of Health & other)
We atthe Officee
11/16/49
..... (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
nomenelen 14 1944
(Month)
(Day)
(Year)
não 1,
I HEREBY CERTIFY,
That I attended deceased from
1944 to 40014, 1944
I last saw him alive on Nov (3, 1944, death is said to have occurred on the date stated above, at. 3.20. .. m.
Immediate cause of death Caravana Thrombosis
Due to.
Due to.
Hypertension (Chronic)
5 years
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was disease er injury in any way related to-occupation of deceased ?..
If so, specify .. (Signed) Winthrop mass Date Nov /6 1944
M. D.
(Address)
21 Willnotbemetry Without 24mm Place of Burial, Cremation or Removal (City or Town) DATE OF BURIAL .. november 19h 19 44
22 NAME OF FUNERAL DIRECTOR. Ches. R. Bennison
ADDRESS
Wirthst mass
Received and filed
19 ......
(Registrar)
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.
100m-2-'40-D-729-A
--
Major findings: Of operations
Date of.
Of autopsy -200ml
What test confirmed diagnosis ?. Clinical Signs
Duration IMPORTANT 14days
Usual
14 BIRTHPLACE OF
FATHER (City)
(State or country)
1
Registered No.
...
(If nonresident, give city or town and state)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer 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 belief 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 by 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 body in a town, or remove therefrom a human hody which has not heen 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 body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiv- ing tomh 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 hody is huried. No such permit shall he issued until there shall have been delivered to such hoard, agent or clerk, as the case may be, 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 member 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 by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously interred, from one town to another within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as ahove 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 heen sooner obtained 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 been 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 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).
SPACE FOR ADDITIONAL INFORMATION
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 hoard 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 hody is to he 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. . . . 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 by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners 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), 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 .- 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 heen 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.
1 A
1
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No. 263 Ma in
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.
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