USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 57
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board of health, or employed by it or by the seleetmen 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 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 obtalned 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 hoard 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 glven 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, 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 burlal 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 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 septice- mla), 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, ete. As principal cause name the disease causing death. As related causes, name earlier 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 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
M R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No 5 Ingleside Ave
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.
1
§ (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Catherine
€. Bethell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5
Ingleside Ave
St.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
{f nonresident, give city or town and state) In this community 15 yrs. mos. - days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
Cecil C.Bethell
(Husband's name in full)
6 Age of husband or wife if alive .. 6.2. .years
7 IF STILLBORN, enter that fact here.
AGE.
57
Years
4 ... Months.
16
Days
If less than I day Hours. Minutes
Usual
Housewife
At Home
1I Social Security No. None
Round Bay
Nova Scotia
13 NAME OF
FATHER
Wyman Hagar
14 BIRTHPLACE OF
FATHER (City) ....
Cannot be learned
(State or country)
Nova Scotia
15 MAIDEN NAME
OF MOTHER
Sarah Perry
16 BIRTHPLACE OF MOTHER (City) .. (State or country)
Cannot be learned
Nova Scotia
17 l'rs Thelma Cole
Relation, if any Daughter
(Address) 5 Ingleside ave Winthrop
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Children (Signature, of Agent of Board of Health or other) Health Ofrecer 9/8/42
(Official Designation) (Date of Issue bf PermitY
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept.
7.
1942
(Month)
(Day )
(Year)
19 I HEREBY CERTIFY. That I attended deceased from March 15 19.42, to September 71942 Duration IMPORTANT I last saw her. alive on del tom. 2, 19.42, death is said to have occurred on the date stated above, at 5:00 Pm. Immediate cause of death
Respiratory Failure
48hr
5 yr.
Other conditions.
(Include pregnancy within 3 months of death)
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? No
If so, specify
(Signed) ..
Robert K
andon
M. D.
(Address) Winthro
.Dat 9/7/194
21 ..
North West Harbor
N. S.
Canada
Place of Burial, Cremation or Removal.
(City or Town)
September 11
1942
19
DATE OF BURIAL
22 NAME OF FUNERAL DIRECTOR. Charles 3 Watson
ADDRESS
11 Magazine St. Cambridge
Received and filed
19
(Registrar)
Major findings:
Of operations.
Date of.
Of autopsy.
What test confirmed diagnosis?
Due to. Carcinome of colom
Due to arrosmetastasis to Liver and lung.
12 BIRTHPLACE (City)
(State or country)
I
3 SEX
Female
(or) WIFE of
8
9 Occupation :
.
PARENTS
Informant ...
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
Industry
10 or Business:
is very important. See instructions and extracts from the laws on back of certificate.
(If U. S.
War Veteran.
specify WAR)
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, untli 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 contalning the facts required by iaw 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 herelnafter provided. If there is no attending physiclan, or if, for sufficlent reasons, his certificate cannot be obtained carly 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 permit for such removal; provided, that sucli body shall be returned to the town from which it was removed within thirty-slx 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 recitai 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 shail 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 buricd 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 discase 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 wliose 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 principai cause name the disease causing death. As related causes, name eariicr 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 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 business, report the usual occupation prior to retirement. Children not gainfully employcd may be returned as a! 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
R-301 A
Suffolk. (County)
Winthrop (City or Town)
No.
44
Locust
The Commonforalth ot 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.
.....
S(If death occurred In a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
44 Locust
St.
Winthrop
Length of stay: In hospital or Institution
(Before death )
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACEL
White
5 SINGLE
MARRIED
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
( Inshand's name in full)
6 Age of husband or wife if alive 68
years
7 IF STILLBORN. enter that fact here.
8
AGE
74 Years
Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Pants
Presser
Industry
10 or Business:
Men's Clothing
11 Social Security No. 020-12-2694A
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Ralph Golditch
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Rita (unknown)
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Goldie Golditch
Relation, if any W.J.t .. e.
(Address)
44 Locust St.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : William S- Childress
(Signature of Agent of Board of Health or other)
Cegent Sept.10/42
...... ( Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
September
9
1942
(Year)
(Month )
(Day)
19 | HEREBY CERTIFY.
That I attended deceased from
I last saw him
alive on
sept
9, 1961 death Is said to
have occurred on the date stated above, at
6.P
m.
Immediate cause of death
Carcinoma of Prostate
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operations ..
Carcinomaal Prostaty
(Peter Bert Brigham Date of July 1942
Of autopsy
none
What test confirmed diagnosi Pathological findings
Physician t'uderline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ? 0 If so, specify.
(Signed)
M. D.
(Address)
Date Sept.91942
21 Mts Les
Kannika Cem.
west
Rox.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Sc.pt.
10
1942
22 NAME OF
FUNERAL DIRECTOR
Jacob
H. Levine
ADDRESS
394 Washington St.
Dorchester
Received and filed. ........
19
(Registrar)
100m (d)-1-41-4667
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
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
1
St
Philip Golditch
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
years
months
days.
(If nonresident, give city or town and State)
In this community 13 yrs. .
mos.
-days.
PERSONAL AND STATISTICAL PARTICULARS
Facturato
Julay
15
1942
to
September 9 1942
Goldie Koltunsky
Duration IMPORTANT July 1441
Informant.
PLACE OF DEATH
1
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 atteroled during his last illness. at the request of an midertaker or other anthurizel person or of any member of the family of the decraseil, furnish for registration a standaril 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 dual, defined as're- quired by section one, where same was contractual, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... tien. Laws, Chap, 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall. if the deceased, to the best of his knowledge and belief, served in the army. navy or marine corps of the I'nited States in any war in which it has been engaged. insert in the certificate a recital to that effect, sprci- fying the war, and shall also certify in such certificate both the primary atol the secondary or immediate cause of death as nearly as he cau 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-sevon of said chapter one humlred and fourteen. the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes. he deemed to have taken place between February fourteenth, eighteen hundred and oinety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried. until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, froin the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it fromn a town. from one cemetery to another, or from one grave or tonib 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 froin the clerk of the town where the body is buriedl. No such perniit shall he 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 he returned amul recopled, which shall be accompanied. in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law. or in lieu thereof a certificate as hereinafter provideil. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the hoard of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence. the oreili- cal examiner shall make such certificate. If such a permit for the renioval 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 hercumuler. 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 l'united States in any war in which it has hren engaged, such recital shall appear upam the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall forthwith counter-ign it atul transmit it to the clerk of the town for registration. The person to whoun the perunt is so given aml the physician certifying the cause of death shall thereafter furnish for registration any other nice+ sary information which can be obtained as to the drceaseil, or as to the manter 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 hody or the ashes thereof which have bren brought into the commonwealth until he has re- ceived a permit so to do from the hoanh of health or its agent ajminted to issue such permits, or if there is no such board, front the clerk of the town where the body is to be buried or the funeral is to be hell, or from a persou appointeil to have the care of the cemetery or burial ground in which the interment is made. .. . Chap. 114. Soc. 46. G. L., (Tereentenary Edition).
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 inrdical examiner has notice that there is within his county the hody of such a person, he shall forthwith go to the jdace where the body lies and take charge of the same; ... - General Laws, Chap. 38, Scc. 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 deaths only as those of persons to whom they have given beilside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physiolans will certify to such deaths only as those of persons who, though disaldrd hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all ilcaths sup- posably due to iojury. These include not only deaths caused directly ot in- directly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aml 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 meana the disease, or com]dication which causes death. not the mode of dying. e. g., heart failure, asphyxia. asthenia, etc. As principal cause namc the discase causing death. As related causes, name earlier morbid comlitions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is 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 on account of the discase 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.
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