USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 31
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(1) Attending physicians will certify to such deaths only as those of persons to whom they have given hedside carc during a last ill- ness from disease unrelated to any form of injury.
(2) Board of iiealth physicians will certify to such deaths only as those of persons who, though disahled hy recognized diseasc un- related to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examinere will investigate and certify to all deaths supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septice- 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 hy 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 fallure, 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 .- Precisc statement of occupation is very important, so that the relative healthfulness of various pursuits can he 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 husi- 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, designatc the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
F1 R-301 A
1
winthrop
(City or Town)
No. 167 Shore Drive
St.
[ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
Rose ..... Rubin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
167 Shore Drive
(Usual place of abode)
Length of stay : In hospital or Institution.
( Before death )
(Specify whether)
years
months
days.
In this community
12 yrs. ~
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACEJ
white
5 SINGLE
(write the word)
MARRIED
WIDOWEOWidowE /
or DIVORCEO
5a If married, widowed, or divorced
HUSBAND of
TT (Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
AGE 65 Years
Months
Oays
If less than 1 day Hours. Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
None
...
11 Social Security No.
.none ..
12 BIRTHPLACE (City)
(State or country )
Russia
13 NAME OF
FATHER
Harris Glaser
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia .........
.......
15 MAIDEN NAME
OF MOTHER
Tobe (Unknown )
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 gilliam Rubin
Relation, if any .S.On
Informant. (Address) 21 Kirkwood Rd. Brighton, Mass
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) Malthe Officer 5/21/42
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
21.
1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
may
to.
36
may 21
19
42
I last saw h ............. alive on.
may 21
.19 Y2, death Is said to
have occurred on the date stated above, at .......... 50
8 .... m.
Immediate cause of death.,
Cerfinal Heraus har
IMPORTANT
Due to.
Parkins our descase
Par
5 yrs.
Que-to.
Hypertension
3yrs.
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to ocoupation of deceased ?.. - ......
If so, specify.
(Signed)
(Address)
284 Warhave
Date ...
5/211
Woburn
M. D. 19 La .
21
Anshe Lebavitz Cem. -
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
May
21,
1942.
.......
22 NAME OF
FUNERAL DIRECTOR
TORF FUNERAL ROME
ADDRESS
151 WASHINGTON AVE., CHELSEA
Received and filed MAY 25 1942
19
(Registrar)
TUIC IC
....... . IL:FARINA DI APU INU
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should State CAUSE OF DEATH In plat ... ..
PLACE OF DEATH
Suffolk (County)
The Commonturalth 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.
88
Svan itam Al information
DEDIAANENT OFCOLIT
100m (d)-1-41-4667
PARENTS
Date of
IMPORTANT Physician Underline the cause to which death should be charged sta. tistically.
....
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
St.
(If nonresident, give city or town and State)
9 ..
Duration
....
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medioal officer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an umulertaker 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 or his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as re- quired 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 ivur- 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, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate 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 sec- tion 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 ex- pedition and the l'hilippine 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 Mexi- can horder service of nineteen hundred and sixteen and nineteen laindred 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 perinit from the board of health, or its agent appointed to issue such purinits, or if there is no such board, from the clerk of the town where the person died; and no wi.dertaker or other person shall exhume a human hody 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 heaith or its agent aforesaid or front 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, s 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 heu thereof a certificate as heleinatter provided. It there is no attending physician, or if, for suficient reasons. his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make in certificate re- quired of the attending physician. If death is caused by violence, the medi- eal examiner shall inake such certificate. If such a permit for the removal " a human body, but previously interred, from one town to another within the counnonwealth cannot be obtained carly enough for the purpose, the certificate of death made as above provided and in the possession of the indertaker 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 · btained 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 neces- sary 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 bc has re- ceived 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 fromn a person appointed to have the care of the cemetery or burial ground in which the interinent is muade. .. . Chap. 114, Sec. 46, G. L., (Tercentenary Edition ).
Medical examiners shall mare examthatton uput the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ...- General Laws, Chap. 38, Sec. 6.
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 deatha only as those of persons to whom they have given bedside care during & last illness froni disease uurelated 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 unrelated to any forin of iujury, have died without recent medical attendance or whose physi- ciau is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aud 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 Causo 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. .is related causes, ame carlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation. - it comment of occupation is very im- portant, so that the relative healthfulness of various pursuits can be kuown. 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 n'ay 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 fataily, cook-hotel, etc. For a person who had no occupation whatever write nonc.
SPACE FOR ADDITIONAL INFORMATION
I R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to insert a recital to that offoot. PARENTS
100M-E -2-42-8855
Informant
....
Son
Relation, If any
(Address) 18] Hudson St. New York City
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE theburial or transit permit was Issued ? u. S. Childress
(Signature of Agent of Board of Health or other)
( Halte Affiche 5/23/42
(Oficial Designation) (Date of Issue of Permit) 1
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
may
21/1942
(Conth)
(Day)
(Year)
19 i HEREBY CERTIFY,
That I attended deosased from
March 21, 1942
to
may
1942
I last saw h.w ........ alive on .........
may
21
19."[ ..... death is said to
·
have occurred on the date stated above, at 11. 20 p.m.
Immediate cause of death.
Duration
IMPORTANT
....
Due to.
Carcinoma of Stomach
year
Due to
Chronic myocarditis
2 years
Other conditions.
( Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy.
What test confirmed diagnosis?
IMPORTANT Physician Underline the cause to which death should be charged sta. tistically.
20 Was disease or injury in any way related to occupation of deceased ? co If so, specify .....
(Signed)
ticholo
Jova
M. D.
(Addre
)27 Bay State Road
Date.
My 22 1942
21 Old Calvary Cemetery, Boston Mass.
Place of Burial, Creniation or Removal.
DATE OF BURIAL
May
25
19 ... 42
22 NAME OF
FUNERAL DIRECTOR
J.S.Waterman & Sons
ADDRESS
Boston, Mass. O.C.W.
Received and fled
MAY 2 5 1942
19
1
PLACE OF DEATH
Suffolk (County)
The Commontoralth 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.
89
S ( If death occurred in a hospital or institution, St. (give Ite NAME instead of street aud nuniber)
PHYSICIAN - IMPORTANT
2 FULL NAME
Carlo
Tosi
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
321 Revere Street
(a) Residence. No.
(Usual place of abode)
St.
Winthrop
(If nonresident, give clty or town and State)
Length of stay: In hospital or Institution
(Before death)
years
months
days.
In this community 20 yrs.
mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX male
4 COLOR OR RACE
white
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEmarried
5a If married, widowed, or divorced Maria Brunnini HUSBAND of
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if alive
7.6
years
9 IF STILLBORN. enter that fact here.
8 .89
6
Months
Days
17
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Porter
Industry
10 or Business !
Retired
11 Social Security No. none
12 BIRTHPLACE (City)
(Siate or comitry)
Bolognia
Italy
13 NAME OF
FATHER
Unknown Tosi
14 BIRTHPLACE OF
Unknown
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
Unknown
MOTHER (City)
.....
(State or country)
Italy
17 Henry J: Tosi
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
SnouIg De Carcluuy SuppNICU. AVL JIVMIN
extracts from the laws on back of certificate.
Winthrop Hlds. (City or Town)
321 Kevere Street
No.
(Specify whether)
(Was deosased a
U. S. War Veteran,
if so speolfy WAR)
none
(Registrar)
×
AGE
Years
(Give maiden name of wife in full)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shali forthiwitb. after the death of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized person or of any meniber of the family of the deceased, furnish for registration a atandard 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 re- quired by section one. wlivre same was contracteil. the duration of his last illnese, when last seen alive by the physician or officer and the date of hia 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 bundred and four- teeu, sliall, if the deceased, to the best of his knowledge and belief, aerved in the army, navy or marine corps of the I'nited States in aus war in which it has been engaged. insert in the certificate a recital to that elect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thie aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humilred and fourteen, the word "war" shall inclmle the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deencd to have taken place between February fourteenth, eigliteen hundred and ninety-eiglit and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred aud sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not been buried, until he has received a permit 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 person died; and no undertaker or other person ahall exhume a huinan body and remove it froin a town. from one cenietery to another, or from one grave or tomb other thau 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 hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to he 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, ot in lieu thereof a certificate as liereinafter 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 physi- cian who is a member of the board of health, or employed by it or hy the selectinen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner chall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the cominonwealth cennot he obtained early enough for the purpose, the certificate of desth made as above provided and in the possession ot the undertaker desiring to make such renroval 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
hy 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 heen 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 clock 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 nece+ sary information which can be obtained as to the deceased, or as to the manber or canse 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 re- ceived a permit so to do from the hoard of health or its agent appointed to isque ruch permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he 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. 16. C. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as sre supposed to have died liy violence. If a medical examiner has notice that there is within lils county the body of such a person, he shall forthwith go to the place where the tundly lles and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calle 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 hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health phyalolans will certify to such deaths only aa those of persons who, though disahled hy recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death ie needed.
(3) Medloal Examiners will investigate and certify to ali deatha aup- posably due to Injury. These include not only deaths caused directly or in- directly hy traumatism (including resulting septicemia), and by the actlon of clientical (drugs or poisons), thermal, or electrical agents, all deaths following abortion, but also deathe from diseasa resulting from injury or infeotlon related to occupation, the sudden deatha of persons not disabied by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Callse of death meana the disease, or complication which causes death. not the mode of dying, e. g., heart fallure, asphyxia, asthenia, etc. Aa principal cause name the disease caualng death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principai cause.
Statement of Occupation .- Precise statement of occupation ia very Im- portant, 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 ou account of the dixcase causing death. report the usual occupation prior to illness. If the deceased hsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at huine. For a woman whose only occupatiou waa that of honie housework. write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terma, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
I R-301 A
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