USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 68
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Duration Important
Due to.
Prematurata
Due to.
Placenta previa.
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations.
Date of .....
Of autopsy.
What test confirmed diag
Clinical Finden.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in way way related to esqueation of deceased ?.
If so. specify.
ihn /Williams
M. D.
(Signed)
(Address).
429 Beacon S.
. "Date253 18(4)
Winthrop
21
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
6
DATE OF BURIAL.
NOV.
1945
22 NAME OF
FUNERAL DIRECTOR ...
ADDRESS.
Winmy mus
Received and filed NOV 3 1945 19
A TRUE COPY ATTEST.
(Registrar)
ALn
100m(h)-1-41-4695
1 3 SEX m. (or) WIFE of. per hack 11/14/15 Uoual 8 Occupation : PARENTS Informant If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF Industry 10 or Business:
PLACE OF DEATH
No Winthrop Community Hosp Baby Boy than
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
-years
1 horas 5 5 m
MARRIED
WIDOWED
or DIVORCED
19 ..
41
Tion viable, (6mod)
Important/
intrump
16 BIRTHPLACE OF
MOTHER (City).
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shali forthwith, after the death of a person whom he has attended during his last iliness. 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 heilef the name of the deceased, hls supposed age, the disease of which he dicd, defined as required by section one, where same was contracted, the duration of his last iliness, 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 hy the preceding section or hy section forty-five of chapter one hundred and fourteen, 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, specifying 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 pro- vision of this section, such physician or officer shail forfeit ten dollars. For the purposes of this section 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 shali, for said purposes, be deemed to have taken piace 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 nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shaii hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not heen buried, until he has received a permit from the board of heaith, or its agent appointed to issue such permits, or if there is no such board, from the cierk 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 tomh other than the receiv- ing 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 huried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall he accompanied, in case of an originai interment, by a satisfactory certificate of the attending physician, if any, as required hy 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 in- sufficient, a physician who is a member of the board of health, or em- ployed hy it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shail make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shail 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 removai, unless a permit in the usual form for the re- movai of such hody has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-
mix, 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 shail appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shail 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 shaii thereafter furnish for registration any other necessary Information which can be ohtalned as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shaii make examination upon the view of the dead hodies of oniy 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 hody lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human hody or the ashes thereof which have heen brought Into the commonwealth until he has received a perinit 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 hody is to he buried or the funeralis to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chop. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ohservance of the following rules of practice:
(1) Attending physicians will certify to euch deaths only as those of persons to whom they have given bedside care during a last iliness from disease unrelated to any form of injury.
(2) Board of Health physicians wiil certify to such deaths only as those of persons who, though disabled hy recognized disease unrelated 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 wiii investigate and certify to aii deaths supposably due to Injury. These include not only deaths caused directly or Indirectly by traumatism (Including resulting septicemia), and hy the action of chemical (drugs or poisons), thermai, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart faliure, asphyxia, asthenia, etc. As principai cause name the disease causing death. As related causes, name earlier morhid conditions, if any, related to the principai cause and any important complication of the principai cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative heaithfulness 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 iliness. If the deceased had retired from husiness, 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
RM R-301
PLACE OF DEATH
+ Suffolk IV (County) Winthrop. (City or Town)
The Commonmealth of Massarbaseits OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
207
Registered No § (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) PHYSICIAN-IMPORTANT - (Was deceased a U. S. War Veteran? If so. (specify WAR)
(a) Residence. No.
(Usual place of abode)
9 Willow Terr.
St
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
years
- months
T
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
4
(Month)
(Day)
4
1945 7 (Year)
19
CERTI 945, 10
TAThat I attended deceased from
1945
I last saw h M alive on nov 4 .m. 194 , death is said to have occurred on the date stated above, at. 9
Immediate gause of death ..... Prematurity
Due to.
now viable (6 mi)
Due to.
Placenta previa
Other conditions.
(Include pregnancy within 3 months of death)
Major findings: Of operations.
/.Date of
Of autopsy
telinical findings.
What test confirmed diagnosis ?.
PHYSICIAN Underline the cause to which death should be charged sta- Hstically.
20 Was disease or injury in any way related to occupation of deceased? If so. specify
(Signed)
(Address)
429 Beacons.
ato Av. 5 19 45
M. D.
21
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
NOV . 6
DATE OF BURIAL
194.3
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
toward SPPerinaldo
Received and filed NOV 9 1945
19
(Official Designation) (Date of Issue of Permit)
Relation. if any
17 Foster Shaw
Informant
(Address)
9 Willor Terr. Winthrop
Father
V
I HEREBY CERTIFY that a satisfactory standard certificate of death was Med with me BEFORE the buried or transit permit was issued: Wque. D. Children. .... (Signature of Agenyof Board of Health or other) Thealite Officer 11/5/45
100m(h)-1-41-4695
1 3 SEX Female (or) WIFE of 8 Industry 10 or Business: PARENTS If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 19, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF unLI, WIIn UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- Usual 9 Occupation:
Winchup
12 BIRTHPLACE (City)
(State or country)
mãas
13 NAME OF
FATHER
Toster @Show.
14 BIRTHPLACE OF
FATHER (City) ....
Dover
(State or country)
New Jersey
15 MAIDEN NAME
OF MOTHER
Dorothy Reid
16 BIRTHPLACE OF
Winthrop
MOTHER (City).
(State or country)
Mass.
Ifless than 1 day
AGE Years Months. .Days .... Hours U.A.
.Minutes
11 Social Security No.
years
7 IF STILLBORN, enter that fact here.
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive
Winthrop Community /top- E. Baby Gul Show
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
A TRUE COPY ATTEST:
(Registrar)
Duration Important 1 day 1 days 1 day Important
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, hls supposed age, the disease of which he died, defined as required by sectlon one, where same was contracted, the duration of his last Illness, when last seen allve by the physician or officer and the date of his death . . . Gen. Lows, 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 fourteen, 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, specifying 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 pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section 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 between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another. or from one grave or tomb other than the receiv- Ing 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 carly enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence. the medical examiner shall make such certificate. if such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval 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 recltal shall appear upon the permlt. 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 certifylng the cause of death shall thereafter furnish 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 .- Chap. 114, Sec. 45, 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 dled by vlolence. 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 Lows, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground In which the Interment Is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
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 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 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, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation Is very 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 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
301 A
r PLACE OF DEATH
Suffolk
(County)
12
Winthrop
(City or Town)
Winthrop Community Hostal/death occurred in a hospita No.
give its NAME instead of street and number)
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give also maiden name.) 1518 Columbia Rd st.
(a) Residence. No.
(Usual place of abode)'
Length of stay: In hospital or Institution
( Before death)
( Specify whether )
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
N.
4 COLDR OR. RACE|
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Cive maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive
yaarş
If less than 1 day Hours ... Minutas
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( State or country)
Frank
13 NAME DF
FATHER
Francis
Simili
14 BIRTHPLACE DF
FATHER (Clly)
Italy
(State or country)
15 MAIDEN NAME
DF MOTHER
Frances Darrigo
16 BIRTHPLACE DF
MOTHER (City)
(State or country)
Messina, Italy
17 Frank Simili Bat)
Relation, If any
Informant ( Address Y 1518 Columbia Rd. So, Bato
I HEREBY CERTIFY that a satisfactory standard oartifloata of death was Mied with me BEFORE the Durlai or transit parmit was issued : William D, Childus (Signature of Agent of Board nf Health or otber)
agent- 145-
... (Dmicial resignation) ( Date of TroyE of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
nov- 4
1945
( Month )
/
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attendad deosasad from
THY
1945to
19
.
! last saw h.
alive on
19
daath Is sald to
hava occurred on the date statad above, at
m.
Duration Immadlata oause of daath
IMPORTANT
Due to
Still born
Due to
Other conditiona.
(Include pregnancy within 3 months of death)
Major findings : Of operations
Data of
Of autopsy
What test confirmad diagnosis ?
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of daceased ? If so, spaolfy
......
...
( Signad)
Charles Valem
M. D.
(Addrass)
21 4 ...... panchay cemetin riscuridal Place of Burial, Cremation or Removal. (City or Town )
DATE OF BURIAL .......
7200. 8
1945
22 NAME DF
FUNERAL DIRECTOR
Permacchio 8.53
ADDRESS
5980 margin It Boston
Received and Alad
NOV 9 1945
19
-
( Registrar)
100m(1)-1-44-13634
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physiolans to Insert a reoltal to that effeot. PARENTS
5
Book
1.6/
....
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 Agen D8
Registered No.
Baby Simili
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
South Boston, Massachusetts
(If nonresident, give city or town and State)
years
months
days.
in this community
yes.
mon.
days.
1
-
7 IF STILLBORN, enter that fact hera.
8 AGE Years 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 bis last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where 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 beeu 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 relicf expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
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