USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 39
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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 funcral 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, Seo. 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 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. 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
R-303-A
1
PLACE OF DEATH
Suffolk County) Wir thooh (City or Town)
Fort Banks
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 110
Registered No. St. [ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.Y
Woodland
St
(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
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX mole
4 COLOR OR RACE!
white
5 SINGLE
MARRIED
WIDOWED
Or DIVORCEDtingle
5a If married, widowed, or divoroed HUSBAND of
(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 21 Years. Months Days
If less than 1 day Hours. Minutes
Usuai
9 Occupation :
Corporal
Where did
Somerville
Injury occur ?
(City or town and State)
Did Injury ocour In or about home, on farm, In Industrial place, or In publlo
place?
(Specify type of place)
Injury
Struck by Rulo
Manner of
Nature of
injury
Whlie at work ?
Was there an autopsy?
400
21 Was disease or injury In any way related to ocoupation of deceased?
If so, specify.
L H Watters
(Signed)
M. D.
(Address)
Date
mag 21
19 .7.3
22
Woodland
Maine
Place of Burial, Cremation or Removal.
(City or Town)
1943
23 NAME OF
FUNERAL DIRECTOR
ADDRESS
254
Beach for Revene
Received and filed ..
MAY .8.5 .... 1943
19
(Registrar)
n
=
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
22
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that
I have investigated the death
of the person above-named and that the CAUSE AND MANNER thereof
areas follows: (If an injury was involved, state fully.)
Shock + Intra cranial nau montage
Facture base of S/y PP
20 Aocident, suioide, or homicide (apecify)
Accident
Date of ooourrence
19
Industry
US Cerny
12 BIRTHPLACE (City)
(State or country )
11 Social Security No. Dalyviele Strane.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maini
15 MAIDEN NAME
OF MOTHER
Beaturi Monde
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Yout Bank
I HEREBY CERTIFY thal a satisfactory standard certificate of death was filed with me BEFORE the buri for bansit permit was issued: M.S. Childress (Denature of Agent of Board of health or other)
Thealite
5/14/43
(Official Designation) (Date of Issue of Permit)!
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
extracts from the laws relative to the return of certificates of death.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect
60m (g)-1-41-4667
No.
Lloyd H. Inc Laughlin
PHYSICIAN-IMPORTANT
world
(Was deceased a
U. S. War Veteran,
If so specify WAR) # 2
Man
(a) Residence. No.
(Usual place of abode)
(write the word)
1943
(Give maiden name of wife in full)
10 or Business :
none
13 NAME OF
FATHER
Henry G. M. Laughter
17 U.S. Grup Relation, if any Informant DATE OF BURIAL May, 26
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 attendeil 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 dieil. 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. 16, Sec. 9.
A physician or officer furnishing a certificate of death as required by tbe preceding section or by section forty-five of chapter one hundred and four- tecn, shall. if the deceased, to the best of his knowledge and belief, served in the army. navy or inarine 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 sail chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-cight and July fourth, nineteen hundred and two, and the Mexl- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Cbap. 46, Scc. 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. fromn 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, froin one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same ceinetery, until he has received a perinit from the board of health or its agent aforesald or from the clerk of the town where the hody 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 internient, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu tbereof 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 selectinen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a perinit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to tbe town from which it was removed within thirty-six hours after such re- inoval, unless a perinit in the usual form for the removal of such body has been sooner obtaincd 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 Uniteil 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 regis- tration. The person to whom the perinit is so given and the physician cer- tifying the cause of death shall thereafter furnisb 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 re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or tbe asbes 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 per- son appointed to have the care of the cemetery or burial ground in which the internicut is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
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.
. . lle shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of deatb .- General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifles the cause and manner of death to tbe best of his knowledge and belief.
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 physiclans 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 pbysi- 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, 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, aud those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state tbe cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example : "Coin- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circutustances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify : (1) Under cause its known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Ilemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-302
1
RUTLAND
(City or Town)
No. Rutland State Sanatorium
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
Registered No.
10211
-
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
2 FULL NAME
Abram Samuel Wingersky
(If deceased is a married, widowed or divorced woman, give also maiden name.)
164 Court Road
St.
Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or institutionsSanatorium
(Before death)
years
months 24 days.
In this community
yrs.
mos. 24 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE!
I.hite
5 SINGLE
(write the word)
MARRIED:
idowed
or DIVORCED
(Month)
(Day)
(Year)
19 1 HER 58Y
CERTIFY,
43
19
to
That 1 attended deceased from May 20
19.
43
1 last saw h
alive on
May
23
19 ...
death Is sald to
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
00
67
AGE
Years.
3
Months.
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Physician
Industry
10 or Business :
11 Social Security No ..
Boston
12 BIRTHPLACE (City)
(State or country)
Mass.
Major findings:
Of operations
Of autopsy
X-ray & laborstory
What test confirmed diagnosis ?.
20 Was disease or injury In any way related to oocupatlon of deceased ?
If so, speolfy.
George Attenhaus
M. D.
(Address)
orest Hills Crem. Boston
3
17 George W.ingersky
Informant
Relation, if any
(AddressBO Sagamore Ave . Winthrop
A TRUE COPY.
ATTEST :
Frances P. Itauf
(Registrar of city or town where death occurred)
DATE FILED
Lay 24,1943
19
(Registrar
Reoelved and filed 19
1943
or Town where deceased resided)
50m (e)-1-41-4667
.warum andnier city of town at the time of death should be made forthwith allt transmitted on form i-80% to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Carolyn Simon
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
21 "PLACE OF BURIAL,
CREMATION OR REMOVAL.
May 26,1943
19
›
(City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
lioward S. Reynolds
ADDRESS
Winthrop ,Mass.
Physician Underline the cause to which death should be charged sta-
13 NAME OF
FATHER
Samuel Wingersky
Due to.
Other conditions.
Diabetes mellitus
(Include pregnancy within 3 months of death)
..
5a If married, widowed, or divorced Florence Huse
HUSBAND of
(Give maiden name of wife in full)
im
have occurred on the date stated above, at.
11: 45 P.M.
Duration
Immediate cause of death
Pulmonary oedema
Due to
Pulmonary tuberculosis
18 DATE OF
DEATH
May
23,
1943
(If U. S.
War Veteran,
speolfy WAR)
(Specify whether)
PLACE OF DEATH
1 ORCESTER (County)
(Signed)
Rutland, Mass.
Date 5/23 19 43
Date of
43
e
R-303-A
Suffolk
(County) Winthrop (City or Town)
13/ Court Road
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 112
Registered No. St. { { If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
131 Court Rd.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution ..
(Before death)
(Specify whether)
years
months
days.
In this community
25 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACEI
5 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or dlvoroed
HUSBAND of
(or) WIFE of
Edwarddemluckferfull)
(Husband's name in full)
6 Age of husband or wife If allve
61
years
7 IF STILLBORN, enter that fact here.
8
AGE.
56
Years
8
Months.
.7 Days
--
If less than 1 day
.Hours.
.Minutes
Date of ooourrenoe
19
Usual
9 Occupation :
House Wife
Industry
Own Home
10 or Business :
None
11 Social Security No ....
Winthrop
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Herbert Colley
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country) Maine
Portland
15 MAIDEN NAME
OF MOTHER
Helen Snow
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Marblehead
17 Edward Gluckler Hubbardny 13] Court Rd. Winthrop Mass.
50m (g)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Www.8. Childrens Signature, of Agent of Board of flearth or other) Health Maier 5/26/43 (Official Designation) (Date of Issue of Permit)
(Date of Issue of Permit)
= | (Official Designation) V V
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to insert a recital to that effeot
1
PLACE OF DEATH
1
No. Edith C. Stuckist
(Colley)
PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran, If so specify WAR)
St.
(If nonresident, give city or town and State)
18 DATE OF
DEATH
may
24
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Asphyxiation By illuminating qas presumably accidental
20 Accident. sulclde, or homicide (specify)
Where did Injury occur ?
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In pub!lo
place ?
(Specify type of place)
Manner of
Injury
Nature of
Injury
While at work?
Was there an autopsy ?.
21 Was disease or Injury In any way related to ocoupation of deceased ?.
If so, specify.
(Signed)
18 86 Waltera
M. D.
(Address)
Date ..
May 250 48
22
Winthrop' ( ...
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
May ....... 27
1943
23 NAME OF
FUNERAL DIRECTOR
howard 5 (Jugnolds
ADDRESS
19
Received and filed MAY 2 7 1943
(Registrar)
( Registrar)
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
extracts from the laws relative to the return of certificates of death.
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, wliere saine 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 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 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 exhunie 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 medical examiner sliall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session 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 re- moval, unless a permit in the usual form for the removal of such body has been sooner obtained hercunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which
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