USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 10
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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 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 he 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RM R-302
1
PLACE OF DEATH
(County)
(City or Town)
No. Hebrew ... LadiesHome for Aged
St.
give its NAME instead of street and number)
2 FULL NAME
Edith Katz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
24 Trident Ave
. St.
Winthrop ... Mass ..
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
4
day 8.
In this community
yrs.
mos.
4 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
Female White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Willow
(Month)
(Day)
(Year)
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Philip ... Katz
(Husband's name in full)
have occurred on the date stated above, at.
m.
Duration
6 Age of husband or wife If allve
years
Immedlate oause of death.
Bronchopneumonia
1/29/46
7 IF STILLBORN, enter that faot here.
8
AGE.
77 Years.
Months.
Days
If less than 1 day Hours. .Minutes
Usual
9 Oooupation :
...
Housework
Industry
10 or Business :
at ... home
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Russia
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be charged sta- tistically.
Of autopsy What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupation of deceased ?
If so, speolfy
B A Udelson
M. D.
(Address)
Boston
Date ..
1/20/16
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Agudath Achim
Woburn
(Cemetery )
(City or Town)
DATE OF BURIAL
Han .31.46
19
22 NAME OF
FUNERAL DIRECTOR
M ...... tanetsky
ADDRESS
Baston ... Mas.s ..
Received and filed. FEB 4 1946
19
DATE FILED Feb 1/46 V 19
50m- (b) -6-44-14607
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 olerk
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
15 MAIDEN NAME
OF MOTHER
Leah ---
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant ..
(Address)
Son
(
Relation, if any
A TRUE COPY.
ATTEST : 1
(Registrar of city or town where death occurred)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return) 23
1034
Registered No.
(If U. S.
War Veteran,
speolfy WAR)
18 DATE OF
DEATH
Jan 30/46
19 I HEREBY, CERTIFY,
1/27 /46 19
to
1/30/46
19
....
That i attended deceased from
I last saw h ... er ....... alive on.
1/30/46
19.
death Is sald to
Due to
Arteriosclerosis
Due to
Myocarditis
?
13 NAME OF
FATHER
Joseph A Feigon
Underline the catise to which death
(Signed)
....... . .. Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased ...... ,
VITFADING DLAUK INK - THIS IS A PERMANENT RECORD
(If death occurred in a hospital or institution,
(Registrar of City or Town where deceased resided)
R-301 A
extracts from the laws on back of certificate. Ima, w tur ir my De properly . Exact same of OCCUPATION is very important. Se instructions and If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physicians to Insert a rooital to that offoot. PARENTS
100m- (g)-1-45-15510
PLACE OF DEATH
Suffolk (County)
Winthrop ....
(City or Town)
No. Winthrop Com ..... Hospital
St. (If death occurred in a hospital or institution, give its NAME instead of street and number) r
2 FULL NAME
Baby GirlMorrocco
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
124 Falcon St.
St.
East Boston
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
( Specify whether )
years
months
days.
In this community
yrs.
mos.
daya
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
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 allvs
years
7 IF STILLBORN, enter that fact here. Stillborn
8 AGE Years Months Days
If less than 1 day Hours Minutes
Usual
9 Ooouoation :
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( State or country)
Winthrop 2
1
13 NAME OF
FATHER
John Morrocco
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Revere
15 MAIDEN NAME
OF MOTHER
Catherine Giuggio
16 BIRTHPLACE OF
MOTHER (City)
(State or country) Salem
17 Informant. John Morrocco ( Address) 124 Falcon St. East Boston
Rels ra CHbHy
I HEREBY CERTIFY that a satisfactory standard certificate of death was Hlad with me BEFORE the burial of transit permit was Issued:
(Signature of Agent of Board of Health or other)
Health Rice 2/4/46
(Official Designation) ( Date of Those of Permit)
18 DATE OF
DEATH
fa tre
1
( Month)
(Day)
1946 (Year)
19 | HEREBY CERTIFY,
19
...
That I attended deceased from
Ło
...
19
I last saw h ...
allve on
19
.... , death Is said to
have occurred on the data statad above,
at 6:40
Duration
Immadlate causa of death. Stillbirth
IMPORTANT
.. ..........
Due to Enencephalic head
Due to
1
Other conditions.
( loclude pregnancy within 3 months of death)
DIPORTANT
Major findings:
Of operations
Data of
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased ?. If so, spsolfy D. D. Patito
M. D.
(Address)
7 Central Sq. Ele te 2/2 1946
21
St. Michael
Boston (City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Eab, . . . 6 .
19.46
22 NAME OF
FUNERAL DIRECTOR Da
Baby Stafino
ADDRESS
9. Chelsea ... Street East Boston
Received and Aled.
FEB 9 1946
19
(Registrar)
21
Ragistsred No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
Notified 3/15/46
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.
1
Famale White
MEDICAL CERTIFICATE OF DEATH
Physician
Underline the cause to which death should be charged sta. tistically.
(Signed)
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 be 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 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 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, Cbap. 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 bas beeu engaged, insert iu the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty seven of said chapter one hundred and fourteen, the word "war" shall include the China relief 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.
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 be 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 bave been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, sball 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 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 sball constitute a permit for sucb removal; provided, that such body shall be returned to the town from which it was removed within thirty six hours after sucb removal, unless a permit in the usual form for the removal of such body bas 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 furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the deatb, 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 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.
No undertaker or other person shall bury a buman 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).
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 forin of injury, have died without recent medical attendance or whose pby- 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), 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., beart 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.
1
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 deatb, 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 tbe 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RM R-301
PLACE OF DEATH
suffolk
(County)
I Winthrop
(City or Town)
Mintheap Community Hosp No ..
2 FULL NAME
Baby Boy Easley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
133 Kimball AVe ..
(Usual place of abode)
St.
Revere Mass
(If nonresident, give city or town and State)
Length of stay: In hospital or institution ..
(Before death)
- years
months
- days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
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.
years
7 IF STILLBORN, enter that fact here.
Stillborn
If less than I day
8
AGE ..
.Years
.Months ..
Days
Hours
Minutes
II Social Security No.
12 BIRTHPLACE (City)
(State or country)
22
13 NAME OF
FATHER
Lawrence Easley
14 BIRTHPLACE OF
FATHER (City).
Howard
(State or country)
Kansas
18 MAIDEN NAME
OF MOTHER
Ruthe Task
16 BIRTHPLACE OF
MOTHER (City) .....
Boston
(State or country)
Mass.
17 Mrs David Task
21 ... Relation, if any (Grandmother)
Informant
(Address) 33/Kimball Que quien
I HEREBY CERTIFY that a satisfactory standard certificate of death was filsd with me BEFORE the buriel or transit permit was issued: Win. D. Childrenfor (Signature of Agent of Board of Health or other Health Officer 15/40 (Offdciai Designation) (Date of Issue of Permit)
20 Was disease or injury in any way related to occupation of deceased ?. 200
If so, specify
(Signed)
D D.
Potito
M. D.
(Address).
7 Central Sq. 4 B Date 2/5 19 46
Piace of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Feb 4
19 46
22 NAME OF
BE Solomons
FUNERAL DIRECTOR
ADDRESS.
H2o Howard St Brookly
Received and filed.
FEB= 1316
1₺
A TRUE COPY ATTEST:
(Registrar)
Duration Important
Due to.
Prolapsed Cond
Due to.
Other conditions. (Include pregnancy within 3 months of death)
Important
Major findings:
Of operations.
Date of ...
Of autopsy
Omphalocele 9 about
What test confirmed diagnosis? If left kidney
PHYSICIAN Underiine the cause to which death should be charged sta- tistically.
3 8EX Male (or) WIFE of Usual 9 Occupation : PARENTS mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF 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. 100m(h)-1-41-4695 N. D .- WRITE PLAINLI, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of infor- Industry 10 or Business :..
4 COLOR OR RACE
White
8 SINGLE
(write the word)
MARRIED
WIDOWED
3
1946
19
HEREBY CERTIFY.
19 ..
.. , to
That I attended deceased from
19
I last saw h .............. alive on
19
,death is said to
have occurred on the date stated above, at.
Immediate cause of death
Stellow
m.
Revers notify 3/03/16
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
25. ...
§ (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)
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 illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, 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 by the preceding section or by section forty-five of chapter one hundred and fourteen, shali, 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 aiso certify in euch 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" shail 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 heaith, 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 cierk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, If any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is 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 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 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- movai 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 i eceased 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 18 80 given and the physician certifying 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 shail make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical exarniner 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.
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 perinit so to do from the board of heaith 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 iliness from disease unrelated to any form of injury.
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