USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 58
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obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to he huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial ground in which the interment is made ... . Chap. 114, Sec. 46, G. L., (Tercentenary Edition.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of llealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name tlie disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complieation 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 husi- ness, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For a woman whose omy 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
M R-303-A
1 3 SEX PARENTS If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effeot extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for SIQUIO De carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, Usual
N. H .WVIT. ...
I HEREBY CERTIFY that a satffaotey standard certificate of death was filled with me BEFORE the burly or transit permit was Issued : Com. Nochildreno (Signature of Agent out Board' of Health or other)
11.0
Sepr. 11/4.5
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
Seht /3
1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) asphyxiation by Drowning
ACHT JOUCHO200 Sil) infileter)
20 Accident, sulolde, or homlolde (specify) Date of ooourrenoe. 19
Where did Injury ocour?
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In publlo
place ?
(Specify type of place)
Manner of Injury
Nature of Injury
While at work?
Was there an autopsy?
21 Was disease or Injury In any way related to ocoupation of deceased?
If so, specify.
Til Ji Letaltère
M. D.
(Signed)
Date.
4/5 1950g.
22 Forest Sale
Malden
Place of Burial, Cremation or Remgyal.
(City or Town)
DATE OF BURIAL.
Sept.
17
19:45
23 NAME OF FUNERAL DIRECTOR OD % A Hard & Sou
ADDRESS
37 Tuakle ID Thallen
Reoelved and filed ..
SEP 1 8 1945
19
(Registrar)
,
(Usual place of abode)
11
Length of stay: In hospital or Institution ....
(Before death)
(Specify whether)
7yearsf - months days.
In this community
P
yrs.
mos.
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Single
5a If married, widowed, or divoroed -HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If alive .. years
7 IF STILLBORN, enter that fact here.
8 AGE 69 Years 3 Months 3 Days
If less than 1 day .. Hours ....... Minutes
9 Occupation :
Kurse
10 or Business :
Industry
Private nursing
11 Soolal Security No ...... Tour
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
13 NAME OF
FATHER
Macia Hayward
14 BIRTHPLACE OF
FATHER (City)
(State or country)
nova Scotia
15 MAIDEN NAME OF MOTHER Card
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
17 Informantladas ty Hayward zu you ( AMITPRA ) would
50ml (g)-1-41-4667
PLACE OF DEATH
Suffolle /kgunty) Winthook no
(City or Town)
No.
Bouton Harlos Skinthrop Beaux za:
00
9 filed for burial permit ith Board of Health or its Agent.
174
Registered No.
eath occurred in a hospit
( give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
226 Clifton Sh
St.
malden
(If nonresident, give city or town and State)
(Was deceased a U. S. War Veteran, so specify WAR)
PHYSICIAN - IMPORTANT
Sara Hayward
The Connuantoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(Address)
EXTRACÎ KOM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physlolan or registered hospital medical officer shall fortliwith, 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 agc. 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 physician or officer and the date of his death . .. Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of dealli as required hy 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 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 cun 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 ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-elght and July fourth, nineteen hundred and two, and the Mexl- csn border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been buried, until he has received a permilt 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 dicd; 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 receiving tomb to another in the saine cemetery, until he has received a permit froin the board of health or its sgent aforesald or from the clerk of the town where the body is burled. 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 he returned and recorded, which shall be accompanied, In case of an original interment, by a satisfactory certificate of the attending physiclan, 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 medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and In the pos- session of the undertaker desiring to make such removal shall constitute & perniit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such re- moval, 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 I'nited 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 regis- tration. The person to whom the permit is so given and the physiclan cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceaard, 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 du 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 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 E'di- tion).
Medical examiners shall make examination upon the vlew 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. G.
... lle 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 obaervance of the following rules of practice :
(1) Attending physiolans 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 physiolans will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any forni of injury, have died without recent medical attendance or whose physi- cian Is absent from home when the certificate of death Is needed.
(3) Msdical Examiners will investigate and certify to all deaths sup- posably dus 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 dissass resulting from injury or Infeollon related to occupation, ths sudden deaths of persons not disabled by recognized disease, and those of persons found dsad.
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 miode of its production together with the circumstances when these are known. For example: "Coin- pound fracture of the femur with ensuing septicemia (gas hacillus) 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 adininistered 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 presumahle 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
-
R-301 A
REAThattions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
100m-9-44-14955
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) No. 22 Pleasant Pk Rd
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.
Registered No.
175
St. § (If death occurred in a hospital or institution, ! give its NAME instead of street and number) )
2 FULL NAME
ilter J. Andrews (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 22 Pleasant Pk Rd. St.
(Usual place of abode)
(If nonresident, give city or town and State)
25
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4
COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
Male White
Laura E. Hanson
HUSBAND of ..
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
67
. years
7 IF STILLBORN, enter that fact here.
8 AG 65
Years
1
Months
-
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Printer
Industry 10 or Business:
Ginn
Co
11 Social Security No. OI0 -03-8135 A.
12 BIRTHPLACE (City)
(State or Country)
N. H.
13 NAME OF
FATHER
John Andrews
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Germany
15 MAIDEN NAME OF MOTHER Cannot be Learned
16 BIRTHPLACE OF
MOTHER (City) .
(State or Country)
Germany
17 Laura Andrews ( RWifefany )
Informant (Artdress) 22 Pleasant Pk Rd.V.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William D. Childress (Signature of Agent of Board of Health or other)
agent (Official Designation) 9/68/14 Per Blue of Permit
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept.
(Month)
16.1945 (Day) (Ycar)
Ja- 2 . 19 X
19 I HEREBY CERTIFY. 6 , to That I attended deceased from 0 16 .. 19 . 19 YA death is said to
1 last saw h
alive on
Have occurred on the date stated above, at
m.
Duration
IMFORENT
...
6 turue
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistigally.
20 Was disease or injury in any way related to occupation of deceased? It so, specity
(Address)
21 Gorham
Gorham Maine
Place of Burial, Cremation or Removal. (City or Town) DATE OF BURIAL Sept 19 1945
19
22 NAME OF
FUNERAL DIRECTOR
John HO males.
ADDRESS Winthrop
Received and Filed SEP 1 8 1945
19
( Registrar)
×5
Immediate cause of death)
Ceuta Pulam Eduna
Due to
Saucer of lever
Saucer of Rechen
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings:
Of operations
Saucer of Realien
Date of
Of autopsy
What test confirmed diagnosis?
( Signed)
19 Hunala SV 2/3 Date
19/17
. M. D.
19℃
PHYSICIAN - IMPORTANT ( Was deceased a U. S. War Veteran, if so specify WAR)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
1
Manchester
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 persou 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, furnisb 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 be died, defined as re- quired 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 four- teen, shall, if the deceased, to the best of bis 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, 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 tbe same. For neglect to comply with any provision of this section, such physician or officer sball forfeit ten dollars. For the purposes of tbis 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 Cbina relicf 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 buried, until he has received a permit from the board of bealth, 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 receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been 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 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 bours 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-aix, 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 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 bis 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 wben 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 deatbs 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.
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