USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 61
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21 Loring Road
Anthrop
I HEREBY CERTIFY that a satisfactory standerd certificate of death wes fed with me BEFORE the burial or transit permit was Issued I William & Childrens
(Signature of Agent of Board of Health or other)
agent Lung 21/43
.... (Offciel Designation) ( Date Issue of rermit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
('onth)
18
1943
(Day)
(Year)
19 | HEREBY CERTIFY,
am 18
1943, to.
amy 18
1943
i last saw h ...
.alive on ...
0
19 43, death is said to
have occurred on the date stated above, at
6
P
m.
Duration IMPORTANT 2.3 km2.
Due to
Due to
Other conditions.
( Include pregnancy within 3 months of deeth)
Major findIngs :
Of operations
Dete of
Of eutopsy
What test confirmed dlegnosis?
IMPORTANT Physician . Underiino the cause to which death should be charged sta- tistically.
20 Was disease or injury in any wey related to oooupation of deceased ?.
If so, spoolfy.
('Signed)
M. D.
(Address)
148 Wul St Date
Deto 18/18 1943
21 Woodlawn Cemetery
l'face of Burial, Cremetion or Removal.
(City or Town)
DATE OF BURIAL
August. 22
19.
43
22 NAME OF
FUNERAL DIRECTOR
J. S. uterman & Sons
ADDRESS
Boston,
0. 0.5
Received and Aled
amy, 23, 1943
( Registrar)
CCB8-21-2- 4 -WAAL n D
PLACE OF DEATH
St.
Hamas
(Was deceased a
U. S. Wer Veteran,
if so specify WAR).
None
(a) Residence. No.
(Usual place of abode)
(Specify whether)
Immediate ceuse of death Geronany
That I attended deosased from
....
13 NAME OF
FATHER
Unknown
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal officer shall forthwith, after the death of a person whoin he has attended during his last illuesa, at the request of an undertsker or other anthorized person or of any meniber of the family of the deceased, furnisb for registration a standard certificate of death, stating to the best of his knowledge and behef 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 Illneaa, when iaat seen alive by the physician or officer and the date of his death ... Gen. Lawa, 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. sud shall slso certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the ssine. For neglect to comply with any provision of this section, auch physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bundred 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 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 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 cemetery 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 aball bave been delivered to sucb board, agent or clerk, as the case inay be, a satisfactory written atatement containing the facta required by law to be returned aml 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. 01 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 is a member of the board of health. or employed by it or by the aelectmen for the purpose, shall upon appliestion make the certificate re- quired of the attending physician. If death is caused by violence, the med]- cal examiner shall make such certificate. If such a permit for the removal of a liumsu body, not previously interred, froin one town to another within tbe 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 containa a recital, aa required
by section ten of chapter forty-six, that the deceased aerved in the army, bavy or marine corps of the United States in any war In which It has heen engaged. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall forthwith countersigo it and transmiit 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+ 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 ashea 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 sgent 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 .... Cbap. 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 llea aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calis for the observance of the following rules of practice :
(1) Attending phyalcians will certify to such deaths only aa those of persona to whom they have given bedside care during a last illueaa from disease unrelated to any form of injury.
(2) Board of Health phyalolana 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 desths sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatism (including rexuiting septicemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following abortion, but also deaths from disease resulting from injury or infection related to occupation, the audden deatha of persona 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 causea death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Ax principal cause name the disease caualug 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 Oooupatlon .- Precise statement of occupation la very Im- portant, so that the relative healthfulnesa of various pursuits can be known, Make some entry in thia aection 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 deceased bsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at hoine. For a woman wbose only occupatiou waa that of honie bousework. write bousework. 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 had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
Certifirenta segunda
medical Exama
Suffolk Com
Brad af Poslech ..
A
1
Winthrop
(City or Town)
Winthrop Community
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 Ägent.
Registered No.
Hospital
St.
§ ( If death occurred in a hospital or institution,
¿ give its NAME instead of street and nuniber)
PHYSICIAN - IMPORTANT
2 FULL NAME
John S. Riley
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
26 Beacon.S.t.
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
months
I
days.
In this communiBO
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
Male White
5a If married,
Maty A. Simpson
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in fuli)
6 Age of husband or wife if alive
years
> IF STILLBORN. enter That fact here.
8 AGE 72 Years- Months Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Retired Laborer
Industry
10 or Business :
Town
11 Social Security No. East Boston
12 BIRTHPLACE (City)
( Siste or country)
Mass
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Johanna Carroll
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Jameg Riely
Reiation, if any
( Address )
35 Beal St.
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burlai or transit permit was Issued :
(Signature of Agent of Board of Heaith or other)
/ health ofle elf 8/20/45
(Official Designation) ( Date of Issue of Permit)/
18 DATE OF
DEATH
19
1943
(Day)
(Year)
19 | HEREBY CERTIFY,
7
1943, to
That I attended deosased from
14
19 .... 4.3
'I last saw h ... L.
.alive on
0,1943, death is said to
have occurred on the date stated above, at.
3. C . on.
Immediate oause of death
Duration IMPORTANT
....
2/2 years
Due to.
Ch. Hypertension Hvert Do
Other conditions.
Someity
( Include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operations
Date of.
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased? La
, M. D.
('Signed).
148khupst
Date 8/19
19 .. 54.3
21
Winthrop Winthrop
l'iace of Burial, Creniftion or Removal. DATE OF BURIAL ....
Cite r Town
Aug! . ... 11943
John Winthrop
maley
22 NAME OF
FUNERAL DIRECTOR 1
ADDRESS
Received and
Aled ......
19 ........
( Registrar)
--
PLACE OF DEATH
Suffolk
(County)
No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
.....
13 NAME OF
FATHER
John Riley
Physician Underiine the cause to which death should be charged sta- tistically.
Due to.
Corona Quase
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medical officer shall 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. defined as re- quired by section one, wliere ssme wss contracted. the duration of his last illness, when last seen alive by the physician or officer and the date of bis 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 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, sud shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the saine. 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 Phillppine insurrection, which shall, for said purposea, he deemed to have taken place hetween February fourteenth, eigliteen 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. Chiap. 46. Sec. 10.
No undertakar 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 has received a permit from the board of health, or ita agent appointed to issue sucb permits, or if there Is no such board, from the clerk of the town where the person dled; and no undertaker or otber 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 be has 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 sball be issued until there shall have been delivered to sucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned ankl 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. 01 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 deatb is caused by violence. the medl- cal examiner ahall 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 ot tbe undertaker desiring to make such renioval 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. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statenient 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 physiciau certifying the cause of death shall thereafter furnish for registration any other neces sary information which can be obtained as to the deceased, or aa to the maimer or cause of the death, which the clerk or registrar may require .- Cbap. 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 luto the conimonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue much 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. .. . Chap. 114. Sec. 46. C. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies of ouly such persons as are supposed to have died hy 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 Inniy Iles and take charge of the same; ... - General Laws, Cbap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these iawa caiis for the observance of the following rules of practice :
(1) Attending phyalclana will certify to such deatba only aa those of persons to whom they have given bedside care during a fast illness from disease unrelated to any form of injury.
(2) Board of Health phyalolana wili certify to such deaths only aa those of persons who, though disabled by recogulzed disease unrelated to any form of injury. have died without recent medical attendance or whose pbsaf- clan is ahsent from home when the certificate of death is needed.
(8) Medloal Examiners will investigate and certify to all dlcatba aup- posably due to Injury. These include ont only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of cheniical (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 audden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death. not the mode of dying. e. g., heart failure, asphyxia, astbenia, 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 .-- Precise statement of occupation ia very Im- portant, so that the relative bealthfulness of various pursuits call be known. Make some eutry in this section for every person aged 10 years or over. if the occupation had been given up or changed ou accouut of the disease 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 occupatiou was that of bonie housework, write bousework. For a person engaged in domestic service for wages. however, designate the occupation by the appropriate terms, aa bousekeeper-private family, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
I A
REVERE NOTIFIED 9/9/43
Suffolk
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.
Hapis { ( It deeth occurred in a hospital or institution, { give its NAME instead of street and nuniber)
Riva Salvin
2 FULL NAME
( If deceased is a merried, widowed or divorced woman, give also meiden name.)
(a) Residence. No.
592 Ocean
ave
St.
Revere
nass
(Usual place of abode)
Length of stay: In hospital or Institution
(Refore deetb)
years
months days.
(If nonresident, give city or town and State)
In this community 2 0 yrs.
mos.
deys.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE|
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
Or DIVORCED Married
( Mopth)
(Day)
Year)
5a If married, widowed, or divorced
HUSBAND of
Man Give ofideas lane (I write in full)
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if alive 62
years
> IF STILLBORN. enter that fact here.
8 59
AGE Years Months ... Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Howurde
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(Siate or country)
Russia
13 NAME OF
FATHER
Louis Segalar
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
PARENTS
.---- - 2 42-8855
I HEREBY CERTIFY that a satisfactory standard certificate of death wes filed with me BEFORE the burial gr trensit permit wes Issued ? Williams, Childress
(Signature of Agent of Board of Health or other) agent aug 20/43
........ (Omcial Designation) (Date of Issue of/Permit)
20 Was diseese or injury in any way related to oocupetion of deceased ? If so, speolfy.
('Signed)
William
M. D.
(Address)
54 Alway
Det -10
1943
21 Everest Ju
com Everio mass Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
aug
22
1943
22 NAME OF
FUNERAL DIRECTOR
manuel Stanetaby
ADDRESS
10 Washington St. Dorchestert mass
Reosived end Aled.
AUG 24 1943
.19
( Registrar)
Duration IMPORTANT .. ..........
.......
2 .... IMPORTANT
Major findings:
Of operations.
Rectobyl Cypolicele
Cervicaleración Date of Guy 3.1943
Of autopsy
What test confirmed diagnosis? Heart
Physicien Underline the cause to which death should be charged sta- tistically.
15 MAIDEN NAME
OF MOTHER
Bessie-cann the learned
16 BIRTHPLACE OF
MOTHER (City)
Russia
(State or country)
18 DATE OF
DEATH
20
1943 ........
That I attended deceased from
43
.....
19 | HEREBY CERTIFY, 3 1943. 19 to .. Ling 20 I lost saw hafen alive on any 201, 19 death is said to heve occurred on the date stated above, at 12.30Pm
doanh Pulmonary
Due to.
Pela Peration
Due to
Other conditions ..
Hypertension Heurtassen
( Include pregnancy within 3 months of deeth)
nect-aux ca
17 max Salvin Poistion, At any and Informent (Address) 592 Ocean are River og gas
... ( County) Winthrop (City or Town) En Route to Winthrop community st. No.
1
PLACE OF DEATH
(Specify whether)
PHYSICIAN - IMPORTANT
(Was deocesed a
U. S. War Veteran,
if to specify WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other authorizeil 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 aud belief the name of the decessed, his supposed age, the disease of which he died. defined as re- quired by section one. where ssme wss contracted. the duration of his last illnesa, 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 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. snd shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such 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 bumired and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, be deemed to have taken place between February fourteenth, eigliteen hundred and ninety eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
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