USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 27
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5/16/47
19
I HEREBY CERTIFY.
That I attended deceased from
Nev. 7. 1946, to april 16
, 19 47
I last saw h halive on afax
/4, 1944 7, death is said to
have occurred on the date stated above, at
945 Am.
Immediate cause of death
Chronic Myorcondition
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis?
Duration IMPORTANT
2 yrs.
5 yrs.
IMPORTANT
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?
It so, specify
Louis 7 Salerno
(Signed)
. M. D.
(Address) 125 Pulamsemnt St Date Ofany 16 1947
21
Hand in Hand,
West Roxbury
Place of Burial, Cremation or Removal. (City of Town)
DATE OF BURIAL 1912
22 NAME OF
FUNERAL DIRECTOR
420 Harvard Street, Brookline.
ADDRESS
Received and Filed APR 18 1947 19
( Registrar)
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.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
PARENTS
Tafelkruger
100m-9-44-14955
. .
-
2 FULL NAME
JOSEPH ZETTER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St
MEDICAL CERTIFICATE OF DEATH
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 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 hy 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 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 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 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 he 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 removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten or chapter toriy. 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 he 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 hody 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 hody 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 hoard, 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 s a deaths only as those of persons who, though disabled by recognized disease unrelated to any forin 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- posally 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.
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
R-303-A
-
1
PLACE OF DEATH
Salluck (County) Northrop
TENNE PETION
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH 1
To be filed for burial permit with Board of Health or its Agent.
Registered No.
29
St. § (If death occurred in a hospital or institution, ( give its NAME instead of street and number)
2 FULL NAME ..
Ellen J. Mahoney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 12
Thurston St. East Boston
(Usual place of abode)
(If nonresident, give city or town and State)
mos.
7
days.
Length of stay: In hospital or Institution.
( Before death)
( Specify whether)
months
7
days.
In this community
In E. B. 40 yrs
yrs.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Female
4 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
Single
Sa If marrled, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve -
years
7 IF STILLBORN, enter that fact here. -
8 AGE 38 Years Months. Days
If less than 1 day
Hours ............ Minutes
Usual
9 Occupation :
House work
Industry
own home
11 Soolal Security No. none
12 BIRTHPLACE (City)
Cambridge
(State or country)
vlass.
13 NAME OF
Dennis Mahoney
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
Johanna Kelleher
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Carrk
17 Www. Leo N. Russell Informant .. ((dilerRN) 12 Thurston SY; S.B.
I HEREBY CERTIFY that a satisfactory standard certificate of death was gled with me BEFORE the burial of transit permit was issued :
...
(Signature of Agent of Board of Heatty or other)
4/18/47
(Date of Issue of Permit)
19 | HEREBY CERTIFY that have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof -arg as follows: (If an injury was involved, state fully.) FEMORAL Thromboses Left l'acte Lt Femoral Recent Sepsis RT Calf
20 Accident, sulolde, or homicide (specify) ... specificac)
Date of ooourrengo.
.19
Injury ooour ?
Where did
Jaunes not Determined
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In publio
place?
(Specify type of place)
Manner
· Said to have received an abrasion
Injury
Nature of A Right legaTE. Besten War 28-1943 Injury
While at work ?
Was there an autopsy ?.
yes
?
21 Was disease orynjury In any way/related to ocoupation of deceased ?.
If so, speolfy
(Signed)
M. D.
(Address)
22
Italy Gross, Malden
Place of Buptal, Cremation gr Removal.
(City or Town)
DATE OF BURIAL
April 21.
19 40
23 NAME OF
FUNERAL DIRECTOR
John G. Kelly
ADDRESS
11 Meridian St. E. B.
Received and filed
APR 22 1947
19
(Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physicians to Insert a reoltal to that effeot
50m. (f) -6-43.12056
(Official Designation)
5 SINGLE
(write the word)
18 DATE OF
DEATH
april - 17-1947
(Month)
(Day)
(Year)
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
No.
notified 5/10/47
Nunthink Commenti Hospital
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so spoolfy WAR)
210
Hospital
years
(Give maiden name of wife in full)
10 or Business :
FATHER
15 MAIDEN NAME
OF MOTHER
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 authorizeil person or of any nientber of the family of the decrased, 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 required hy section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer aud the date of his death ... Gen. Laws, Chap. 16, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five ol 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, invert in the certificate a recital to that effect, speci- fying the war, and shall also certily in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the sante. 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" shsil incinde the China relief ex- pedition and the l'hilippine insurrection, which shall, for aaid purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can bonler service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human hody in a tuwn, or remove therefrom a human body which has not been buried, until he has received a perinit from the board of heaith, 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 thau the receiving tomb to another in the same cemetery, until he has received a permit from tite board of health or its agent aforessid or front the clerk of the town where the body is buried. No such permit shall be issued until there shail have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement coutsining 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 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, shail upon application make the certificate re- quired of the attending physician. If desth is caused by violence. the medical examiner shall make such certificate. If such a permit for the removai of a human body, not previously interred, from one town to an- other within the commonwealth cannot he 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 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 re- moval, unless a permit in the usual form for the removal of such hody has heen sooner obtained hereunder. If the death certificate contains a recital, 88 required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the limited 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 atul transmit it to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human hody or the ashes thereof which have been brought into the commonwealth untii lie han re- ceived a permit so to do from the board of health or its agent appointed to issue sucht 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 per- son appointed to have the care of the cemetery or burial ground in which the intermeut is made. . . . Chup. 114, Sec. 46, G. L., (Terceutenary Edi- tion).
Medicai 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 hia county the body of such a person, he shall forthwith go to the place where the hody iies and take charge of the sanie; ...- Generai Laws, Chap. 38, Sec. 6.
. He shall in all cases certify to the town clerk or registrar in the ..
place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the hest of his knowiedge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the foliowing rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whiont they have given bedside care during a last illness from disease unrelated to suy form of injury.
(2) Board of Health physicians wili certify to such deaths only as those of persona who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posahly due to Injury. These include not only deaths caused directly or in- directly hy traumatism (including resulting septicemia), and hy the action of chentical (druga or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths front disease resulting from Injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certilying to a death wiil state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicemia (gas bacillus) caused hy 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 internai injury sus- tained under circumstances unkuwn."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause it's known or presumable nature; sıul (2) under manner, indicate the circum- atances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (hasal ganglia ) (lound 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
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) Winthrop Community Hosp. No.
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.
80
St. ¿ (If death occurred in a hospital or institution, 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 ..
70 Cottage Park Road
St.
(Usual place of abode)
Hosp.
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
In this community
vrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Ma le
4 CDLOR OR RACE
White
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed or divorgednie E Wells
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
75
years
7 IF STILLBORN, enter that fact here.
8 82 2
AGE
Years
Months
Days
16
If less than 1 day
. Hours
Minutes
Usual
9 Dccupation:
Railroad Engineer (Retired
Industry
3. R. B. & L. Railroad
10 or Business:
11 Social Security No .. ..
031-05-7888
Chelsea
12 BIRTHPLACE (City)
(State or Country)
Mass
13 NAME OF
FATHER
Robert Calder
14 BIRTHPLACE DF
FATHER (City).
oston
(State or Country) Mass.
15 MAIDEN NAME
OF MOTHER
Elizabeth Ross
16 BIRTHPLACE OF
MDTHER (City)
(State or Country)
Skowhegan
Maine
17 Annie E Calder Wife Relation, if any
Informant
(Address· 70 Cottage Park Rd. Winthrop I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit peut was issued:
Vater A. Kaner (Signature of Agehy it Board of Health mother
Healte (Official Designation)
Officer (Date of Issue ermit
7/23/41
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
21
(Day)/
1947 (Ycar)
, 19 47
Duration IMPORTANT
17 hours
3 days 5 days
IMPORTANT
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?
If so, specify
(Signed) Maurice Traunstein
. M. D.
(Address) 562 Shipley St. Withrode abril 21 1947
21
Riverview
Grove land
Mass.
Place of Burial, Cremation of Removal.,
(City or Town)
DATE DF BURIAL
April
24
1947
22 NAME DF
FUNERAL DIRECTOR
Lowend Stymolas
ADDRESS
Winship
mues.
Received and Filed APR 3 0 1717 19
(Registrar)
See instructions 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.
100m-9-44-14955
19
| HEREBY CERTIFY,
That I attended deceased from
april 19,
1947
, to
april 21
I last saw heis alive on
april
have occurred on the date stated above, at 11:42 p.
m.
21
. . 1947, death is said to
Immediate cause of death acute Coronary throne boris with acute pulmonary edema
Due to
Bronchopneumonia
Benign prostatic hypertrophy
with urinary obstruction + wienia
Other conditionsin
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of
Df autopsy
What test confirmed diagnosis?
Clinical+ Laboratory
PARENTS
1
Walter Lincoln Calder
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) .
"(If nonresident, give city or town and State)
25
1
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person 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 seen alive by the physician or officer and the date of his death .. . Gen. Laws, Chap. 46, Sec. 9.
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