USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 19
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Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
+
SUFFOLK I BOSTON (County)'
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return) 4110 62
Registered No. J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ..... .years 5 months. .days. In place of residence
15 years
months.
.. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED !!
Widowed
4 I HEREBY CERTIFY,
That I attended deceased from
19/19
alive on
May 9
19.44.9. death is said to
7:25 PM.
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET
AND DEATH
TO DEATH
(a) Carcinoma of stomach
4 yrs
11 IF STILLBORN, enter that fact here.
12
Years
AGE.(.
.71
2
22
Months
Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation:
Housewife
14 Industry
or Business:
Home
15 Social Security No.
None
16 BIRTHPLACE (City)germany
(State or country)
17 NAME OF
FATHER
Charles Oeffinger
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
Marie Geiser
20 BIRTHPLACE OF
MOTHER (City) .Germany ..
(State or country)
21
Informant
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
19
...
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
L H Nason
M. D.
Date May 10 10 49
Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
May 12
1940
7 NAME OF
FUNERAL DIRECTOR
H ... S .... Reynolds
Winthrop .... Mass
ADDRESS
May ..... 12
19.49
Received and filed MAY 3 1 1949
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
RM R-302 1
PLACE OF DEATH
No. 42 Southbourne Rd
2 FULL NAME
Bertha Geweke
(a) Residence.
No.
45 Pleasant St
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May 9/49
(Month)
(Day)
Jan
45,
19
to.
May 9
I last saw
.er
DISEASE OR CONDITION
DIRECTLY LEADING
/
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
Metastases to liver
SIGNIFICANT
CONDITIONS
Of operations
What test confirmed diagnosis?
(Address).
Boston ... Mas.s.
6
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
Date of operation
11-5-45
Was autopsy performed?
50m-(e)-10-48-24658
(Year)
10a
If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Adolph Geweke
(Husband's name in full)
(Kind of work done during most of working life)
Major findings:
Carcinoma of stomach
C Oeffinger
RM R-301A 1
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
To be filed for burial permit with Board of Health or its Agent.
Registered No.
63
2 FULL NAME. Herbert Wilson Floyd
.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 139 Somerset Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ...... years months days. In place of residence. 90
.years ... months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
may
11
1949
(Months
(Day)
(Year)
4 I HEREBY CERTIFY,
Jan 15
19
49
to
May 11
19
49
That I attended deceased from
I last saw him alive on
May 10, 1949, death is said to
have occurred on the date stated above, at
6:30 A m.
INTERVAL BE-
TWEEN ONSET AND DEATH
years
ANTE Due To CEDENT (b) CAUSES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation
.Was autopsy performed?
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? no If so, specify.
(Signed) Dorothy Cheney appleton M. D.
(Address) 197 Wordside and, Witha Date May 11 19:49
maso
6 Winthrop
Place of Burial or Cremation
DATE OF BURIAL
May 14
149
7 NAME OF
FUNERAL DIRECTOR ....
Lawand rynoll
ADDRESS Winthrop Mes.
Received and filed 19
MAY 2 0 1949
(Registrar)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced
HUSBAND of
Helen M .Yaw
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
90 6
Months
4
.Days
If under 24 hours
Hours ... . Minutes'
13 Usual
Occupation :.
Clerk (retired)
(Kind of work done during most of working life)
14 Industry
Tea & Coffee Co.
or Business:
15 Social Security No.
None
Winthrop
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF FATHER William Bates Floyd
18 BIRTHPLACE OF
FATHER (City)
Winthrop
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Hannah Augusta Wilson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Malden
Mass.
21 Informant (Address)
Henry Floyd Sampson
18 Robert St. Wakefield, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Water & Makers (Signature of Agent of Board of Health or other)
Health Office 5/Kg/49
(Official Designation) (Date of Issue of Permity "
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean de of dying, such failure, asthenia, means the disease, plications which death.
orbid conditions, giving rise to the ause (a) stating derlying cause
nditions contrib- the death but not to the disease or n causing death.
100M-(D)-10-46-24658
No.
139 Somerset Ave
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(Usual place of abode)
(write the word)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) .
arteriosclerosis
PARENTS
Winthrop
(City or Town)
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 he 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 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 four- een, shall, if the deceased. to the best of his knowledge and belief, served in the rmy, 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 hall also certify in such certificate both the primary and the secondary or imme- liate cause of death as nearly as he can state the same. For neglect to comply rith any provision 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 f said chapter one hundred and fourteen, the word "war" shall include the China elief expedition and the Philippine insurrection, which shall, for said purposes, be leemed to have taken place between February fourteenth, eighteen hundred and inety-eight and July fourth, nineteen hundred and two, and the Mexican border ervice of nineteen hundred and sixteen and nineteen hundred and seventeen. S. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body n a town. or remove therefrom a human body which has not been buried, until he as received a permit from the board of health, or its agent appointed to issue uch permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shall exhume a human body and emove it from a town, from one cemetery to another, or from one grave or tomb ther than the receiving tomb to another in the same cemetery, until he has eceived a permit from the board of health or its agent aforesaid or from the clerk f the town where the body is buried. No such permit shall be issued until there hall have been delivered to such board, agent or clerk, as the case may be, satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original inter- nent, by a satisfactory certificate of the attending physician, if any, as required by aw, 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 nough for the purpose, or is insufficient, a physician who is a member of the board f health, or employed by it or by the selectmen for the purpose, shall upon pplication make the certificate required of the attending physician. If death is aused by violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from one town o 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 he undertaker desiring to make such removal shall constitute a permit for such emoval; provided, that such body shall be returned to the town from which it was emoved within thirty-six hours after such removal, unless a permit in the usual orm 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 registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- 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 persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or 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 follow- ing 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 physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
A R-303 A 1
of Death. See reverse alde for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplled. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD.
PLACE OF DEATH
Уврев County)
Winthrop (City of Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agent.
Registered No.
61
46 Washington St. - Kirkpatrick Rest House No. Catherine Wallace
J(If death occurred in a hospital or institution, "St. [ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased is a married widowed or divorced woman, give also maiden name.)
67 Cottage Park Rd
(If nonresident, give city or town and State)
Length of stay: In place of death .......
.days.
In place of residence.
9 % ..... years.
.. months
.......
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF DEATH May 11 1949
(Month)
(Day)
(Year)
SEX
Female white
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Widowed
"Give maiden name of wife in fall) (or) WIFE Michael Wallace (Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE.
Years
83 years.
6
Months.
10 Days
If under 24 hours
Hours ........ Minutes
5 Accident, suicide, or homicide (specify)
Acc
Date and hour of injury.
4-28 1949
Where did
Injury occur?
Winthrop, mases.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
Manner of
Fell to flor
(Specify type of place)
Injury
(How did injury occur?)
18 NAME OF
FATHER
Patrick Jemand
19 BIRTHPLACE OF FATHER (City) (State or country)
Suland
20 MAIDEN NAME
OF MOTHER
many Gorman
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ordland
Catherine Wallace daughter
I HEREBY CERTIFY that aSatisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Received and filed MAY 20 1949
19
(Signature of Agent of Board of Health or other)
....
4525
(Official Designation) (Date of Issue of Permit)
(Registrar)
PARENTS
Was autopsy performed? no
6 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
ichart tart
(Signed)
Lichard
M. D.
(A de) Boston
Date 5-12 19 49 LA Josephis Cem. Flymento 7
Place of Bumal, of Cremation. (Gy or Town)
DATE OF BURIAL man 14 194/9 7 ....
8 NAME OF FUNERAL DIRECTOR Rad . Ryan
ADDRES 28 midelle St. Glymnetto.
50m-(g)-10-48-24658
(a) Residence. No.
(Usual place of abode)
Nature of
Injury
While at work?
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
place?®
At home
4I 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.) Generalized arteriosclerosis
Fracture of hip. Accidental-
14 Usual
Occupation:
(Kind of work done during most of working life)
15 Industry
or Business:
none
16 Social Security No more .
17 BIRTHPLACE (City).
(State or country)
Seland
22 Informant ...... (Address)
10 COLOR OR RACE
11a If married, widowed, or divorced HUSBAND of ...........
(Was deceased a U. S. War Veteran. { if so specify WAR)
Every Item of
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 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 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, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate 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 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-eigbt and July fourth, nineteen hundred and two, and the Mexican 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 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 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 inter- ment, 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 physician 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 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 removal of such body has been sooner obtained hereunder. If the
desta Cofunctie confrunb & recital, as required by section ton of chapter forty -. 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 registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased. or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L. as amended by Chap. 48, Acts of 1927 and Chap. 414. Acts of 1931. No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made ......... Chap. 114. Sec. 46. G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead ....... - General Laws, Chap. 38. Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
.. 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 observance of the follow- ing 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 physician is absent from home when the certificate of death is needed.
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