USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 43
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(3) Medical Examiners will investigate and certify to all deaths supporably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and hy 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 nf 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- ditlons, 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
01 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No.
82 Putnam Street
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled før burial permit with Board of Health or its Agent, 129
Registrar's No.
St.
§ (If death occurred in a hospital or institution,
{ give its NAME instead of strect and number)
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
82 Putnam Street
(a) Residence. No.
(Usual place of abode)
St.
(If nonresident, give city or town and Statc)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community 5 1yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEIBingle
18 DATE OF
DEATH
June
24
1944.
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8
AGE
51 Years.
5 Months.
29
Days
If less than 1 day
_Hours.
Minutes
Usual
9 Occupation :
None
Industry
10 or Business:
None
11 Social Security No.
None
12 BIRTHPLACE (City)
Winthrop
(State or country)
Mass
13 NAME OF
FATHER
Charles 0 Ford
14 BIRTHPLACE OF
FATHER (City)
Pennbrook
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Ethelda Newall
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Novia Scotia
17 .
Relation, if any Informant Mrs Lewis Souza sister (Address)34 Baldwin St. Cambridge Mass
21 Winthrop
Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL.
June 27
1944
22 NAME OF
FUNERAL DIRECTOR
Howard Surynolds
ADDRESS
Winthrop mais.
Received and filed
JUN-28 1944
19
(Registrar)
50m-(e)-3-43-11574
was filed with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that a satisfactory standard certificate of death Www. D. Children
(Signature of Agent of Board of Health or other) Health Aplicar 6/24/44
(Official Designation) (Date of Issue of Permit)
I last saw h
alive on.
19
death is said to
have occurred on the date stated above, at.
8.27 Pz
Immediate cause of death.
Duration IMPORTANT
Due to.
ativo Deluisa
Med. Stammer
Due to main puraliation)
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations.
Date of.
Of autopsy
What test confirmed diagnosis?
IMPORTANT Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
M. D.
(Address)
abilititão
19
(Month)
(Day)
19 I HEREBY CERTIFY,
That I attended deccascd from
19
-- , to
from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
(City or Town)
2 FULL NAME
Charles E Ford
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 dicd, defined as re- quired by section one, where sanie was contracted, the duration of his last iilness, when last scen 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 sball also certify in such certificate both the primary and the secondary or immediate cause of death as ncarly 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 expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder service of nineteen hundred and sixteen and nine- teen 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 buricd, until he has received a permit from the hoard of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may bc, 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, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner 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 carly enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician ecrtifying 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 muanner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
Medical examiners 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 lics 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 fron 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 discase unrelated to any form of injury, have died without recent medical attendance or whose phy- sician 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 indirectly 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, ctc. 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 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, how- ever, designate the occupation by the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
RM R-301 ||
1 PLACE OF DEATH No 3 SEX male HUSBAND of (or) WIFE of. AGE 63 Years Usual 9 Occupation: Industry 10 or Business: 13 NAME OF FATHER PARENTS Informant is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 200m-10-'39. No. 8427-d N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of (State or country)
4 COLOR OR RACE
5 SINGLE MARRIED WIDOWED or DIVORCED
"write the word) Wedried
Sa Il marted, widowed, at& Tattachants
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive. .years Immediate cause of death acuta Pulmonar edema
7 IF STILLBORN, enter that fact here.
If less than I day
Hours.
Minutes
WEat
butter
1I Social Security No. 028-09-7267
12 BIRTHPLACE (City)
(State or country)
Russia
Harris Millee
14 BIRTHPLACE OF FATHER (City)
Russia
15 MAIDEN NAME
OF MOTHER
E année LeurTan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Evelyn millee Daithe 640 Mani St Malieu ..........
I HEREBY CERTIFY that a satisfactory standard certificate 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 June 28/44
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH
teur.
(Month)
(Day)
28.1944
(Year)
HEREBY CERTIFY . That I attended deceased from
19
ore. 14
19.43
June 28
to
19xx
I last saw h ............ alive on ......
Juh 28
. 1984
to have occurred on the date stated above, at.
630%
.. m.
Duration
Des to
Chronic Husscandales and
Due to Ny perfusion
1 yr.
Other conditions
(Include pregnancy within 3 months of death)
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 ?
If so, specify
.....
(Signed)
Seom. A. Schwartz
M. D.
(Address).
19 Pricelist· E.B
Date 6/28 19 44
21
moses Mendelssohn bEin U . PT Place of Burial, Cremation or Rer ova (City or Town) 19 ... Y.Y
DATE OF BURIAL June 29
22 NAME OF
FUNERAL DIRECTOR
PERme
ADDRESS
470
Harward st . Brooklyn
Received and filed. jui 5 1911
19
A TRUE COPY ATTEST:
Winthrop .... (City or town making return)
130
Registered No
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Bruganni Mille
2 FULL NAME
..........
(If deceased( a married, widowed or divorced woman, give alse maiden name)
640 Main (maldau).
(a) Residence. No .. (Usual place of abode) Length of stay : In hospital or institution (Specify whether)
years
months
days.
(If U. S. War Veteran. specify WAR)
man. ............
(If nonresident, give onu or town and state)
In this community 2J
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Boldratified
7/11/4
Luppoli (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town) Mulheres bom.
St. l
death is said
1 Day
6 would
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
(Registrar) .....
Months.
Days
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 regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove thercfrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another In the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body Is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificatc. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a removal shall constitute a perinit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be
obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chop. 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 huricd 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, 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 dicd without recent medical attendance or whose physician is ahsent 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- 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
M R-302
2 FULL NAME
3 SEX
M
(or) WIFE of
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Informant.
(Address)
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
(State or country)
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced anet T Dorgan
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If alive 34 ..
years
7 IF STILLBORN, enter that fact here.
8 AGE. 44Years. 1Months ...... 24Days
If less than 1 day Hours. Minutes
Usual
9 Occupation :
Electrician
NavyYard ,Boston, Mass.
Boston,Maso.
William Francis O'Connor
14 BIRTHPLACE OF
FATHER (City)
Salom,Mass ...
Isabelle Anktell
17 Margaret O'ConnorRelation, if any
38-Madison Ave. . inthrop"
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June 11,1944
(Month)
(Day)
(Year)
19
1
CERTIFY,
44
19
to
That tune 1I
+ attended deceased from
19
44
I last saw h
janve on
Juno ..... 1.1 ..... , 19 .... 4/death Is sald to
have occurred on the date stated above, at.
10.55
Duration
Immediate cause of death Malnutrition
Due to.
Pyloric obstruction
Due to.
Carcinoma stomach.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
Major findings :
Of operations ..
Ant. gastro-ontorost whichdeath
obstruction
Date of 8/07/44 should be
Cautopsydistal third of stomachharged sta-
What test confirmed dlagnosis ?.
20 Was disease or injury in any way related to occupation of deceased ?
If so, speolfy
(Signed)
Porin B. Enydor
M. D.
(Address)
Date ./7.7.19
:44
21 PLACE OF BURIAL
CREMATION-OR REMOVAL,
Winthrop
DATE OF BURIAL
June 14 (1944own)
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Kirby Funeral ParIor
Temning on St. .. Boston
Lossple Q Tyrel
(Registrar of City den The deceased resided)
50m (e)-1-41-4667
PLACE OF DEATH
Suffolk
(County)
1
Chelsea (C'ity or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
31
Registered No.
344
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
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