USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 30
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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 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 hy 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
R-301 A
PLACE OF DEATH
1 Suffolk (County)
(City or Town) 10. 363 Shirley Rebecca
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.
Registered No.
85
(If death occurred in a hospital or institution, { St. 1 give its NAME instead of street and number) S
PHYSICIAN- IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR) no
(a) Residence. No. (Usual place of abode)
363 Shirley
St
Mintherapy Mass. (If nonresident, give city or town and State)
In this community 35 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4
COLOR OR RACE
White
5 SINGLE (write the word) MARRIED WIDOWED or DIVORCED Colawo
5a If married, widowed or divorced HUSBAND of ..
(or) WIFE of
Samice de machlatein
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
ÅGI
:94 Y
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual 9 Occupation:
Housework
Industry 10 or Business: at Home
11 Social Security No. none
12 BIRTHPLACE (City)
(State or Country)
Quasia
13 NAME OF
FATHER
abraham Glickman
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Russia
15 MAIDEN NAME
OF MOTHER
"Hola (Cannot be leamed)
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
CL
17 Informant (Address) /375 Shirley Add Winthrop
100M -7-46 -19068
I HEREBY CERTIFY that a satisfactory, standard certificate of death was fued with the BEFORE the burial betragsty permut was issued: Walter A Palest (Signature ChAgent of Board of thalth or other) Health officer 4/30/47
K(Official Designation)
(Date of Issue of Permy)
MEDICAL.CERTIFICATE OF DEATH
18 DATE OF
DEATH
april
30
(Month)
(Day)
19 I HEREBY CERTIFY. That I attended deceased frogt
File
-
19.47. . to
30 april 1947
| last saw h Oralive on
24 april 1947, death is said to
have occurred on the date stated above, at 5:00 A.m. Immediate cause of death
arterioscleratic Ht. Disease
Due to
Due to
generalized.
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy What test confirmed diagnosis? Clinical.
20 Was disease or injury In any way related to occupation of deceased ?- If so, specify
200
(Signed) Charles frele xuan, , M. D.
Cremation of Renmy. (City of Townf 1047
DATE OR BURIAL
22 NAME OF
FUNERAL DIRECTOR
ADDRESS 10 Washington St. Novelusto 19
Received and Filed MAYA 1947
(Registrar)
Duration
IMPORTANT 30 yrs 30 yrs.
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
See instructions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
2 FULL NAME
Gabelstein
(If deceased je a married, widowed or divorced woman, give also maiden name.)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
1947. (Year)
female
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 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, 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 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 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 110 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 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- eian 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- eal 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 removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten ui chapter forty-six, tuat 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 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 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 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).
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 discase unrelated to any forin of injury, have died without recent medical attendance or whose phy- sician is absent from home wben 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., 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 eause 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
R-301 A
+
Suffolk (County)
Winthrop
(City or Town)
No. 24 Underhill Street, Winthrop
St { {If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME Lewis G. H. Tucker
( If deceased is a married, widowed or divorced woman, give also meiden name.)
(a) Residence. No. 24 Underhill St .Winthrop
(Usual place of abode)
None
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
months
days.
In this community
55 yre.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divoroed HUSBAND of
Irene .... A ....... Thompson (Give maiden name of wife in fuff)
(or) WIFE of
( Husband's name in fulf)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here.
8 AGE Z1. Years .1.
Months
2.8
Days
If less than 1 dey Hours Minutes
Usual
9 Occupation :
Steward
Industry
10 or Business :
Club.
11 Social Security No.
01.8-12-3268
12 BIRTHPLACE (City)
(State or country)
Lockport, New York
13 NAME OF
FATHER
George H. Tucker
14 BIRTHPLACE OF
FATHER (Clty)
New ..... York
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Ann Dolan
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
New ...... York.
17 Maxine Higginbotham daughter
Informent ( Address ) 24 Underhill St., Winthrop
I HEREBY CERTIFY thet a satisfactory standard certificate of death was Aled with one BEFORE the burist or tranelt permit wes Issued :
(Signature of Agent of Board of Health or other) 5/2/4,-
platte (Omelal Designation) 11 ( Date of Inque of Permit)/
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
april
(Month)
30
1947
19 | HEREBY CERTIFY,
Feb 1
1945. to.
Thet I attended deceased from
april 30
19 47
I last sow h.
i'malive on
april 30, 194 7 death Is said to
.
have occurred on the dete stated above, at.
11.30
Immediate osuse of death
Branchogenic
carcinoma
IMPORTANT
....
6 mos
Due to.
Due to
Other conditions
( Include pregnancy within 8 months of desth)
Mejor findings : Of operations
Date of
Of autopsy
What test confirmed diagnosis? Bronchoscopy
IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
20 Wes disease or injury in any way related to oooupetion of deocesed ? [ ... If so, spoolfy
. M. D.
(Signed) .... 14 .. 5
(Address) +4.7 2 horas
it withir Deto mays
19.91.7
21 Winthron Cemetery, Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
May 3rd , 1947.
19
22 NAME OF
FUNERAL DIRECTOR
Richard. C. Kirby
ADDRESS
Boston, Massachusetts
19
Received and Aled MAY 6 -194
( Registrar)
100m. (g)-1-45-15510
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, Q. L. Chap. 46, Seotion 10, requires physicians to Insert a recital to that offact. PARENTS
1
PLACE OF DEATH
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.
Registered No.
86.
PHYSICIAN - IMPORTANT
(Was deceased 2
U. S. War Veteran,
if so specify WAR).
No
St.
(If nonresident, give city or town and State)
(Day)
(Year)
Duration
...
1
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 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, 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 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, he 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 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 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 hy 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 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 he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such hody has been sooner ohtained hereunder. If the death certificate contains a recital, as required
by section ien 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 certifylng 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 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 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 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).
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 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), 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 morhid 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 hy 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
A R-302
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
3686
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Baby Girl Peters
(If deceased is a married, widowed or divorced woman, give also maideu name.)
(a) Residenoe. No.
145 Bowdoin St
St.
Winthrop Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or institution ...
(Before death)
(Specify whether)
years
months
1
days.
In this community
yrs.
m08.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE|
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
( Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if allve
years
7 IF STILLBORN, enter that fact here.
8 AGE Years. Months. ..... Days
If less than 1 day
... ]Q .. Hours
Minutes
Usual
9 Ocoupation :
Industry 10 or Business:
11 Soolal Security No ..
12 BIRTHPLACE (City)
(State or country)
WinthropMass
13 NAME OF
FATHER
John Peters
PARENTS
50m. (b) .6.44-14607
A TRUE COPY,
ATTEST,
Michael Planning
( Registrar of city of town where death occurred)
DATE FILED 1) April 22/470 19
22 NAME OF
FUNERAL DIRECTOR
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