USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 88
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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 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 sball, 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 bundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a buman 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 receiving tomb to anotber 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, bis certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of bealth, or employed by it or by tbe 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 buman 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 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 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 be 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 beld, 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 sucb 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 sucb deaths only as those of persons wbo, 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 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 deatb, 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-botel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
IR-302 1
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
250
J(If death occurred in a hospital or institution, St. [ .give its NAME instead of street and number)
DUPLICATE OF No. 256 (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
........... years .........
months.
.days. In place of residence.
........... years.
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
4 I HEREBY CERTIFY,
That I attended deceased from
19
to
19
I last saw h
alive on.
19
death is said to
have occurred on the date stated above, at. .m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
Months.
Days
If under 24 hours
Hours ..
Minutes
13 Usual Occupation :. (Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City) (State or country)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? If so, specify (Signed) (Address) Date
M. D.
19
6 Place of Burial or Cremation
(City or Town)
DATE OF BURIAL 19
7 NAME OF
FUNERAL DIRECTOR
ADDRESS.
Received and filed. 19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF FATHER
18 BIRTHPLACE OF FATHER (City). (State or country)
19 MAIDEN NAME OF MOTHER
20 BIRTHPLACE OF MOTHER (City) (State or country)
21 Informant (Address)
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
.......
19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a)
ANTE
CEDENT (b)
CAUSES
Due To
Due To (c)
50m-(e)-10-48-24658
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
No.
2 FULL NAME
Registered No. VOID
(Was deceased a
U. S. War Veteran,
if so specify WAR)
3 DATE OF
DEATH
(Month)
(Day)
(Year)
MR-301 A
Suffits Boston 1/10/49
(County)
Wwithop
(Chy or Town) W withinla Community No.
?
2 FULL NAME
(If deceased fa . merried, widowed or divorced women, give also maiden neme. )
(.) Residence. No.
V 25 Rep Fire
Rd.
(Usual place of @bode)
Hospital
years
months
5
days.
In this communi
ty 67 yrs.
mos.
dayı.
PERSONAL ANO STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEI
Female White
5 SINGLE
( write the word)
MARRIED
WIOOWED
or DIVORCED armed
5a If married, widowed, or divoroed
HUSBANO of
Of higuys maiden name of were none
(or) WIFE of
( Husband's name in full)
6 Age of husbend or wife if allve
9/ years Immedlete cause of death
7 IF STILLBORN, enter that fect here.
AGE
88 re
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Ocouoation :
ar
Home
Industry 10 or Business :
11 Social Security No.
vint
12 BIRTHPLACE (City)
( Siate or country)
22.0.
13 NAME OF
FATHER
Not Known
Walsh
14 BIRTHPLACE OF
FATHER (City)
Harlan
Brack
(State or country)
15 MAIDEN NAME
OF MOTHER
Not Known
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
na
Harlan Brace
17 Informant ( Address)
ThomasJ. Murphy(.
25 neptune trata
I HEREBY CERTIFY thet a satisfactory standard oartifioste of death was filled with me BEFORE the burial of transit parmit was Issued: Watter & Baker (Signature · Host of Board of Health or ofher)
Ho Dec.31/1948
(Omcial Designation) ( Date of Trque of Permit)
20 Was disease or injury in any way related to occupation of deceased ? 14
If so, spoolfy ...
(Signed).
Sars-
M. D.
(Address) 52 CALL A. B.B. Onte 12/31 1948
mardin
(City or Town)
Place of Burial, Cremation or Removal.
OATE OF BURIAL ....
Jan
3
1949
22 NAME OF
FUNERAL OIREO
ADORESS
OR Tudevik + mancate
Received and filed ...
JAN 3-1949
19
( Registrar)
ehautd ha carefully cunnlied
extracts from the laws on back of certificate. terms, so that it may vụ property ciast :u. KAnti ···· MƯU VIV If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physicians to insert a recital to that offoot. PARENTS
100m-(g)-1-45-15510
AGE should be stated EXACTLY .. PHYSICIANS auld stato.CAUSE OF DEATH in slain 8
12.4
To be filed for burial permit with Board of Health or its Agent. 251
Registered No.
{ (If death occurred in a hospital or institution, { give its NAME instead of street and numher)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
none
St.
(If nonresident, give city or town and Stete)
Length of stey : In nnsoitai or Institution/.
( Before death)
( Specify whether)
18 DATE OF
DEATH
(Mfonth)
31
1948
(Day)
(Year)
19 I HEREBY CERTIFY.
Oct. 1
1948, to Dec. 31
1948
i lest saw h.
er
.alive on
Du, 30, 1948, death Is said to
have occurred on the date stated above, at 3:25 A. .m.
Duration
IMPORTANT .... 4 days
Que to ...
Chimie Cofidis
arterio - recursos
Due to
Other conditions.
(Include pregnancy within 8 mouthe of death)
Major findings:
Of operations
Dete of
Of autopsy.
What test confirmed diagnosis?
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
21
Relation, If any
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
1
PLACE OF DEATH
Hartan Grave
That i attended deosased from
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 helief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired hy section one, where same was contracted, the duration of his last illness, when last seen alive hy 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 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 hoth 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, he deemed to have taken place hetwecn February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder 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 heen huried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomh 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 hoard, agent or clerk, as the case may he, 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, hy 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 hy 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 hody shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has heen sooner obtained hereunder. If the death certificate contains a recital, as required
hy section ten oi chapter tory-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can 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 hy 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 hody 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 he huried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given 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 hy 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 hy traumatism (including resulting septicemia), 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 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 morhid 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 he 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 he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation hy the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OM R-305
PLACE OF DEATH
JEFOLK (County STON
(City or Town) "
No. Ma.s.s .. Gen. Hosp
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
11852
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME.
(If deceased ie a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
104 Cliff
St.
Wånthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months 3
days.
In this community
15yrs.
mos.
daye.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Marr.
Sa If married, widowed, of divorced an Kerr
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
19 | HEREBY CERTIFY that ! 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.) Flame burns of body and of arms Old cerebral hemorrhage
6 Age of husband or wife If allve
5.6
years
7 IF STILLBORN, enter that fact here.
8
AGE.5.5
Years.
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Sales eng.
Industry
10 or Business :
heating equipt.
11 Soolal Security No.
Chelsea
Did Injury occur In or about the home, on farm, In Industrial place, or In
publlo place?
about ..... home.
(Specify type of place)
Manner of
Injury
Clothing accidentally
Nature of
ignited at
his home 12 /23/48
Injury
While at work?
Was there an autopsy?
no
21 Was disease or Injury In any way related to occupation of deceased ?
If so, speolfy
W
J Brickley
(Signed)
M. D.
(Address)
Boston
Date
12 259 48
22
Winthrop - Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
12 /28 48
19
23 NAME OF
FUNERAL DIRECTOR
M W Kirby
ADDRESS
Winthrop
Received and filed
JAN 22 1949
19
(Registrar of City or Town where deceased resided)
=
of the city or town in which the deceased resided as soon as possible after the close of the month in which the death resided in another city or town at the time of death should be made forthwith and transmitted on Form R-305 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
WRITE PLAINLY. WITH UNFADING BLACK INK
occurred. (See Chap. 46, Sec. 12, G. L.)
25m (h)-1-41-4667
A TRUE COPY.
ATTEST :
12/29/48
(Registrar of esty or town where death occurred)
DATE FILED
19
20 Acoldent, sulclde, or homloide
( specify).
accidental
Date of occurrence ....
12/23/48
19
Where did
Winthrop
Injury occur ?
(City or town and State)
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Harry Hanson
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Norway
15 MAIDEN NAME
OF MOTHER
Augusta Bengt son
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
17
Informant.
(Address)
wife
Relation, if any ( ..
18 DATE OF
DEATH
Dec.
25/48
(Month)
(Day)
(Year)
M
W
PARENTS
1
THIS IS A PERMANENT RECORD
St.
Chester B. Hanson
RECEIVED
.12
5
6
JAN221949 PM
FI R-302
1
PLACE OF DEATH
S.U.F.FOLK (County)
...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
11323253
( If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
(If deceased ie a married, widowed or divorced woman, give also maiden name.)
88 CLIFF AVE
St.
WINTHROP
MASS
(a) Residence. No.
(Usual place of abode)
Length of stay : In hospital or Institution ..... HOSR.
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