USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 53
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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 hla 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 hls 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 permlt 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 recelving 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 untll 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 accompanled, 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 physiclan, 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 regulred of the at- tending physician. If death Is caused by vlolence, 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 carly 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 hercunder. 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 permlt. 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 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 elerk or registrar may require .- Chap. 114, See. 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 Ita 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 burled 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 fer the observ- ance of the following rules of practice :
(1) Attending physlelans will certify to such deaths only as those of persons to whom they have given bedside care during a last III- ness from disease unrelated to any form of injury.
(2) Board of Heaith physielans 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 anpposably 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, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earller morbld con- ditlons, if any, related to the principal cause and any important complleation of the prinelpal cause.
Sialement 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 housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 |
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 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
PLACE OF DEATH
No ......
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
159
(If death occurred in a hospital or institution, give its NAME instead of street and number)
mian
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(1)& Congress Que
St.
Chelsea mars
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX um
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of ..
(Husband's name in full)
G Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8 AGE Years
.. Months. .. Days
Minutes
Usual 9 Occupation: Industry 10 or Business:
Il Social Security No.
12 BIRTHPLACE (City)
Auchrop
(State or country)
13 NAME OF
FATHER
abraham Steinmän
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
meui Gesti
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Informant. (Address)
Relation, if any
......
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January 27 1941 Month)
(Day) (Year)
19 | HEREBY CERTIFY. That I attended deceased from
19
.. , to .....
19
I last saw h ............ alive on.
19.
death is said
to have occurred on the date stated above, at ... ...... ... m.
Duration
.years Immediate cause of death
Due to ...
Prematur.Ty /1
Due to
Other conditions
(Include pregnancy within 3 months .of death)
Major findings : Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury lo any way related to sccupation of deceased ? .. .....
If so, specify. ........
~ (Signed)
, M. D. Sich to fully curti us th 19 Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL.
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
fazer a proper autorité
Received and filed ......................................
19
Å TRUE COPY ATTEST:
(Registrar) ₹
Per Dr. Below
200m-10-'39. No. 8427-d
Sulfiet
(County)
(Chy or Town)
umunityHospitals St. (
(a) Residence. No. (Usual place of abode) Length of stay : In hospital or institution
years
months
days.
(II U. S.
War Veteran.
specify WAR).
1
Stillborn
If less than I day
Hours
.....
PARENTS
...
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medieal 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 belicf the name of the deceased, his supposed age, the discase 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 huried, until he has received a permit from the board of health or its agent appointed to issue such, permits, or if there is no such 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 interinent, 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 enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal ; provided, that such body shall he 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 transinit it to the clerk of the town for registration. The person to whom the perinit is so given and the physician certifying the cause of death shall thereafter 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, See. 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 observ- ance of the following rules of practice :
(1) Altending 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) Medieal 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 scptice- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to 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, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid 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 pursults 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 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
#21 -
to Tutto Amedica
R-302
1
PLACE OF DEATH
-(County) SURMOLN Bičity pr (Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON 160
(City or town making return)
Registered No
6977
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Mary
DiVita
(If deceased is a married, widowed or divorced woman, give also maiden name.) 287Main
St. Winthrop
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF
DEATH.
Aug 4 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
8/4/47
19
...... ,
8/4/41
19.
That I attended deceased from
I last saw h ........ alive on.
8/4/47
to have occurred on the date stated above,
11/46Am
Immediate cause of death
cerebral hemorrhage
Duration 17 hrs
Due te vascular nephritis
(
5 .... yrs
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Of autopsy
.Date of.
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis ?
20 Was disease cr Injury la any way related to occupation of deceased ?
If so, specify
(Signed)
Stewart Hamilton
M. D.
(Address)
Boston.
Dato 8/4/1947
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Mass
(Cemetery)
(City or Town)
DATE OF BURIAL
Aug 7 1941
19
22 NAME OF
FUNERAL DIRECTOR
A Sementa
ADDRESS
Boston
Received and filed 19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
3 SEX
fem
white
5a lf married, widowed, or divorced
HUSBAND of
8
44
Usual
9 Occupation:
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
WeVwrive au your city of town it case the deceased resided in another city or town at the time
AGE
Years
Months ..
.Days
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
(Give maiden name of wife in full)
(or) WIFE of
z0 DiVita
V.inCAffg's name in full
6 Age of husband or wife if alive.
48
Years
7 IF STILLBORN, enter that fact here.
lf less than 1 day Hours. .Minutes
dressmaker
Giuseppe Lamposana-
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Anna DiVita
IG BIRTHPLACE OF
MOTHER (City)
(State or country)
"Italy
17
Informant
(Address)
husband
.
Relation, if any
A TRUE COPA Nancia
ATTEST:
9. ray
(Registrar of city of town where desty occurred)
DATE FILED
8/8/41
19
.....
Sa. 1
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
No. Mass .... General ... Hospital
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. ) 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
PARENTS
Due to
hypertensive heart dis
19
death is said
F
1 f
( 1 ] i
1
R-302
PLACE OF DEATH
Middlesed (County)
Littleton (City or Town) Groton Road
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Littleton (City or town making return)
161
5 (If death occurred in a hospital 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.)
Le Triton Roz
St.
1 (If U. S. War Veteran, specify WAR) Winthrop, Mass.
(a) Residence. No ....
(Usual place of abode)
Length of stay : In hospital or institution
(Specify whether)
years
months
days.
(If nonresident, give city or town and state)
In this community
yrs.
2
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, br 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.
years
7 IF STILLBORN, enter that fact here.
AGE
9 84 Years
Months.
240
Days
If less than 1 day .Hours. Minutes
Usual
9 Occupation:
Fisherman
Industry 10 or Business:
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
East Boston Mass.
13 NAME OF FATHER
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mãos.
15 MAIDEN NAME
OF MOTHER
Elija lane March
16 BIRTHPLACE OF MOTHER (City) Newburyport
(State or country)
Massa
17 His games Student.
tion Wany
Informant! (Address) cateton was
A TRUE COPY!
Whichamming Brown
ATTEST:
(Registrar of city or tomo where death occurred)
DATE FILED
augustle
1941
MEDICAL CERTIFICATE OF DEATH
1941
(Month)
(Day)
(Year)
That I attended deceased from
19 I HEREBY CERTIFY.
June 27
19.41. 1
19/ .... ]
I last saw
hmm.alive on ..
Quanst 5 4941, death is said
to have occurred on the date stated above, at 1.45
A.m.
Duration
Immediate cause of death.
Myocarditis
Due to
Moltible carcinomata
3 mts 3 yrs ...
V
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
Of autopsy
What test confirmed diagnosis? Chuical Sons
20 Was disease or Injury In any way related to occupation ol deceased ?
If so, specify
Frets In chrétien
(Signed)
M. D.
(Address)
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Winthrop Com. Whicherop
DATE OF BURIAL
Dug
(Cemetery)
(City or Town
22 NAME OF FUNERAL DIRECTOR
Edile TO list od St, howalt, Mars ADDRESS
Received and filed ...... 13:41
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
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 posible wywieww ti your city of 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.)
Jerome B. Wyman
Date of.
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
Dug 5 1941
Aolite
Belcher
18 DATE OF
DEATH.
Registered No
No Wallace S Wymau
SEP1:12'1 41
15.
HI R-302
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
50m-10-'39. No. 8427-f
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
162
(City or town making return)
Registered No ..
7843
1 (If death occurred in a hospital 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.)
6 Jefferson
.St.
Winthrop
(If nonresident, give city or town and state)
...
years
months
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
(write the word)
married
(Month)
(Day)
(Year)
IS I HEREBY CERTIFY,
8/16/41
19.
.. , to ..
That I attended deceased from
I last saw h .. i.m ... alive on
8/17/41
19.
to have occurred on the date stated above, at.
12/358
Duration
Immediate cause of death.
anemia ............
3 ..... wk.s
8 AGE 67 Years 9 ... Months .. 6 ... Days
If less than I day Hours .Minutes
Usual
9 Occupation:
Industry
10 or Business:
laborer( retired)
Glue Co
II Social Security No.
12 BIRTHPLACE (City)
(State or country)
Boston Mass
13 NAME OF
FATHER
Jose Vazquez
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Cuba
15 MAIDEN NAME
OF MOTHER
Elizabeth Lang
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston Mass
Relation, if any
17
Informant.
(Address)
...... wife
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED 8/20/41
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Aug 17 1941
-
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
62
years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
Due to g&c.t.ro .... i.n.te.s.tinal ..... hemmorhage ........
V
Due to carcinoma of stomach
4-8 yrs
Other conditions
(Include pregnancy within 3 months of death)
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 ?
If so, specify
(Signed)
WTS Thorndike
. M. D.
(Address)
Boston
Date 8/18/19 41
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Winthrop
Mass
(City or Town)
DATE OF BURIAL.
(Cemetery)
Aug 20 1941
19
22 NAME OF
FUNERAL DIRECTOR
H S Reynolds
ADDRESS.
Winthrop
Received and fled 19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
(County) Roston
(City or Town)
No. Mase General Hospital
William Vazquez
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution
Ella M Laws
8/17/41
19
..... death is said
Underline the cause to which death should be charged sta- tistically.
PARENTS
FI R-302
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