USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 18
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SPACE FOR ADDITIONAL INFORMATION
R-301 A +
1
PLACE OF DEATH
Suffolk (County)
Winthrop
....
(City or Town) Winthrop Community Hospital 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 or its Agent.
45
§ (If death occurred in a hospital or institution,
St.
{ give its NAME instead of street and number)
2 FULL NAME
Henrietta (Fuller) Paine
(If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
23 Cliff Ave.
(Usual place of abode)
St.
Length of stay: In hospital or Institution
Hosp
....
years
months
2 Gays.
( If nonresident, give city or town and State)
In this community 7 0 yrs.
mos.
days.
( Before death)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Widow
5a If married, widowed, or divoroed HUSBAND of
(or) WIFE of
Geor'Sge maidep meme of wife In full)
( Husband's name In rull)
6 Age of husbend or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE
.96
Years
10
13
Months
Days
If less than 1 day
Hours.
Minutes
Usual
Housewife
Industry
At home
10 or Business :
11 Social Security No.
None
12 BIRTHPLACE (City)
Boston
(State or country)
Mass
13 NAME OF
FATHER
Richard Fuller
14 BIRTHPLACE OF
FATHER (Clly)
Boston
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Charlotte
?
16 BIRTHPLACE OF
MOTHER (City)
Unable to obtain
(State or country)
17 Leon A Paine
Son Relation, If any
Informant
( Address)
23 Cliff Ave, Winthrop, Mas
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me, BEFORE the burial, or transit permit was issued : Walter
{Signature of Agent of Board of Heakw or other)/,
/ Health
office
3/18/18
(Date of Issue of Permit)
18 DATE OF
DEATH
March
17
1948
( Month)
(Day) /
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
February 27, 19.
48, to March 17
19 ..
48
7 ....
l last saw h. A .... . alive on ..
March 17, 1948, death Is said to
have occurred on the date stated above, at 2:45 Am. Immediate oeuse of death
Duration
IMPORTANT .... 20 days
Due to
arteriosclerosis
3 years
Due to
Chronic myo carditis
3 years
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operetions
Date of
Underline the cause to which death should he
What test confirmed diagnosis?
Clinical+ Labora Tor charged Stil.
20 Was disease or injury in any way related to occupation of deceased? Ko
If so, spoolfy.
.....
(Signed) Maurice IrannatEin, OF
(Address) 562 Chiley St. With Dato March 17 1948
21
Winthrop
winthrop
Place of Burial, Cremation or Removal.
(City or Town)
March 19
19.48
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR ....
Howard S Aufnolds
ADDRESS
Lunchrop mars
Received and flad MAR 2 3 1948
19
(Registrar)
100m· (g)-1-45-15510
extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
Registared No.
PHYSICIAN · IMPORTANT
(Was deceased 2
U. S. War Veteran,
if so specify WAR).
PERSONAL AND STATISTICAL PARTICULARS
(Official Designation)
IMPORTANT Physician
Of eutopsy
Branchofilumonia
9 Occuoetlon :
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 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 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 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 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 hy 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 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 aud 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 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 suchi 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 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, 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 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
M R-302
1
PLACE OF DEATH
V. ORCESTER (County) RUTLAND
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
St.
S (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Karl Johnson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
57 Beacon
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.anatorium
(Before death)
(Specify whether)
months
13
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE|
White
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 allve years
7 IF STILLBORN, enter that faot here.
8 AGE 51 Years 1 Months
2
Days
If less than 1 day
Hours
Minutes
Usual
Kitchen helper
9 Ocoupation :
Industry 10 or Business :
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Sweden
Major findings :
Of operations.
Date of.
Physician Underline the cause to which death should be charged sta-
tistically.
What test confirmed diagnosis ?.:
20 Was disease or injury in any way related to oooupation of deceased ?.
If so, speolfy.
Heinz .Lorge
(Signed)
Rutland Mass
Date
3/187 48
(Address)
21 PLACE OF BURIAL, CREMATION OR REMOVAL! inthrop winthrop, Mass March 22,1948 19. (City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
Maurice V.Kirby
ADDRESS
Winthrop, dass.
Reoelved and filled
A.P.R .S.1948
19
DATE FILED
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March
18,
1948
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
March 5
That I attended deceased
from
1948
to.March 18
19.
48
ir1
March 18
48
death
19.
death Is sald to
5.55 p.
m.
Duration
Immediate cause of death
Tuberculosis
of
the lungs
Due to
Due to.
Other
Tuberculosis of intestines
(Include pregnancy within 3 months of death)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
weden
15 MAIDEN NAME
OF MOTHER
Anna (not known)
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
17 Hospital Records
Relation, if any
Informant
(Address)
A TRUE COPY.
ATTEST :
Frances O. Hanff
(Registrar of city of town where death occurred)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
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-308 to the clerk
RUTLAND
(City or town making return)
Registered No.
46
(City or Town) Jewish Tuberculosis Hospital No.
(If U. S.
War Veteran,
speolfy WAR)
St.
Winthrop, Mass.
I last saw h
allve on.
have occurred on the date stated above, at
13 NAME OF
FATHER
Frank Johnson
Of autopsy
X-ray and sput
PARENTS
years
(Registrar of City or Town where deceased resided)
R-301 A
1 Suffolk 2 (County)
No. 268 Ruter Road
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. .
47
St. ¿ (If death occurred in a hospital or institution ( I give its NAME instead of street and number'
Porter
Winter
PHYSICIAN - IMPORTANT no ( Was deceased a U. S. War Veteran, if so specify WAR) mais (If nonresident, give gify or town and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
In this community
1
yrs.
4
mos.
2 2days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Finale
4 COLOR OR RACE
White
5 SINGLE
(write the word)
single
MARRIED
WIDOWED
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 alive years
7 IF STILLBORN, enter that fact here.
8
ÅGE
1
Years
4
Months
22 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
nome
Industry
10 or Business:
svane
11 Social Security No.
12 BIRTHPLACE (City)
(State or Country)
Winthrop mass
PARENTS
14 BIRTHPLACE OF
FATHER (City).
(State or Country)
Lithuania
15 MAIDEN NAME
OF MOTHER
Eva Cihen
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
Boston, mas
17 Herbert Cohen (Belirliany)
(Address)'
268 Kiver Ref. Wenthrys
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or; transit permit was issued: Matter & Wakerx (Signature of Agent of Board of Health or other) Health Officer (Official Designation) (Date of Issue of Permet) 3/19/48
18 DATE OF
DEATH
(Month)
(Day)
18
1948 (Year)
19
WHEREBY CERTIFY,
That I attended deceased from
3/12
I last saw h. alive on
31/5. 19 48 death is said to
have occurred on the date stated above, at
6:30 p. m.
Immediate cause of death acute Upper Resp. dufaction
Due to
Congenital Heart
Due to Judicial Examiner Declined Jurisdiction . C.La
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
Mylinical
What test confirmed diagnosis?
Duration
IMPORTANT
16 mos.
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
200
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Charles Fiberway M. D.
(Signed)
(Address) 26 Wane Way Teve, With Data 3/18/1948
21 Winthrop
Place of Burial, Cremationfor Removal.
(City of Town)
DATE OF BURIAL
March
19
19 48
22 NAME OF
FUNERAL DIRECTOR
Benjamin Dirnbach
ADDRESS
10 Wastenylon St Dorobuste
19
Received and Filed MAR 2 3 1948 (Registrar)
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
2 FULL NAME
Helen Susan
(If deceased is a married, widowed or divon ed woman, give also maiden name.)
268 Timer Road
St .
(a) Residence.
No.
(Usual place of abode)
PLACE OF DEATH
See instructions and extracts from the laws on back of certificate.
13 NAME OF
FATHER
Daniel Carter
MEDICAL CERTIFICATE OF DEATH
3/18/1948
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 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 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 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 tomb other than the receiving tomh to another in the same cemetery, until he has received a permit from the hoard 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 he, 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 ahove 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 body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section teu or 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 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 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 forum 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 hy 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 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 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.
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