USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 34
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A physician or officer furnishing a certificate of death aa required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased. to the best of his knowledge and helief, served in the ariny, navy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate s recital to that effect, speci- fying the war. sud 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 thia aec- 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 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 horder service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he haa received a permit from the board of health, or ita agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it 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 haa received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall be issued until there ahall have been delivered to such board, agent or clerk, as the case may be, a aatisfactory written statement containing the facta required by law to be returned and recorded, which shall he accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, aa 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 hoard 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 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 death made ss above provided and in the possession ot 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 aerved 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 perinit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other nece+ aary information which can be obtained as to the deceased, or as to the manner or canse of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a 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 hoard, from the clerk of the town where the boily 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 internient is made. . . . Chap. 114. Sec. 16. C. 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 his county the hody of such a person, he shall forthwith go to the place where the hody iies aud take charge of the same; ... - General Lawa, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deatha 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 Health physiolans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian ia ahsent from home when the certificate of death is needed.
(3) Medloal 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 reauiting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from diseasa 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. Aa principal cause name the disease caualng death. As related causes, name earlier morbid conditiona, if any, related to the principal cause and any important complication of the principal cause.
Statement of Oooupatlon .- Precise statement of occupation ia very im- portaut, so that the relative healthfulnesa of various pursuits can be known. Blake some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the discase causing death. report the usual occupation prior to illness. 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 whose only occupatiou was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private family, cook-hotei, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
A
PLACE OF DEATH
Suffolk (County)
winthrop
(City or Town)
No. 105 Grovers Ave.
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.
Registrar's No.
100
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number) PHYSICIAN-IMPORTANT
2 FULL NAME
Dagney 0. Paulson, (nee Hansen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
105 Grovers Ave.
St.
(Usual place of abode)
Hone
years
months
days.
In this community
'55rs. 7
22
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
may
13
1995
(Month
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Ernest 0. Paulson
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. 44
.years
7 IF STILLBORN, enter that fact here.
8
AGE 55 Years.
7
22
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business:
At home
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
Cambridge ...
Mass.
13 NAME OF
FATHER
Olof Hansen
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Norway
15 MAIDEN NAME
OF MOTHER
Gunda Michaelsen
Oslo
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Norway
(Signed).
(Address)
89 Crest ve Winsdeath 194).
21 Mt, Auburn Cambridge *
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL ..
May 17. 1945 19
22 NAME OF
FUNERAL DIRECTOR
Christian Berglund
ADDRESS
Arlington. 2. fase 6
Received and filed. MAY 1 5 1945
19
(Registrar)
Duration IMPORTANT unknown
Due to. Metastases to rection
Other conditions.
(Include pregnancy within 3 months of death)
and bladder
2
IMPORTANT
Major findings:
Of operations.
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? no
If so, specify.
Jane Weinsaft
/.M. D_
17
Relation, if any
Ernest 0. Paulcon Hushand
)
Informant. (Address) 105 Grovers Ave. Winthrop
was filed wird me BEFORE the burialfor transit permit was issued: I HEREBY CERTIFY hat a satisfactory fandard certificate of death Children
(Signature of Agent of Board of Health andthe Thatthe Officer 5/14/4 (Official Designation) (Date of Issue/of Permit)
19 I HEREBY CERTIFY,
april
7
That I attended deceased from
19
45,
to ...
May 13.
19
I last saw h
er
alive on
May 13, 19 40
death is said to
have occurred on the date stated above, at 11 40PM
Immediate cause of death./. Recurrent carcinoma of uterus
Due to.
(Post operative)
u ueceasea was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
50m1-(e)-3-43-11574
St.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
1
Oslo
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 nainc of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where samc 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 deccased, to the best of his knowledge and helief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourtecn, 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 hody 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 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 tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the hoard 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 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 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 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 he 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 transinit 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, Scc. 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, Sec. 46, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The 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 hedside 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 traumatisin (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, namc 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
-
ORM R-301
+ 1 3 SEX Male (or) WIFE of 9 Occupation : PARENTS 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. nation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF 10 or Business:
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No § (If deatb occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHILLIP
2 FULL NAME
Philip .. I .... Quinlan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
123 Quincy Avenue
(Usual place of abode)
St.
Winthrop,
Massachusetts
Length of stay: In hospital or institution ... 19 .... days
(Before death)
(Specify whether)
Ho Syeats ta 1months
days.
(If nonresident, give city or town and State)
In this community 50
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
Sa If married, widowed, or
Forced
HUSBAND of
Marion G. Davis
(Give maiden name of wife in full)
(Husband's name in fuil)
6 Age of husband or wife if alivs
years
7 IF STILLBORN. enter that fact here.
8 AGE.7.9. Years Months Days
If less than 1 day Hours Minutes
Retired
Industry
Advertising
11 Social Security No.
12 BIRTHPLACE (City)
PrinceEdward ..... Island
(State or country)
13 NAME OF
FATHER
Michael Qu'en
14 BIRTHPLACE OF
FATHER (City) ..
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Prince Edward Island
Relation, if any
17 Informant Mildred M. Quinlan Daughter) (Address) 123 Quincy Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificats of death was filed with me BEFORE the burial or transit permit was issusd: William D. Childress
(Signature of Agent of Board of Health or other)
agent May, 20/45
... (Official/Designation) (Dare of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
(Month)
(Dáy)
(Year)
19 I HEREBY CERTIFY 9pm1/30
19.40, to.
1Yay19
19 45
I'last saw him alive on.
Мау 18
1945, death is said to
have occurred on the date stated above, at.
8.30 Am.
Immediate cause of death.
Carcinoma
140 denom
Due to.
Due to.
Other conditions (Include pregnancy within 3 months of death)
Important
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 W'as disease or injury in any way related to occupation of deceased? 220
If .o. specify
Daniel )K /Juin
(Signed)
M. D.
(Address) Pointkrop Mass Date May 19 1945
21 ..
Lakeside
19
Cochituate Mass
Piace of Burial, Cremation or Removal
DATE OF BURIAL
John F. Omaley
22 NAME OF
FUNERAL DIRECTOR ..
ADDRESS
Winthrop Massachusetts
Received and filed
19
MAY 2 2
1945
A TRUE COPY ATTEST:
(Registrar)
Duration Important
2
years
Major findings: Of operations.
Date of
Of autopsy
What test confirmed diagnosis? Clinical Signs
May 2](City or Town) 49
0m (h)-1-41-4695 =
KITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- Uoual
No. Winthrop Community Hospital
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran?
If so,
specify WAR)
19
1945
That I attended deceased from
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlclan 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 famlly 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 dled. defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . 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 fourteen, shall, if the deceased, to the best of his knowledge and belief. served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying 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 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" 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 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 toinb 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 18 buried. No such permit shall be Issued until there shall have been 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 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 recital, as required by section ten of chapter forty-
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