USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 6
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(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
3 SEX
Female
Thite
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Andrew Doig
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
AGE 87
Years
Months.
15
Days
Usual
9 Occupation:
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Dundee
(State or country)
Scotland
13 NAME OF
FATHER
Thomas Gray
PARENTS
17
Informant ..
William Doig
CAUSE OF 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.
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Industry
Own home
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
Of autopsy
.......
What test confirmed diagnosis? Clomid-he
Major findings :
Of operations
Date of.
(Address)23 Almont St
Winthrop Mass
Relation, if any
son
V
St.
(If U. S.
War Veteran,
specify WAR)
years
months
days.
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 iliness, at the request of an undertaker or other authorized person or of any member of the family of the deceased. furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccased, 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.
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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shai! make such certificate. If such a permit for tl:e 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 shali 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 thereatter fur- nish 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.)
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 heid, or from a person appointed to have the care of the cemetery or burlai ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths oniy as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death Is needed.
(3) Modical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia). and 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 occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, c. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name carlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had 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 busi- ness, 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 houscwork. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekceper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-303 B
PLACE OF DEATH
Suffolk (County) Mutterop (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS <
MEDICAL EXAMINER'S CERTIFICATE OF DEATH 1ER
To be filed for burial permit with Board of Health or its Agent.
Registered No ..
17
§ (If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME.
(If doetased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 76 Fremont St. Fruttirob
C
(Usual place of abode)
Length of stay: In hospital or institution
years
(Specify whether)
months
days.
(If nonresident, give city or town and Sizle)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE| 5 SINGLE
Swrite the word)
MARRIED
WIDOWED
or DIVORCED
Single
Sa If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
AGE 39 Years
2 ..... Months.
.... Days
If less than 1 day
Hours
Minutes
Laborer
Industry Road construction
II Social Security No.
East Bouton
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Robert J. Smith
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
Ennis
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Mary A, Laith Kelation, if any SISTER
76 Freneti Quetrok
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or ptransit permit was issued: Www. D. Childressx. (SInature of Agony of Board of Health or other) Reality Offices 2/2/40 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Jan -
31-1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereo? are as follows: (If an injury was involved, state fully.) asphyxia due To Smoke Inhalation. alcohol:
Found collapsed in hested room which was afine
Presumably accidental
Was there an autopsy ?.
yes
(See reverse side for description for unknown person)
20 Where did
injury occur?
frutti
(City or town and State)
21 Was disease or Injury In any way related to occupation of deceases ?.
If so, specify.
(Signed)
(Address)
Bester
Kogte-1- 1940
22
Holy Cross Halden
Place of Bufial, Cremation or Removal.
4 et 3
(City or Town)
DATE OF BURIAL
194-6
23 NAME OF
FUNERAL DIRECTOR ...
David De Dooley
ADDRESS
35 London 1
Received and filed. 19
(Registrar)
3 5m-10-139. No. 8427- correction on weathers name as persundulating PARENTS
I 3 SEX (or) WIFE of Usual 9 Occupation: Informant. (Address) of Death. See reverse side 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 supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 10 or Business:
No gu suite to bauturile Community Hvad George & Smith
.St.
(If U. S.
War Veteran,
speci'y WAR).
World
M. D.
15 MAIDEN NAME
OF MOTHER
Rose LA, Euis
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 regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed agc, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46. Sec. 9.
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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory 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 physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner 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 cnough 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 rceital 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 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. 15. G. L., as amended.
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 issuc 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 cure 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 only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within hla 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.
. .. 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 man- ner of death .- General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is 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 septice- mia). 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 occupa. tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences ; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemla (gas bacillus) caused by a stcam railway ac- cident." "Pistol shot wound of the chest with associated hemor- rhage, homicidal." "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal Injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If Inves- tigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under man- ner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death) ."
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-305
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m-10-'39. No. 8427-g
17
Informant
Nathan Goldberg
Relation, if any uncle
(Address)
A TRUE COPY.
ATTEST:
(Registrar of city ortewn where death occurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January 2 .1940.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
Asphyxiation by suspension
Paranoid psychosis-previous
attempts.
20 Accident, suicide, or homicide (specify)
Suicidal
Date of occurrence. Jan 2 0 40
Where did
Boston
Injury occur?
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in
public place?
Hospital
(Specify type of place)
Manner of Injury
Nature of Injury
While at work?
Was there an autopsy ?
NO
21 Was disease or injury la any way related to accapation of deceased ?
If so, specify.
(Signed)
T Leary
(Address)
Boston
Date
1/2/460
D.
22.
Hertzel-Everett
ity or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
19
1/3/48
23 NAME OF
FUNERAL DIRECTOR
M Stanetsky
ADDRESS
Dorchester
Received and filed.
1/4/40
19
(Registrar of City or Town where deceased resided)
1
Boston
(City or Town)
No Boston City 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 ..
15
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Sumner Porter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
411 Shirley
St.
Winthrop
(If nonresident, give city or town and state)
Hospital ..
years
months
7 days.
In this communit22 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX M
4 COLOR OR RACE 5 SINGLE
MARRIED
W
WIDOWED
or DIVORCED
Single
5a li married, widowod, or divorced
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.
7 IF STILLBORN, enter that fact here.
8
AGE
28
Years
.Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Chauffeur
WPA
Industry 10 or Business:
11 Social Security No.
-
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Abraham Porter
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Fannie Goldberg
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
PARENTS
Suffolkx
PLACE OF DEATH
(County)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
(write the word)
Years
1
THRUP.
FEB171940 AM
R-302
PLACE OF DEATH
(County)
Boater
(City or Town)
No. Beth Israel ... Hosp
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOGSOM (City or town making return)
Registered No.
168
(If death occurred in a bospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 70 Beach Road
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
2
days.
In this community
1 5'rs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE 5 SINGLE
MARRIED
W
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
47
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
AGE 52
Years
Months.
Days
If less than I day
Hours
Minutes
Usual
9 Occupation:
Grocery business
Industry
10 or Business:
Retail store
II Social Security No. -- -
12 BIRTHPLACE (City)
(State or country)
"Russia
I3 NAME OF
FATHER
Louis Freedman
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Louise J Levitas
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant.
(Address)
Wife
(.
A TRUE COPY.
ATTEST:
James Q. Burke
(Registrar of city or town where death occurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
January 7, 1940
(Month)
(Day)
(Year)
19
-
1/5/40
19.
CERTIFY.
eased from
I last saw h ... ].m ... alive on
1/7/40
to have occurred on the date stated above, at.
11:15A
Daration
Immediate cause of death.
Cerebral thrombosis
wks
Congenital heart failure
mos
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 ?.
20 Was dlsease or Injury In any way related to occupation of deceased ?
If so, specify
L Rosenfeld
(Address)
Beth
.. Israel Hos Date ..
1/7 19 40
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mt. Lebanon Beth El
West Roxbury
(Cemetery)
1/8/40
19
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
J H Levine
ADDRESS
Dorchester
Received and filed 1/10/40 19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) Q1 uçath anydid be wansittty of Form A.Jos to the clerk of the city of town in which the deceased resided as soon as possible PARENTS
1
1
(If U. S.
War Veteran,
specify WAR)
Winthrop
St.
(If nonresident, give city or town and state)
That I attend
1/48
19
...
to ...
19 ........ ,
death is said
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
(Signed)
Relation, if any
1
Israel Freedman
0
THEO?
FEB171340 MM
·
R-302
1
PLACE OF DEATH No. Holy Ghost Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge (City or town making return)
Registered No ...
60
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
2 FULL NAME
EdilirasLawrence e & direred goman, give also maiden name.)
..... .St.
(If nonresident.1ghereityrr town and state)
Length of stay: In hospital or institution ...
years
months
days.
In this community
yrs."
35
mos.
days.
Hopital 3
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH
(Monthy
Jan 13 1940
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden Amebl ffe Gobbeman
(or) WIFE of
(Husband's name in full)
Years
7 IF STILLBORN, enter that fact here.
8 AGE
Years
.Months.
Days
If less then 1 day
Hours.
Minutes
Usual
9 Occupation:
Waiter Retired
Industry
10 or Business:
Hotel
11 Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
St John
13 NAME OF
FATHER
Newfound land
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