USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 49
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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 e physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sce: 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 secondaty. of .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 shalla 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 bord is service of nineteen hundred and sixteen and nineteen hund nd even
G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a Lian 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 tt person died; and no undertaker or other person shall exhumJULnen Ledy 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
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 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.
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 &Mfrom 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 ..
IR-301A 1
PLACE OF DEATH
Nuffalle (County) Meuthray (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
161
Tenthrop Community Hosp No.
J(If death occurred in a hospital or institution. St. { give its NAME instead of street and number)
Surah Maged0
(If deceased is a married, widowed or divorced woman, give also maiden name.)
33 nevada
I Vinith
(If nonresident, give city of town and State)
Length of stay: In place of death .. years. months.
3 days, In place of residence.
4. .years. .. . . . . months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
24 (Day)
1953 (Year)
deceased from
I last saw h .c. Lalive on 7/2/ 19 death is said to (or) WIFE of
10a If married, widowed, or divorced HUSBAND of .. Julie maide
(Give maiden Thing of wife in full) Mayla
(Husband's name in fall)
11 IF STILLBORN. enter that fact here.
12
AGE.
63 Years
Months .. .. .Days
If under 24 hours
Hours .. .. Minutes
13 Usual
Occupation :
(Kind of work done Mluring most of working life)
14 Industry or Business:
15 Social Security No More .
16 BIRTHPLACE (City) .... (State or country) quinta
17 NAME OF
FATHER
Tebraham Westerman
18 BIRTHPLACE OF FATHER (City) (State or country) Jussen
19 MAIDEN NAME
OF MOTHER
Dena- Cannot be learned
20 BIRTHPLACE OF MOTHER (City) (State or country)
Quesia
21 Informant. Julius Maged
(Address) 23 Nevada Off, Minthogy I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter &- Bakerg
(Signature of Agent of Board of Health of other)
7,25.57
e
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED, WIDOWED or DIVORCEShred
4 I HEREBY CERTIFY, 7/22 53 to
That I attended
7/24
53
have occurred on the date stated above, at m.
INTERVAL BE- TWEEN ONSET AND DEATH
3cup
ANTE
Due To
CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
What test confirmed diagnosis?
Was autopsy performed? Electrocandrigo-
5 Was disease or injury in any way related to occupation of deceased? If so, specify (Signed) (Addres 122/110207 ST
Thirn Dr. Ali M. D.
Date 1/2/ 19.1-
Melase (Chty or Town)
DATE OF BURIAL July 26
195 3
OB alaron Dolor
7 NAME OF FUNERAL DIRECTOR ADDE S/OWashington DA Dorchester
Received and filed
87-1953 19
(Registrar)
Tealle Officer (Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
does not mean of dying, such lure, asthenia, > ns the disease, ations which th.
d conditions, ng rise to the e (a) stating lying cause
ions contrib- death but not he disease or ausing death.
PARENTS
SOM (B)-1-51 903586
2 FULL NAME ..
(a) Residence. No. (Usual place of abode)
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, no if so specify WAR)
DISEASE OR CONDITION
anterior
DIRECTLY LEADING
TO DEATH (a) Pinte cualquier y podle wir
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 cleath 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-eight 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
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 inforination 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 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.
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 funeralis to be held, or from a person appointed to have the care of the cemetery. ør burial ground to 'which the interment is made.
.Chap, 10A 8H /6. GAL, (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules ofpractice: 1. (1) . Attendjitgiang siians will certify to such deaths only as those of persons to whom t ave rivon Aside care during a last illness from disease unrelated to any form (2)
Board Jej enit physicians will certify to such deaths only as those of persons who, ALLabled 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) uniners willinvestigate and certify to all deaths supposably due to Mitlane includeftet only deaths caused directly or indirectly by
, traumatisme (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.
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town) 231 Bowdoin Street
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
162
Registered No.
J(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
2 FULL NAME ..
Elsie ( W,, Then) Harper
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 231 Bowdoin Street St.
(Usual place of abode) 39
39
(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
3 DATE OF
DEATH
July
(Month)
27
1953
(Year)
(Day)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED arried
4 I HEREBY CERTIFY,
That Inattended deceased from
October
1951
to
27
July
1953
I last saw her alive on
24 July
1953, death is said to
have occurred on the date stated above, at 4. A.m.
INTERVAL BE- TWEEN ONSET AND DEATH
2 mo
71 5
27
Months
.Days
If under 24 hours
Hours
.Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No. .
None
16 BIRTHPLACE (City)
(State or country)
South Carolina
17 NAME OF FATHER Carsten Wulbern
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
Unable to obtain
19 MAIDEN NAME OF MOTHER Meta
20 BIRTHPLACE OF MOTHER (City) (State or country)
Unable to obtain
Germany
21 Ralph M Harper
Informant ... (Address) 231 Bowdoin St. Winthrop
7 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Received and filed
. 1953 19
(Registrar)
10a If married, widowed, or divorced
HUSBAND of ...
(Give maiden name of wife in full)
(or) WIFE of
Ralph M Harper
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING >
TO DEATH (a)
Carcinoma of liver
ANTE
CEDENT (b)
CAUSES
Due To
To Carcinoma of breast.
8 mo
Due To (c)
OTHER SIGNIFICANT CONDITIONS
angina Pectoris
10 you.
Major findings:
Ul Operations Carcinoma of breast
Date of operat
Dec. 1952 Was autops
no
What test confirmed diagnosis? biopsy
5 Was disease or injury in any way related to occupation of deceased ?.... 270
If so, specify thus @ murray
M. D.
(Signed)
Winthrop Mass. Date 28 July 1953
Winthrop
Winthrop
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL July 29 19.5.3
50M-2-19-25666
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter . Makers. (Signature of Agent of Board of Health or other)
Health
7.28.53
(Official Designation) (Date of Issue of Permit)
TRUCTIONS FOR L CERTIFICATE
giving : OF DEATH
not enter e than one e for each (b) and (c)
s does not mean e of dying, such failure, asthenia, eans the disease. lications which eath.
bid conditions, iving rise to the use (a) stating lerlying cause
ditions contrib- the death but not the disease or causing death.
M R-301A 1
No.
......
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Housewife
Charleston
PARENTS
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 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 ing rules of practice: ninety-eight 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 shallexhume 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"l' received a permit from the board of health or its agent aforesaid or from the Jerk of the town where the body is buried. No such permit shall be issued unti there shall have been delivered to such board, agent or clerk, as the case may be ? person's found dead.
physician, or if, for sufficient reasons, his certificate cannot be obtained flan face side of standard certificate of death.
a satisfactory written statement containing the facts required by law to 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 atten 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 If such a caused by violence, the medical examiner shall make such certificate. 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
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