USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 60
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Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits cant 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 discase causing death, report the usual occupation prior to illness. If the ileceased: had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at hume. For a woman whose only occupation was that of home huusework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans 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 plain
-
1
PLACE OF DEATH
Suffolk County) Winthrop (City or Town)!) 149 Shore Dove No.
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.
[ (If death occurred in a hospital or institution, St. į give ita NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
149 Shore Amie
st.
( If nonresident, give cits or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community /3 yrs.
moa.
days.
PERSONAL ANO STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female White
4 COLOR OR RACE|
5 SINGLE
(write the word)
·
MARRIED
WIDOWEO
or
5a If married, widowed, or divorced
HUSBANO of
Qui Give maiden name It with holder
(or) WIFE of
(Ilusband's name in full)
have occurred on the date stated above, at.
10:15 Am.
6 Age of husband or wife if alive 5 .. 2 ... years
7 IF STILLBORN, enter that fact here.
8 AGES2 Years Months ..... Oays
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Housework.
Industry
10 or Business :
at Home
11 Social Security No ..
12 BIRTHPLACE (City)
( State or country )
Russia
PARENTS
15 MAIOEN NAME
OF MOTHER
Yeah Kim
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Queso
17 Abraham H Boys
Informant
(Address) 144 Short Olay Funthree
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlal or transit permit was issued: Www.D. Childress &
...
( Signature of Agent of Board of Health or other)
Realtle Mhielt 9/29/42
(Official Designation) (Date of Issue of Permit)
18 DATE OF
OEATH
September 29
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
January 29.
1938
September 29.
19/2
That I attended deceased from
11 last saw her
.allve on
Lept. 29, 1942 death Is said to
Duration
IMPORTANT ......
Due to.
anguia Pectoris
Due to.
Chuonic Brondules
4 yrs.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
noire
Oate of.
Of autopsy
none
What test confirmed diagnosis ?. clinical 1 labi
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
M. D.
20 Was disease or injury in any way related to occupation of deceased ?. 47
If so, specify ........
(Signed) Jacobo Chamo
(Address) 562 Stanley It
Data epp 29 1942.
21 Menthrop Com
......
Everest The
Relation/ if any
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
12× 30
1942
22 NAME OF
FUNERAL
AOORESS
10 Washington SV Doute
19
Received and filea
(Registrar)
5 mas
13 NAME OF
FATHER
Charles Schwartzman
14 BIRTHPLACE OF FATHER (City) (State or country) Quasi
9
100m (d) - 1-41-4667
M R-301 A
Sarah Schwartzman Bayer
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
1942
Immediate cause
acute Coronary Thrombosis
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physlolan 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 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 four- 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 relicf ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemcd to have taken place between February fourteenth, eighteen hundred and nincty-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, 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 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 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 the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shali 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 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 cicrk of the town for registration. The person to whom the permit is so given and the physiclan 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 he 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 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).
Medical examiners shali 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 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 deaths only as those of persons to whom they have given bedside care during a iast illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons who, though disabied by 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) 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 dlsease, 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., iteart 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 Oooupation .- l'recise statement of occupation is very im- portant, so that the relative healthfuiness 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 housekceper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1
Board of Health of Vital Statistics
NON RESIDENT COPY
State File N
4798
Registrar's No. 424 Non-R ESTd
S OF DEATH: Dade
11-01
District Non
Precinct No.
City or .
11-510
Town No.
of hospital or Institution 3811 Wood are. (If not in hospital or institution, write street number or location)
of etdy: In hospital or institution
dogth (Specify whether years, months or days)
2. USUAL RESIDENCE OF DECEASES
(a) State Massachusetts County
Sullolle
(c) City or Town
Winthrop
(If outside city or town lihle. „rite RURAL)
(d) Street No. 62 Flad &t.
(If rural, give location)
(e) Citizen of Foreign country? 20.
20
If yes, name country
(City or town making return)
180
Registered No. red in a hospital or institution, : instead of street and number)
specify WAR)
ident, give city or town and state)
nmunity
yrs.
mos.
days.
ATE OF DEATH
(Day)
(Year)
That I attended deceased from
19 .. .....
19 ... death is said
ove, at .......
........ m.
Duration
angina Pectornão
.
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings: of operations
(Give date of operation)
of autopey
Underline the caune to which death should be charged xtn- tistically.
22. If death was due to external causes, fill in the following:
(a) (Probably) Accident, suicide, homicide (specify)
(b) Date of occurrence
(c) Where did Injury occur?
(City or town)
(County) (8tate) (d) Did Injury occur in or about home, on farm, in industrial place. in
spubile place?
(Specify type of piace)
C While at wor
riesce
3. Signature
M. D.
Dato.
19
N. B .- WRIT
inforn
CAUS is ver
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issueda
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
DATE OF BURIAL.
22 NAME OF FUNERAL DIRECTOR ADDRESS
Received and filed
15
A TRUE COPY ATTEST:
(Registrar)
me
war nonse
male
5. Color or race white Year 19.42 hour
Widowed
married, widowed or divorced married, widowed er divorced, husband of (or)
Georgia Jarvis
of husband or wife. It alive
yeare
date of deceased September 16 1870 (month)
(day)
(year)
: Years 7
Months
Days
If less than one day
20
hra.
min.
lace
Yarmouth ViCity, towner county Selecting
occupation
y or business
me
rthplace
iden name
rthplace
ant'e Signature Harvey d. C
dress 1539 7.8.2ª are minh, 720.
, cremation or removal Remark
to Mar, 7, 1942 }] (b) Place Winthrop Director's Singure Ska Content Lireas Coulis Ju 3. 7- 4200 for Mina well nes Local Registrar
Wit Jarvis
MEDICAL CERTIFICATION
20. Date of Death: Month __ MAIS Day
6
Minute
19 21. I hereby certify that I attended the deceased tour an mar 210$ To that I last saw h Ld allve on Met 195
and that desth occurred on the date and hour stated above. Immediate cause of death
Duration
eath)
PHYSICIAN
...
...
e of
Underline the cause to which death should be charged sta- tistically.
of deceased ?
M. D.
(a) Address
(City or Town)
19
200m-10-'39. No.
3 (b) Social Security
veteran,
NAME OF DECEASED Cameron De
-
yu or no
(Write pame, not number) Miami Fla
Ontario, Canada 7 (State or forgiga country) Carmen Retired MwEx bul IT
-
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 otber authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until be has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- incr shall make such certificatc. 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, tbat such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall 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 he 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 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 llealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supporably due lo injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicc- 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 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 whosc 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
RM R-302
Essex
(County) Danvers
(City or Town) Danvers State Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town, making return)
Registered No.
S
( If death occurred in a hospital or institution,
St.
2 give its NAME instead of street and number)
Joseph Greeley
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
25 lincoln Ter
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months 6
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE
37 Years
Months.
Days
If less than 1 day
Hours ...
Minutes
Usual
9 Occupation :
Letter carrier
Industry
10 or Business :
Il Social Security cannot be learned
12 BIRTHPLACE (City)
(State or country)
Chelsea
13 NAME OF
FATHER
Chelsea
John Greeley
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Alice
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cannotbe learned
17
Mary K. McPhillips
(
Relation, if any
(Address)
DSH
A TRUE COPY.
ATTEST :
al restar Chair
or town where death occurred)
DATE FILED 19
18 DATE OF
DEATH
Sep. 5, 1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That 1 attended deceased from
Aug ..
30
19
42
to
Sep
5
19
42
I last saw h .. 1ml ...... alive on.
Sep
5 .. , 19 .... 42death Is sald to
have occurred on the date stated above, at.
8.35A.
.m.
Duration
Immediate cause of death.
Delirium Trements
days
Lobar Pneumonia 3 days
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of.
Underline the cause to which death should be charged sta-
Of autopsy
clinical
tistically.
What test confirmed diagnosis ?.
20 Was disease or Injury in any way related to oocupation of deceased ?IO
If so, speolfy
Melvin Goodman
(Signed)
M. D.
(Address)
DSH
Date.9./11,19.42
21 PLACE OF BURIAL,
St. Mary's
Boston
CREMATION OR REMOVAL.
DATE OF BURIAL
9/8,42
(City or Town)
.19
22 NAME OF
Tobn F. O'Brien & Sons
FUNERAL DIRECTOR
ADDRESS
.. Boston.
Received and filed 19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
PLACE OF DEATH r
1
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
7
(If U. S.
(Usual place of abode)
M R-303A
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
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