USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 57
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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 re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or fromn a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114. Sec. 46, G. L., (Tercentenary 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 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 or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal. 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 principal cause name the disease causing death. As related causes, name earlier murbid conditions, if any, related tu the principal cause and any important complication of the principal cause.
Statement of Ocoupation .- 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 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 housekeeper-private family. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1 A
1
(City or Town)
No.
Bessie
9/9/10 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. 170
Registered No. § ( If death occurred in a hospital or institution, St. [ give ite NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME.
( If deceased is a married,
hoved or divorced woman, give also maiden name.)
Heller
(a) Residence. No.
...
12 Sherman
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hnsoltal or Institution
(Refnre death)
(Specify whether)
yeara
months
days.
in this community
1
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
AUG
10 1993
(Month)
(Year)
19 | HEREBY CERTIFY,
June
1933, to.
aug 10
19 43
I last saw h ............
.. alive on
aug
10 , 1943, death Is said to
have occurred on the date stated abova, at.
4:45 A. m.
Duration
Immadlate oause of death ..
Coronary thrombosis-acute
IMPORTANT 3/4 hour
Due to.
Hypertension
10400
Due to
arteriosclerosis
10 yrs.
Other conditions.
Cotropy labais
( Include pregnancy within 3 Months of death)
2 yrs. IMPORTANT
Major findings :
Of operations
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in ony way related to pooupation of deceased ? If so, speolfy
(Signed)
abraham
M. D.
( Address)
16 rue Jean S
Date. Ceux 10 1943
?
21
Thehandle Isreal. on. Ro l'late of Farial, Cremation or Removal. (City or Town)
19.49
22 NAME OF
FUNERAL DIRECTOR
DATE OF BURIAL ..
aug.
Jacob H. devries
ADDRESS 994 With Words
Racelived and filed. AUG 12 203
19
...
Usual
9 Occupation :
House wife
Industry
10 or Business :
aptime
11 Social Security No. more
·2 BIRTHPLACE (City)
( State of country)
Musica
13 NAME OF
FATHER
Lazur Silverman
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Partia
15 MAIDEN NAME
OF MOTHER
Rose (andcover)
Russia
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
"a. Heller
Relat An, If any
17 nathan 9. 490 CommiQue. com Informant
I HEREBY CERTIFY that a satisfactory standard certifiosta of death was filled with ma BEFORE the button or transit permit was Issued : Www. D. Childress x .
(Signature of Ageht of Board of Health or other)
feature aplicar (Omcial Designation) ( Date of lesue of Permit)
8/10/43
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
Is aoc ciden Kobber
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
years
> IF STILLBORN. enter that fact here.
8 75 Years - Months Days
If less than 1 day Hours Minutes
AGE
4 COLOR OR, RACE
3 SEX
female
Tr wovensdu Was & V. 9. War veteran, d. L. Chap. No, Soutien au, requires prifergratis to insert & recital to that ofest. PARENTS
100M-G - 2.42-8855
PLACE OF DEATH
Suffolk Country winthrop
Date of
Of autopsy ..
What test confirmed diagnosis?
( Registrar)
St.
Beverly
(Was deceased a
U. S. War Veteran,
if ao specify WAR)
(Day)
That I attanded deosasad from
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail forthwith, after the death of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnisb for registration a standard certifcate 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. deflued as re- quired by section one, where same was contracted. the duration of his Isst flineas, when laat seen alive by the physician or officer aud 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, aerved 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 immediate cause of death as nearly as he can state the same. For neglect to comply with any pruvision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sectione 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 purposea, 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 buman body in a town, or remove therefrom a human body which has not been buried, until he haa received a permit from the board of health, or ita agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person 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 frum the board of health or ita agent aforexaid or from the clerk of the town where the body is buried. No such permit ahall be Issued until there sbail have been delivered to sucb board, agent or clerk, as the case inay 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, aa required by law. or in lieu thereof a certificate aa hereinafter provided. If there ia no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physl- cian who ia a meniber of the hoard of health, or employed by It or by the selectmen for the purpose, shali upon application make the certificate re- quired of the attending physician. If death ia caused by violence. the medi- cal examiner shall make such certificate. If aucb a permit for the removal of a human body, not previuusly interred, fruin one town to another within the cominonwealth 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 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 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 hren engaged. such recital shall appear upun the permit. The board of health. or its ageut. upon receipt of such statenient aud 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 uther urce+ sary information which can be obtained as to the deceased, or as to the mabuer or cause of the death, which the clerk or registrar ulay require .- Cbap. 114. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereuf which have been brought into the commonwealth until he has re- ceived a permit so to do frum the board of health or its agent appointed to issue such permita, 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 tbe care of the cemetery or burial ground in which the internient is made. . . . Chap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examinera shall make examination upon the view of the dead bodies of only such persons as are supposed to have died hy 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 aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calla for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deatha only as those of persons to whom they have given bedside care during a last illueaa from disease unrelated to any form of injury.
(2) Board of Health phyaloians will certify to such deatha only aa 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 ahsent from home when the certificate of death ia needed.
(3) Medloal Examiners will investigate and certify to all dicatbe sup- posably due to injury. These include not only desths caused directly or in- directly by traumatism (including resulting septicemla). and by the action of chemical (drugs or poisons). thermal, or electrical agents, and deatbs following abortion, but also deaths from diseass 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 deatlı meana the disease. or coniplication which causea death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name tbe disease causing death. As related causes, 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 la 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 yeara 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 bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at huine. For a woman wbose only occupation waa that of home huusework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as housekeeper-private family. cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
A
1
PLACE OF DEATH
Suffolk SCAinty)
Brookline notified 9/9/430
Minttuich (City or Town) 60 Haun Bail Ave 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, ¿ give ita NAME instead of street aud number) PHYSICIAN - IMPORTANT
2 FULL NAME
George Albert Kelley
( If deceesed is a/married, widowed or divorced woman, giye also maiden name.)
(e) Residence. No.
36 Cypress
(Usual place of abode)
Length of stay: In nosoltal or Institution
(Before death)
(Specify whether)
years
months
days.
(If nonresident, give city or town and State)
In this community 59
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Nocle
4 COLOR OR RACE!
5 SINGLE
( write the word)
Single
MARRIED
WIDOWED
or DIVORCED
Sa 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 yeers
> IF STILLBORN. enter that fact here.
8 AGE 59 Years Months Days
If less than 1 day
Hours
Minutes
Usual 9 Occuoatlon :
Chief Engineer
Industry
10 or Business :
Tour of OBI colline
11 Social Security No.
12 BIRTHPLACE (City)
( State or country)
13 NAME OF
FATHER
Mulaul Kelley
14 BIRTHPLACE OF
FATHER (Clty)
Ruland
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary J. Galan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Relation,, If any & sthe A Ford Informant ( Address) 36 Bypace St 03 Value"
I HEREBY CERTIFY that a satisfactory standard certificats of death was filed with me BEFORE the burial or transit permit was Issued : William D. Childress
(Signature of Agent of Board of Health or other)
agent- aug 10/43 ( Date of thue of Permk)
18 DATE OF
DEATH
( Month
(Day)
(Year)
That I attended deosased from
19 | HEREBY CERTIFY,
June 24
43
august 10
1973
to.
i last saw h.
.allve on.
august 10, 1943 death Is sold to
have occurred on the date stated ebove, at .. 5:20 P: n.
Immedlate peuse of death .... acute Coronary Thrombosis
Duration IMPORTANT 1 hour
2 .- 3 days
angina
Due to.
Other conditions.
none
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findings :
Of operations
none
Date of.
Of autopsy
une
What test confirmed diagnosis
Underilne the cause to which death should be charged sta- tistically,
20 Was disease or injury in any way related to occupation of deceased ?. 60 If so, spolfy ............. .......
(Signed)
Cham 1. 00
, M. D.
(Address) 562 Sturday JT
21
Holy Head Brookline Man
l'lace of Burial, Cremation or, Removal.
ACity or Town)
4 ?
DATE OF BURIAL ...
19
3
1
John H. Lacy
(OmcialDesignation)
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS
27 Halvard St Bloodline Marc
Rsosivsd and Alsd AUG 12 8649 1.9
( Registrar)
No
St.
La road y S. Wer Veteran.
Høg spotify WAR)
10
1943
Huma Pectoris
....
PARENTS
St.
(Was deceased a
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or regiatered hospital medioel 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 anthorized 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 wss contracted. the duration of his last illness, when last seen alive hy 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 the preceding section or by section forty five of chapter one hundred and four- teen, shall, if the decessed, 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, 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 stste the same. For neglect to comply with any provision of this section, such physiclan or officer shall forfeit ten dollars. For the purposes of thia 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 Phillppine insurrection, which shall, for said purposea, he deemed to have taken place hetween Februsry fourteenth, eighteen hundred and ninety eiglit 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. 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 has received a permit from the board of health, or its agent appointed to lesue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person ahall exhume a human body and remove it froin a town, from one cenietery to another, or from one grave or tomb other thau the receiving tomb to another In the same cemetery, until he has received a permit from the board of health or Its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be Issued until there shall have been delivered to such board, agent or clerk, as the case inay be, a satisfactory written statement containing the fsets 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. o1 in lieu thereof a certificate as liereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by It or 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 medl- 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 desth made as above provided and in the possession of the undertaker desiring to make such removal slisli constitute a jermit 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 hody has been sooner ohtalned 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 transniit 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 veces sary information which can be obtained as to the deceased, or aa 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 hunian hody 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 permite, or if there is no such hosrd, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall mske exsmination upon the view of the dead bodies of ouly such persons ss are supposed to have died by violence. if a medical examiner has notice that there is within lils county the body of such a person, he shall forthwith go to the place where the luxly liea and take charge of the same; ... - General Laws, Chap. 38, Suc. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only. aa those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death is 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 hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical sgents, and deaths following abortion, but also deaths from dlacasa resulting from Injury or Infeotlon releted 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 desth. not the mode of dying, e. g., heart fallure, asphyxia, asthenla, etc. Aa principal cause name the disease caualng death, As related causes, name earlier morbid conditions, If any, related to the principal cause and any important complication of the principal cause.
Statement of Oooupation .- Precise statement of occupation la 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 desth, 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 he returned aa at school or at hoine. For a woman whose only occupatiou was that of honie housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
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