USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 60
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Winthrop Community Hospital DELLA. M. HOWE
Registered No.
PHYSICIAN · IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Rasidence. No.
(Usual place of abode)
MARRIED
WIDOWED
or DIVORCED
1947
Physician Underline the cause to which death should be charged st .. (istically .
Data of
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 hest 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 hy 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 hy section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the hest of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has heen 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 Fehruary 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 huried, 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 tomh 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, 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 early enough for the purpose, the certificate of death made as above provided and in the possession of the nadertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody 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, 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 forth with countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given aud the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can he 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 hodies 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 hrought 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 hoard, from the clerk of the town where the hody 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 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 hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut 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 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 heen 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
-301 A Sullrik (County4 Winthrop 1 (City or Town) 50 Coral are No. Harry Kalish r 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. 182 1
Registered No.
[ (If death occurred in a hospital or institution. St. [ give its NAME. instead of streer and number)
2 FULL NAME
(if deceased is a married, widowed of) divorced woman, give also maiden name.)
50 /canal are.
St.
PHYSICIAN - IMPORTANT
(Was deceased a
200
U. S. War Veteran.
/if so specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
yeara
months days.
(If nonresident, give cify or town and State)
In this community 26 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
13 DATE OF September 18.
1947
( Month)
( Day)
( Year )
19 | HEREBY CERTIFY, That i attended deosased from
July 28
19
47
Sep 18
to
19
47
t tast saw h
alive on
have occurred on tha date stated above, at
9.35
A
m.
6 Age of husband or wife if alive
yaars
7 IF STILLBORN, enter that fact hera.
8 AGE8 4 Years Months Oays
if less than 1 day Hours Minutes
Usual
9 Occupation :
Retired
industry
10 or Business :
11 Social Security No. . none
12 BIRTHPLACE (City)
( Sisie or country)
Russia
13 NAME OF
FATHER
Didelia Kalish
14 BIRTHPLACE OF( Médialig)
1
FATHER (Clty)
(State or country)
Russia
15 MAIOEN NAME
OF MOTHER
Cannot Be Learned
16 BIRTHPLACE OF
MOTHER (City)
(Stote og country )
17 informant ( Address ) Ibmumaid and Winshop
I HEREBY CERTIFY that a satisfactory standard oartifloata of death wss Aled with me BEFORE the burial or transit; permit wep istund : Walter Q. Maker
H.O.
(Signature of Agent of Board of Health or other) Sept- 18/1947
(Official Designation) ( Date of Theuse of Pergill)/
20 Was disease of injury in any way related to occupation of deceased lo. ury in any way related
Il so, specify Les verwerft ihren
( Signed}8
(Add3) Shore Dr. Winthrop, 89474
M. O.
21 Wirthise
Place of Burial, Cremation or Remoyat.
OATE OF BURIAL.
Sept 18
(City or Town )
22 NAME OF
FUNERAL DIRECTOR
Benjamin Benkach.
ADORESS
10 Washington St. Durcheste
Reosived and fied SEP 1-9-19+++ 19
( Registrar)
? 4 m
Due to
and obstructive jaundice
Due to
Other conditions.
Generatizegafterio-
( Include pregnancy within 3 months of death)
Major findings : Of operations
Oata of
Of autopsy
What test confirmed diagnosis?
clinical
IMPORTANT
Physician
Undertine the cause to which death should be charged st .. Istically
PARENTS
100m-(R)-1-45-15510
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, Q. L. Chap. 46. Section 10, requires physicians to insert a recital to that effect. ки ксм
3 SEX
male
4 COLOR OR RACE
1 white
5 SINGLE
MARRIED
WIDOWED
or DIVORCEO
( write the word) OEATH
If married . HUSBANO of
d. Brooka Kellerman
(Cive tnaiden name of wife in full)
(or) WIFE of
( Husband's name in full)
im
Sep 18
. 19 47
death is said to
Duration
Immediate cause of death
IMPORTANT
Carcinoma of pancreas
Reistion, If Any
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 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.
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 reasc 's, his certificate cannot be obtained early enough for the purpose, or is insu ncient, 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 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 of chapter forty-six, inat 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 aud 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 examiner 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, thoughi disabled by recognized disease 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), 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 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.
i
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
IR-302
1
Boston
(City or Town)
No.
Children's Hospt
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
82183
(If death occurred in a hospital or institution, St. give its NAME instead of street and number) -
2 FULL NAME
Thomas M Safallo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
204 Pauline
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution ..
(Before death)
(Specify whether)
years 5
months days.
In this community
yrs. 5
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX M
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
Single
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Aug .. 6./4.7
19
to
That I attended deceased from
47
Sept. 20
19.
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that faot hore.
8 AGE Years 8 ..... Months1& ....... Days
If less than 1 day .Hours Minutos
Usual
9 Occupation :
Industry 10 or Business :
11 Social Security No .....
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass.
13 NAME OF
FATHER
Robert Safallo
14 BIRTHPLACE OF
Boston Mass.
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Helen L White
If so, spoolfy
L Longino
(Signed)
(Address)
300 Longwood Ave.
Date
9-20 M. 27
21 PLACE OF BURIAL,
CREMATION OR REMOVALWinthrop Cem-Winthrop Mass.
(City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS
Winthrop ... Mass ..
Reoelved and filed SEP 29 10.17
19
DATE FILED
(Registrar of city or town where death-occurred) Sept .23/47
19
Other conditions
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
Major findings :
Of operations
which death
Date of
should be charged sta- tistically.
Of autopsyRhobdomyosarcoma
What test confirmed diagnosis?autopsy.
20 Was disease or Injury in any way related to oooupation of doooasede.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Winthrop Mass.
17 Informant (Address)
Father ( Relation, if any
A TRUE COPY
ATTEST :
50m-(b)·6.44-14607
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Suffolk (County)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
I last saw h .... 1m ..... alivo on
Sept.20
19.47
death Is said to
have ooourred on the date stated above, t.9:45FM m.
Duration
Immediate oause of death Rhobdomyosarcoma .... of ... urinary bladder
$ Mos
Due to
Due to.
PARENTS
18 DATE OF
DEATH
Sept. 20/47
(If U. S.
War Veteran,
speolfy WAR)
Winthrop
Mass.
(Usual place of abode)
Registered No.
(Cemetery)
Sept. 23/47
19
(Registrar of City or Town where deceased resided)
X
R-302
1
PLACE OF DEATH
.SUFFOLK (County) BOSTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
824384
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
2 FULL NAME
Harriet H Burtt
(If deceased is a married, widowed or divorced woman, give also maideu name.)
5 Lincoln St
St.
Winthrop
Mass
(a) Residence. No.
(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
2
days.
In this community
yrs.
1
mos.
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE
W
5 SINGLE
(write the word)
Widow
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
Sept ....... 1.9 ...... , 1
.4.7,
to.
That g attended, deosased
Sept.
ram
5a If married, widowed, or divorced HUSBAND of
fif maiden name of gife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve
yearı
7 IF STILLBORN, enter that fact here.
8
AGE .... 67 Years
3
Montha .. 1.9.
„Days
If less than I day .Hours. .Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
At Home
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
Smith Cor. N.B.
13 NAME OF
FATHER
George Christie
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
New Brunswick
Of autopsy
What test confirmed diagnosis ?. .autopsy .. --
No
If so, spoolfy NA Wilhelm
(Signed)
(Address)
721 Huntington ABA. 9-21, M. 27
21 PLACE OF BURIAL,
CREMATION O
Burtt Cornor New Brunswick
DATE OF BURIAL
(Cemetgypt. 25/47City or Town)
19
A TRUE COPY.
ATTEST :
(Registrar pkEn( ontown where "death occurred)
Michael
Sept ~ 24
22 NAME OF
FUNERAL DIRECTOR
H S Reynolds
ADDRESS
Winthrop Bass.
Received and flied.
19
DATE FILED
1
₹
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
50m- (b) .6.44-14607
17 informant. (Address)
Anne Nickerson Daughter
Relation,
18 DATE OF
DEATH
Sept.' 21/47
19
...
I last saw h ..... er ...... alive on
Sept. 2119 47
death Is sald to
have occurred on the date stated above, at.
2:45AM
M.
Immediate oause of death.
Arterio sclerotic cardio vascular
Ter.
disease
Due toMyocardial infarction
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations.
Date of.
Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury In any way related to oooupation of deceased ?.
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