USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 25
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by section ten of chapter forty-six, tuat 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 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).
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.
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, 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 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 .- Precise 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
M R-301
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF
3 SEX
male
(or) WIFE of.
8
Usuel
9 Ocoupation :...
Industry
10 or Business:
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
(State or country)
per hosp.
PARENTS
Informant.
1001(h)-1-41-4695
N. B .- WRITE PLAINLY, WITH ONTADINO BLACK INK AIRO WO A TANTIANLIT ALVVA.
NB MAIDEN NAME
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
Mar
28
((Month)
(Day)
(Year)
19
I HEREBY CERTIFY.
19
.. , to.
19
I last saw halive on
19
death is said to
have occurred on the date stated above, at.
Immediate cause of death.
Duration Important
Due to.
Stillon
Brutto
Due to
Phasenlatin
Other conditions
Presentation
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?..
PHYSICIAN Underiine 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, specify
huis Reggel.
M. D.
(Signed)
(Address).
72 twenty Ho Date 8/30 1945
21
glenwood Century, Everest
Plad of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
March 30
19:45
22 NAME OF
Edith Mu. Meruric
FUNERAL DIRECTOR
ADDRESS
305 Beach St. Herer mars
Received ond filed 19.
A TRUE COPY ATTEST
(Registrar)
X
69 ....
2 FULL NAME
Male Baby Johnson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
252 Crescent are.
St
.....
(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
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in fuli)
8 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
stille.
If less than 1 day Hours Minutes
AGE ...
Ysarı
Months
Days
Wurthroß
mass
13 NAME OF
FATHER
Edwin Johnson
14 BIRTHPLACE OF
FATHER (City) .....
north Oxford
maso.
OF MOTHER
Elsie Johnson (OK)
16 BIRTHPLACE OF
MOTHER (City) .....
(State or country)
arizona
Bisbee
17 Mr. Edwin Johnson (facher)
Relation, if any
(Address) 252 cresceil are Beachwant
maga
I HEREBY CERTIFY that satisfactory standard certificate of death wan filed with me BEFORE the burial or transit permit was issued: Nu. D. Click der ( Signature of Agent of Board of Health or other ) Health Officer 3/30/49
(Oficial Designation) (Date of Issue of Permit)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
(City or town making return)
1
PLACE OF DEATH
, Suffolk (County) Wuiltrop
(City or Town)
Winthrop Community. No ..
Hopital
S (If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN-IMPORTANT
(Was deceased a U. S. War Veteran?
If so.
(specify WAR)
Pesce maso
(a) Residence. No.
(Usual piace of abode)
MEDICAL CERTIFICATE OF DEATH
1945
That I attended deceased from
Prolapsed Cord Breed
Important
+14145
CERTIFICATE OF DEATH
Registered No.
APR 3
1945
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 lilness, 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 hla 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 seen alive by the physiclan or officer and the date of his death . . . Gen. Laws, Chap. 46, Suc. 9.
A physlclan or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and fourteen, shali, 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, specifying the war, and shall aiso 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 pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shail include the China relief expedition and the Philippine insurrection, which shall, for said purposcs, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and slxteen and nineteen hundred and seventeen .- General Laws, 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 its agent appointed to Issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesald or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or cierk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as 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 board of health, or em- ployed by It or by 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 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 re- moval of such body has been sooner obtained hereunder. If the death certificate contains a recltal, 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 recltal shall appear upon the perniit. The board of health, or Ite agent, upon receipt of such statement and certificate, shall forthwith counterslgn it and transmit 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 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 .- Chop, 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the vlew of the dead bodies of oniy such persons as are supposed to have died by vlolence. If a medical examlher 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.
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 burlal ground in which the interment la 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 bedslde 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 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 fallure, 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 la very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may 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
4/7/45
3
To be filled fer burial permit with Board of Health or its Agent.
120
St.
S (If death occurred in a hospital or institution,
¿ give its NAME instead of strect and number)
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
2 FULL NAME
Minna Gertrude (Loeffers) Mann
(If deceased is a married, widowed or divorced woman, give also maiden name.)
if so specify WAR)
(a) Residence.
No.
116 Saratoga St
St.
East Boston Marc
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
Hospital
years
months
Pdays.
In this community OG yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
r DIVORCED Married
18 DATE OF
DEATH
march.
29 - 1945
(Monthi)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
19 I HEREBY CERTIFY, That I attended deceased from
March 1
19
45 to
March 29
1945
(or) WIFE of
(Give maiden name of wife in full)
Herepy C Mann
6 Age of husband or wife if alive.
76
years
Immediate cause of death
Venta Pulmon Edema
Duration JMPORTANT 2 Days
2 months
Usual
9 Occupation :
Housewife
Industry
10 or Business:
Own Home
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
Germany
13 NAME OF
FATHER
Loeffen
Unable To Obtain
Major findings:
Of operations.
Date of
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased ?. 200
If so, specify.
Froma. H. Schwartz
M. D.
(Address) 19 Therealin St. "
Date: 3/30
Everett
Place of Burial, Cremation or Removal.
DATE OF BURIAL.
April
2
(City or Town)
45
19
was filed with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that a satisfactory standard certificate of deatlı
. Children
(Signature of Pcent of Board of Health of other) Healthe Office 4/2/47
Received and filed.
APR 3
1945
19
(Registrar)
from the laws on back of certificate.
50m-(e)-3-43-11574
PLACE OF DEATH
Suffolk
(County)
1
Winthrop
(City or Town)
No. Winthrop Community Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Koenermann
16 BIRTIIPLACE OF
MOTHER (City)
(State or country)
Germany
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
17 Elizabeth Mann
Daughter
Informant
(Address)
116 Saratoga St. E Boston
21 Woodlawn
22 NAME OF
Howard S reynolds
FUNERAL DIRECTOR
ADDRESS
Nunthis -trenes.
(Official Designation) (Date of Issue of Permit)
I last saw h wr
alive on
45
March 29
19
death is said to
(Husband's name in full)
have occurred on the date stated above, at
6 isp.
M.
7 IF STILLBORN, enter that fact here.
8
AGE 74 Years
1
Months.
19 Days
-
If less than 1 day
Hours.
Minutes
Due to.
Cancer of Stomach
(Signed)
132
(Before death)
(Specify whether)
Registrar's No.
1 A
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last scen 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 United States in any war in which it las heen engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen 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 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 board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from onc 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 hody is huried. No such permit shall be issued until there shall have heen delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death mnade 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 eertifying 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 registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thercof 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 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).
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 eounty the body of such a person, he shall forthwith go to the place where the body lics 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, 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.
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