USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 24
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obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Scc. 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) 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 scptice- 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 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
IR-301 A Suffolk.
PLACE OF DEATH -
Scounty) .....
Jantherap (City or Town) 44 Finderhill No.
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.
62
§ ( If death occurred in a hospital or institution, St. ¿ give its NAME instead of street aud nuniber)
Chilipo Shuman
( If deceased is a mafried, widowed or divorced woman, give also maiden name.) 44 Underhill St.
(a) Residence. No.
(Usual place of abode)
Length of stay : In hospital or Institution
( Before death)
(Specify whether)
yeara
months days.
In this community
/ / yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEĮ
Male White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Married
Sa If married, widowed, or divorced HUSBAND of
Jeannette Levere (live maiden name of wife in fall)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
44 years
> IF STILLBORN. enter that fact here.
8 AGE
48 Years
Months Days
If less than 1 day Hours Minutes
Usual
9 Occupation:
Dry Goods Store
Industry
10 or Business :
For Himself
11 Social Security No.
'2 BIRTHPLACE (City)
( State or country)
Queria
13 NAME OF
FATHER
Jacob Shuman
14 BIRTHPLACE OF
FATHER
(City)
(State or country)
15 MAIDEN NAME OF MOTHER Machael (Cannot beune
16 BIRTHPLACE OF MOTHER (City) (State or country )
Jeannette Shuman mitige Many
17 Informatie. (Address) 44 Underchill It. Medali
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the Dutlal or tragsit permit was issued : War.D. Valdresxx
(Signature of Agent of Board of Health or other)
I de alte Officer 3/26/43
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
marche
25
(Month)
(Day)
(Year)
19 THEREBY CERTIFY, That I attended deosased from
...
-
I last saw himenalive on.
Lecarele 2, 1943, death is said to
hava occurred on the date stated abova, at.
8:20 Am.
Immadlate causa of death ..
Comomany , paranaboris
IMPORTANT 2/2 miles
5 yrs,
Dua to.
Other conditions.
( include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operations
Date of
Of autopsy .....
What test confirmed diagnosis ?.
Physician Underline the cause to which death should be charged sta. tiatically.
O Was disease or injury in any way related to occupation of deceased? Lo
so, spoolfy ...............
Gladles Liberman, M. D.
('Signed)
(Address) of Wand Way Read Data3 /25/ 19 45
Lebanon motherver Com/ W. 1204.
Place of Durial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
march
26.
19.43
22 NAME OF
FUNERA
Manuel Stundtaky
ADDRESS 10 Nachmenton dr. Dor.
19
Received and fied
( Registrar)
100M-6 - 2-42-8855
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 recitai to that effeot. PARENTS
1
2 FULL NAME
PHYSICIAN - IMPORTANT
(Was deocasad a
U. S. War Veteran,
if ao specify WAR)
Med
(If nonresident, give city of town and State)
MEDICAL CERTIFICATE OF DEATH
1943
1942, to march 25 1943
Duration
Dua to.
Coronary Aclerosis
1
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medioal offioer shall forthwith, after the death of a person whoin he has attemled 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 standard certificate of death, stating to the best of his knowledge and belief the bante 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 illnesa, when laat 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 aa 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 s recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or iinmediste cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, auch physician or officer shall forfeit ten dollars. For the purposes of thia aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humired 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 hetwcen February fourteenth, eighteen hundred and ninety- eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen bundred and seventeen. G. L. Chiap. 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 hsa received a permit from the board of health, or ita agent appointed to isque such permita, 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 cenietery to another, or from one grave or tomb other than the receiving tomb to another In the same cemetery, until he haa received a permit from the board of health or ita 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 aatisfactory written atatenient containing the facta required by law to be returned and recorded, which shall be accompanied. in case of an original internient, by a satisfactory certificate of the attending physician, if any, aa required by law, o1 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 ia insufficient, a physi- cian who ia a member of the hoard of health, or employed by it or by the selectmen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death ia caused by violence. the medi- cal examiner shall make such certificate. If auch 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 ot the undertaker desiring to make such rentoval 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 containa a recital, aa 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 sud 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 nece+ Bary information which can be obtained as to the deceased. or us to the manner of cause of the death, which the clerk or registrar uray require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a hunisn body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived s perutit so to do from the hoard of health or its agent appointed to issue such 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. ... Cbap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as sre supposed to have died by violence. If a medical examiner has notice that there is within his county the hody of such a person, he shall forthwith go to the place where the body lies aud take charge of the same; ... - General Lawa, Cbap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calla for the obaervance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deatha only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose pbyaf- cian ia absent from home when the certificate of death ia needed.
(3) Medloal 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, and deaths following abortion, but also deatha from disease resulting from injury or Infeotlon 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 dlaease, or complication which causes death, not the moile of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causea, name earlier morbid conditiona, if any, related to the principal cause and any important complication of the principal cause.
Statement of Oooupation .- Precise statement of occupation ia very im- portant, so that the relative healthfulnesa of various pursuits can be known. Make aome 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 dixcase causing death, report the usual occupation prior to illness. If the deceased hsd retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at home. For a woman whose only occupatiou waa that of honie bousework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as bousekeeper-private family, cook-hotel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffolk Winthrop
(County) BOSTON MUSTAFA 4 - 8 - 43
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.
Ragistarad No.
a hospit al or institution,
{ give its NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No.
8 Horton Gout
St.
East Boatoi
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
7/
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female White
5 SINGLE
( write the word)
Widowed
18 DATE OF
DEATH
Tuanh. 27. 1943
(Month)
(DẤY)
(Year)
I HEREBY
March 27
X3
CERTIFY, ^
That I attended deceased from
19
to.
March 29
1943
....
1 last saw h
aliva on
3/27
1943
death Is said to
have occurred on tha date stated abova, at
10.P.
m.
6 Age of husband or wife if alive deceased years
> IF STILLBORN. enter that fact here.
8
AGE
71. Years
Months
.....
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
House work
Industry
own home
11 Social Security No.
none
12 BIRTHPLACE (City)
East Boston
( Siate or country)
13 NAME OF
FATHER
William Ring
14 BIRTHPLACE OF
FATHER (City)
(State nr country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary Barry
16 BIRTHPLACE OF
MOTHER (City)
(State nr country )
Freland
17 Charles W. Pero Informant (Address) 6H00 Tou GY, E.B (ROW
,If any
I HEREBY CERTIFY that a satisfactory standard certificata of death was filed with ma BEFORE the burial or transit permit was Issued: Wms. Children
(Signature of Agent of Board of Health or other)
Health officer 3/19/43
"tomcial Designation) ( Date of Issue of Permity
( Registrar)
=
.
٢
Terms, so nar ir may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
extracts from the laws on back of certificate.
100M-6 -2-42-8855
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
PARENTS
20 Was disease orinjury in ony way related to occupation of daoaased ?
If so, spol. Langs It Fcharts
(Signed).
(Address) 19 Genealo ST. 213 Data
. M. D.
Data 3/28
19 83
21
My. Benedict
Rostou
l'iace of Burial, Cremation or Removal.
DATE OF BURIAL
March 3%
19.
City, or Town)
43
22 NAME OF
FUNERAL DIRECTOR
* Kelly
ADDRESS
11 Meridian St ., 16.13.
Rsosivad and flad
19 ....
"
1 Day
Other conditions.
Time
( Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
Tooperations
Date of.
Of autopsy
What test confirmed diagnosis?
Duration DerANT
Immediata oause of death.
tante cardiac dilatation
Due to
general Peritonitis
Due to
? Rupturas Galt Hadder
10 or Business :
4 COLOR OR RACE|
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced HUSBAND of
(or) WIFE of
Stacieweisen hamot write 2020
( Husband's name In full)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
Hospital
....
Winthrop Conimmunity Hossumah. No. Catherine E. Pro
1
Physician Underline the cause to which death should ba charged sta- tistically. tio
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 lias 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 aud 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 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 l'uited States in any war in which it lias 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 ail 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 inchide 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 ninety-eight and July fourth. nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen bundred 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 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 liealth or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case inay be, & 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 liereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate canmot 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 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 reinoval 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 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 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 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 issue such 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 beld, 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 Editiou).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within 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 last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose 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 of in- directly by traumatism (Including reaulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very 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 discase causing death, report the usual occupation prior to illuess. 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-botel, etc. For a person who had no occupation whatever write nohe.
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