USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 28
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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 tbe interment is inade. . . . 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 whoin they have given bedside care during a last illness froin disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, thougb 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 .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., lieart failure, asphyxia, astbenia, 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 important, so that the relative healtbfulness 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 froin 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, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 A
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) 199 Shore Drive .......
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
St.
[ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
Barnet Klein
(If deceased is a married, widowed or divorced woman, give also maiden name.) 199 Shore Drive St
(a) Residence. No .....
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
years
months
days.
In this community /3 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR, OR RACE
white
5 SINGLE
MARRIED
(write the word) married
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of.
Hannah Grund
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
38
.years
6 Age of husband or wife if alive ..
7 IF STILLBORN, enter that fact here.
8 41 Years ..... Months. 3. Days
If less than 1 day Hours. Minutes
9 Occupation :
Dentist
Industry
10 or Business:
For himself
11 Social Security No. more
12 BIRTHPLACE (City) Cack Bastos Marc (State or country)
13 NAME OF
FATHER
Samuel Klein
14 BIRTHPLACE OF
FATHER (City)
OF Russia
(State or country)
15 MAIDEN NAME
OF MOTHER
da Francia
16 BIRTHPLACE OF
MOTHER (City) .....
Russia
(State or country)
17 Hannah Klein (wife Informant ... (Address) 199 Shore Drive, With
I HEREBY CERTIFY that a satisfactory standard certificate of death wes filed with me BEFORE the burial or transit permit was issued: William D. Childress (Signature of Agent of Board of Health or other)
agent.
may 12/4/
(OfficlalDesignation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Iman
12
1941
(Month)
(Day)
(Year)
19
HEREBY CERTIFY,
19
to
That I attended deceased from
I last saw h.
.alive on
19
death is said to
have occurred on the date stated above, at ...
5:40 A m.
Duration
IMPORTANT
Immediate cause of death.
Natural causes.
Due to. Presumably
Due to.
Coronam /occlusion
Few hours
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings:
Of operations.
Date of
Of autopsy.
What test confirmed diagnosis?
20
Was disease or injury in any way related to occupation of deceased? MO
If so. specify,2 .....
(Signed).
(Address) Winthrop Board of Days 15/10h
19.4%
21
Public Raac Uchanan em Everest Place of Burial, Cremation or Removal. (City or Town) 12 1941
DATE OF BURIAL.
may
22 NAME OF
Manuel Stanetiky
FUNERAL DIRECTOR ...
ADDRESS
10 Wuchington At. Dans
Received and filed Zulay 20
(Registrar)
To be filed for burial permit with Board of Health or its Agent.
Registered No
no.
(If U. S.
War Veteran.
specify WAR)
Winthrop
(If nonresident, give city or town and state)
I AGE ... PARENTS is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-2 -* 40-D-729-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Usual
No ...
Relation, if any
Underline the cause to which death should be charged sta- tistically.
19
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.
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 receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. if there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed 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 perinit 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 re- moval 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 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 held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to 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 .- 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 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 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, 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
ARM R-303
MARGIN RESERVED FOR BINDING
50m-10-'39. No. 8427-h
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued: Www. D. Childress (Signature of Agent of Board of Health or other) Healthe Officer 5/14/4/
..
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
man -
13-1941
(Month)
(Day)
(Year)
49 | 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.) acute cardiac Failure Private Corman clerosis arterio Jelenti Heart Disease
20 Accident, suicide, or homicide (specify).
Date of occurrence .....
19
Where did Injury occur ?.
( City or town and State)
Did injury occur in or about home, on farm, in industrial place, in
public place?
....
(Specify type of place)
Munnof of
Injury
Collapsed while pushing a
Inftry
Nature of
laun mouve
/While at work ?
Was there an autopsy ?.
20
21 Was disease or lojory lo any way related to occupation of deceased ?
If so, specify.
Hr .. Suckles
(Signed)
M. D.
(Address)
Mais, 13 1941
22
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
I6
4I
19.
23 NAME OF
FUNERAL DIRECTOR ..
Howard Sternaldo
ADDRESS.
U inthof mass.
Received and filed
may 20.
A TRUE COPY ATTEST: (Registrar)
1
.........
.St.
(If deceased is a married, 'widowed or divorced woman, giveAlso niden name.)
(a) Residence. No 154 Circuit Read Millones
(Usual place of abode)
Length of stay : In hospital or institution
years
months
(Specify whether)
(write the word)
Married
Annie
Rafael Ittt
6 Age of husband or wife if alive. Years 7 IF STILLBORN, enter that fact here.
If less than 1 day
Hours
Minutes
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
No en route to Writterof Community Hospi
(City or town making return) ...
Registered No
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
(If nonresident, giye city or town and state)
days. In this community-
yrs.
mo3.
days.
.-
1
2 FULL NAME
William Little
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE| 5 SINGLE
MARRIED
Male
White
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
67
IO
8
AGEZO
Years
Months20
Days
Usual
9 Occupation:
Machinist
10 or Business:
II Social Security No .........
None
12 BIRTHPLACE (City)
(State or country)
Scotland
14 BIRTHPLACE OF
15 MAIDEN NAME
OF MOTHER
Mary Law
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
17
Annie Little
Informant ..
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
Industry
Navy Yard
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
FATHER (City)
(State of country)
Scotland
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
13 NAME OF
FATHER
William Weir Little
PLACE OF DEATH
Suffolk ( County) Wattrop (City or Town)
Relation ef any
(Address)
154 Circuit Road Winthrop
DATE OF BURIAL
May
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiclan or rogistered hospital medical officer shall forthwith, after the death of a person whom he bas attended during his last illness, at the request of an undertaker or otber authorized person or of any member of the family of the deceased, furnisb 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 be 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, Scc. 9.
No underlaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefroin a human body which has not been buried, until be 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 elerk 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 cemetcry 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 bealth 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 hercinafter provided. If there is no attending physician, or if. for sufficient reasons, bis certificate cannot be obtained early enough for tbe 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 witbin the commonwealth cannot be obtained early enough for the purpose, tbe 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 sucb removal, unless a permit in the usual form for the removal of such body has been sooner obtaincd 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 sball appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, sball 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 fur- nisb 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 er the ashes thereof which bave been brought into the commonwealth until he has received a permit so to do from the board of bealth 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 bave 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 only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within bis 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 dicd 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, Scc 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 discase un- related to any form of injury, have died witbout recent medical attendance or whose physician is absent from home wben tbe certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably duo 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 lo occupa- lion, 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, tbe mode of its production together with the circumstances wben these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam 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 discase or injury was related to occupation, specify. If inves- tigation shows the death to have been duc 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
M R-301 A |
1
Winthrop
(City or Town)
No ... 164
3 SEX
Female
4 COLOR OR RÄCE
White
AGE
2
Usual
9 Occupation :
Housewife
10 or Business:
11 Social Security No.
None
PARENTS
17
Informant
Helen Smith
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
100m-2-'40-D-729-a
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Industry
Own Home
PLACE OF DEATH
Sufflok (County)
Court Road
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.
§ (If death occurred in a hospital or institution.
St. { give its NAME instead of street and number)
2 FULL NAME
Florence Perley (Huse Wingersky
(If deceased is a married, widowed or divorced woman, give also maiden name.)
164 Court Road
.... ...... ...........
St
(If nonresident, give city or town and state)
years
months
days.
In this community 36
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Marrie
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Abram Samuel Wingersky
(Husband's name in full)
.years
7 IF STILLBORN, enter that fact here.
8
.65
Years
3
Months.
Days
If less than 1 day
Hours
Minutes
12 BIRTHPLACE (City).
(State or country)
Maine
13 NAME OF
FATHER
George Huse
14 BIRTHPLACE OF
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