USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 67
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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 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
PLACE OF DEATH
(County) 1
(City or town) 167 Shore drive
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. .
.202
st. ¿ (If death occurred in a hospital or institution ! give its NAME instead of street and number
2 FULL NAME
Charles Zommer (If deceased is a married, widowed or divorced woman, give also maiden name.) 167 Shore Drive (Usual place of abode)
winthrop
St.
(If nonresident, give city or town and State)
In this community
5
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX 3
4
COLOR OR RACE
W
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
dowed or d
Fannie Lireff
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
6 Age of husband or wite if alive . .
years
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Tailor
Industry
10 or Business:
Tailor Shon
11 Social Security No.
12 BIRTHPLACE (City)
(State or Country)
Russia
13 NAME OF FATHER Sam Zommer
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State of Country)
russia
15 MAIDEN NAME
OF MOTHER
Sarah ( unknown)
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
Russia
17 Edward Gommer (s'chtion, if any
Informant (Address) 130 Brainerd Rd Allston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial, or trapat permit was issued Walter & Bakery Signature M Agent of Board of Health or other)
Health Officie Oficial Designation) (Date of l hue /f Pernuit)
10/14/47
18 DATE OF
DEATH
Oct
13-1947
(Month)
(Day)
(Ycar)
19 I HEREBY CERTIFY,
That I attended deceased from
, 19
, to
, 19
I last saw h - alive on , 19 , death is said to
have occurred on the date stated above, at
7
P. M.
Duration
Immediate cause of death Natural Causes
Due to
Presumably coronary
Due to
orchision
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operations
none
Date of
Of autopsy none
What test confirmed diagnosis? -
20 Was disease or injury in any way related to occupation of deceased? no If so, specify
(Signed
(Address)
Winthrop Board of Health
, M. D.
21 Mit
Lebe nen Shara
Tefilo W. Rox
Place of Burial, Cremation of Removal
ity of Town)
DATE OF BURIAL
October 14
194 7
22 NAME OF
FUNERAL DIRECTORIO
ADDRESS
1272 Blue Hill Ave. Matt.
Received and Filed OCT 1 4 1947
19
( Registrar)
oct Instructions and extracts from the laws on back of certincate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
100M-7-46-19068
1
Winthrop
No.
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
PHYSICIAN- IMPORTANT (Was deceased a nohc U. S. War Veteran, if so specify WAR)
(a) Residence.
No.
7 IF STILLBORN, enter that fact here.
8
AGE
Years
Months
Days
75
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
Oct 14 1947
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- 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 chapier 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 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 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
01 A Suffolk (County) Winthrop 1 (City or Towns Y Lo Grain No.
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 its Ag 203 Registered No. { {If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Maria De Maio Intesa
(Il deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
7. S. Unain h
St.
(Usumi piace of abode)
Length of stay: In mesoltal or institution
( Before death)
( Specify whether)
years
months
days.
In this community yra.
mon.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female White
5 -SINGLE
( write the word)
MARRIED
widowed
OF DIVORCEO
Sa If married, widowed, or divorced
HUSBANO of
(Give maiden name of wife in full)
(or) WIFE of
mario De Ch
( Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8 AGE 75 Years 2 Months Oays
If less than 1 day
Hours
Minutes
Usual
9 Occupetion :
Industry
10 or Business :
11 Social Security No.
Ban Deaty
13 NAME OF
FATHER
anthony antega
14 BIRTHPLACE OF
FATHER (City) Banca,
(State or country) 21
Italy
15 MAIDEN NAME
OF MOTHER
RI Mania Mirabello
16 BIRTHPLACE OF
MOTHER (City)/
(Siste or country )
1
Bane
17 Informant (Address) ] La main Havi
Reiation, If any
I HEREBY CERTIFY that a satisfactory standard oartifioste of death was fled/with / BEFORE the bugisy or transit parmit was Issued ? Walter M. MalerX ... Simnature of Akyst of Board nt Health or other) Healthe Officer 10/14/47
(Ofdelal Designation} ( Date of Issue of Peymity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
( Month)
/(Day)
(Year)
19 1 HEREBY CERTIFY,
june
947,10.
Thet /l attended deosased from
0x16
4-7
19
IJJast saw h ............
alive on
2 & 15, 19:27, death Is said to
have occurred on the data stated abova, at
.m.
Immediate oeuse of death.
IMPORTANT
Due to w.
-Nimic Myocarditis
1940 ....
Due to@
Diabetes
1942
Other conditions
( Include pregnancy within 3 months of death)
Major findIngs:
Of operations
Osta of
Of eutopsy
What test confirmed diagnosis?
IMPORTANT
Physician
Underline the cause to which death should be charged sta. tistically.
20 Was disease or injury, in any way related to_cooupation of deceased ? if so, spaolfy
M. O.
( Signed )
(Address) 2 i never of Da's
10/15 1947
21
Holy Cross, Maten, ithals.
Place of Bugal, Cremation or Removal
(City or Town)
OATE OF BURIAL
Sat. Det. 14
19,2.2.
22 NAME OF
FUNERAL DIRECTOR
Ornest Cassant
ADDRESS 39 Qualiano . . Tuvier
Reosived and fied OCT 1.6.1947 19
( Registrar)
100m(1)- 1-44-13634
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effect. PARENTS
PLACE OF DEATH
2 FULL NAME
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
( If nonresident, give city or town and State)
16 1947
Duration
12 BIRTHPLACE (City)
( State or country )
Bari
Anthony DiMaio & fan
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 hy 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 hoth 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. Cbap. 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 hoard, 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 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 hody 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 hy 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 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 heen 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 he obtained as to the deceased, or as to the nianner 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 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, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled hy 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 he 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
301 A Sulfalk.
Boston
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.
{ {If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME
(If deceased Is a married, widowed or divorced womax, give also maiden name.)
(229 Manwreck SV.
St.
(a) Rasidence. No.
(Usual place of abode)
Hosp
years
months days.
In this community
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE1
Muito
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Sa If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in rull)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact hera.
8 AGE Years Months Days
If less than 1 day
3 ... Hours .. / Minutas
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (Clly)
( State of country)
0
13 NAME OF
FATHER
Frances. Fact
PARENTS
14 BIRTHPLACE OF
FATHER (Clly)
6. Norton Somerville
mass.
(State or country)
15 MAIDEN NAME
OF MOTHER
Therese
16 BIRTHPLACE OF MOTHEP. (City) (State or country )
East Salon,
17 Francis. Fa
Informant ( Address)
I HEREBY CERTIFY that s, satisfactory standard carti bate of death was Aled with me BEFORE theSunal of fransit bermit was Issued : Water & Bakes
(Ilgesture of Agent of Board Hf Heath or other)
Theatthe office 10/23/47
( Date of Inque of Permit)
1
18 DATE OF
DEATH
10
(Month)
(Day)
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