USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 42
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If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1)Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)''
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING. .
2
ORGANIZATION AND OUTFIT ..
SERVICE NUMBER
[ R-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
does not mean of dying, such lure, asthenia, ns the disease. ations which h.
d conditions. ing rise to the e (a) stating lying cause
ions contrib- death but not he disease or ausing death.
Chapter 137. 1954, requires ns to print or cause or causes h on death :es.
50M-3-54-911887
7 NAME OF
Benjamin Bernbach
FUNERAL DIRECTOR.
ADDRESS
10 Washington St. Dorchester
Received and filed. JUN 6, 1955 19
(Registrar)
-
9 COLOR OR RACE
White
10 SINGLE
,
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
4 I HEREBY CERTIFY,
200
1953
That I attended deceased from
to ..
gene 3,
19 55
10a If married, wido Morire con Diner
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months.
Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation:
Shoe Repair TRETikEd
(Kind of work done during most of working life)
14 Industry
or Business:
REFInedStice REQUIRING
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Joseph Paull
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Rose (cannot he learned)
20 BIRTHPLACE OF MOTHER (City) (State or country) Reuben Paull
Russia
21 Informant.
47 Douglas St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter S. Bakerg
(Signature of Agent of Board of Health or other)
Health pucer 6/5/55
(Official Designation)
(Date of Issue of Permit)
1.1.V
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
3.
1955
(Month)
(Day)
1
(Year)
I last saw h.j ........ alive on
Juice 2, 1955 death is said to
have occurred on the date stated above, at 1:00 A.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (
(a)
Bronchopneumonia
TWEEN ONSET
AND DEATH
4 days.
ANTE
CEDENT
(b)
Due To Hypertension
CAUSES
Due Toemiparesis. Rt.
6 mos.
OTHER
SIGNIFICANT
CONDITIONS
Hypertrophied Prostate.
2mos.
Major findings:
Of operations.
Date of operation
NONE Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify .......
i Charles Libera
-M. D
(Signed).
(Address) Minttemay Mass Date 6/3/1953
6
Montifiore
Place of Burial or Cremation
Everletti
DATE OF BURIAL
June 5
1053
(City or Town)
x Suffolk (County) Winthrop (City or Town)! Mayflower Nursing Home No. Morris Paull PLACE OF DEATH
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial ·permit with Board of Health or its Agent.
121
Registered No.
J(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 woman, give also maiden name.) 23 Trident Are
St.
Winthrop.
(If nonresident, give city or town and State)
Length of stay: In place of death. .. years .months. days. In place of residence
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
(a) Residence. No. (Usual place of abode)
25
.years.
months.
.days.
8 SEX
Male
69%
PARENTS
7yrs.
(c) ...
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 required 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 hy 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, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate 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 section 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 nineteen 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 inter- ment, 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 physician 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 required of the attending physician. If death is
caused by violence, the medical 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 forthvith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled byrecognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Set. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been Ardught into the commonwealth until he has received a permit so to do from the boardof health or its agent appointed to issue such permits, or if there is no such board, from the derk of the town where the body is to be buried or the funeral i'tuibe 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).
O 3
RULES OF PRACTICE
The fulfillmentof the purpose of these laws calls for the observance of the follow- ing rules of practice's (1) Attending på icians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness front disease unrelated to any form Unfall
(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 physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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, however, 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-301A 1
PLACE OF DEATH
X SUFFOLK (County) Win Throp (City or Town)
BOSTON 7.5.55
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
125
WINThrop Community Hosp. No.
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Jacob
King
(If deceased is a married, widowed or divorced woman, give also maiden name.)
10 KiNa ST. DOR
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ...... .. years 11
months .. days. In place of residence. ...... .. years. months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
(Month)
10
(Day)
1955 (Year)
4I HEREBY CERTIFY,
That I attended deceased from
WAY 50
1955
to ..
June 10
1955
I last saw
h ... 2.K.M.alive on
June 10, 1955, death is said to
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
78 %
Years
Months
Days
If under 24 hours
.Hours
Minutes
13 Usual
Occupation :
Insurance
Broker
(Kind of work done during most of working life)
14 Industry
or Business:
For Himselfinsurance
15 Social Security No. 033-26-09087
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Harris
King
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Florence (C.B.L.)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russi
21 Informant. Grace, F. King
(Address) 20 Pemberton Sql Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Master D. Paper
(Signature of Agent of Board of Health or other)
6/11/55
(Official Designation) (Date of Issue of Permit)
100M-10-53-910621
7 NAME OF
FUNERAL DIRECTOR.
AARON GOLOV
ADDRESS
1668 Beacon ST., BrookLINe
Received and filed
JUN 13 1933 19
(Registrar)
12 days
Due To (c)
OTHER
Coronary Artery Heart
5 yrs.
CONDITIONS Diseasel
Major findings:
Of operations
Abscess of Gall Bladder.
Date of operation.
Junela,1955 Was autopsy performed?
no
What test confirm
Clinical and operative
5 Was disease or injury in any way related to occupation of deceased? Ko
If so,
Chablis
(Signed).
Liberum M. D.
(Address) Winthrop Miss Date June 10 1955
6 .
Pride OF Boston
Place of Bumal or Cremation
woburn (City of Town)
DATE OF BURIAL
June
12
19.55
PARENTS
8 SEX
9 COLOR OR RACE
Make White
10 SINGLE
MARRIED
WIDOWED
of DIVORCED
Goldberg
(write the word)
Widowed
10a If married, widowed, or divorced
.HUSBAND of
FANNIE
(Give maiden name of wife in full)
have occurred on the date stated above, at. 11:30 P.m.
DISEASE OR CONDITION
DIRECTLY LEADAS seess of Gall
TO DEATH (a)./
13ladder
INTERVAL BE- TWEEN ONSET AND DEATH 12 days
T Acute Cholecystitis
ANTE CEDENT (b) CAUSES
UCTIONS FOR CERTIFICATE giving OF DEATH t enter than one for each b) and (c)
does not mean f dying, such ure, asthenia, ns the disease. ations which h.
conditions, ng rise to the (a) stating ying cause
ions contrib- death but not e disease or using death.
(a) Residence. No. (Usual place of abode)
(Was deceased a
U. S. War Veteran.
if so specify WAR)
N
Registered No.
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 required 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, specifying the war, and) shall also certify in such certificate both the primary and the secondary or imme- diate 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 dollarsin? For the purposes of this section and of sections forty-five, forty-six and forty-seven' of said chapter one hundred and fourteen, the word "war" 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 nineteen hundred and seventeen G. L. Chap. 46. Sec. 10.
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 inter- ment, 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 physician 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 required of the attending physician. If death is caused by violence, the medical 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 and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner of 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 persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
RECEIVE
undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit se 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 for the funeral is to be held, or from a person appointed to have the care of the cemetery pr burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillhent of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) ... Attending physicians will certify to such deaths only as those of persons "o" Whoth they have given bedside care during a last illness from disease unrelated o any form of injury.
No undertaker or other person shall bury or otherwise dispose of a human body 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 physician is absent from home when the certificate of death is needed. 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 (3) Medical Examiners will investigate and certify to all deaths supposably remove it from a town, from one cemetery to another, or from one grave or tomb fque 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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, however, 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 R-301A 1
PLACE OF DEATH
X Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
126.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME. Joshua Remby
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
1.76 .... Circuit ..... Road
..... St.
(If nonresident, give city or town and State)
Length of stay: In place of death4.O .... .years. months .days. In place of residence. .40 years. months days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
June
10
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
-
19 48.
to
I last saw h /M alive on 10
May, 1955, death is said to
have occurred on the date stated above, at 10:15/m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cerebro-vascular
incident
INTERVAL BE- TWEEN ONSET AND DEATH 6 wKs
11 IF STILLBORN, enter that fact here.
12
AGE 9.1 ... Years.
10 Months2.4
.. Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
retired executive
(Kind of work done during most of working life)
14 Industry
Custom woodworking Mfg.00
15 Social Security No.
none
West Dublin
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
John William Remby
18 BIRTHPLACE OF
FATHER (City)
London
(State or country)
England
5 Was disease or injury in any way related to occupation of deceased? no
M. D.
(Signed).
(Address) Minkrop
6 Winthrop Cemetery, Winthrop Place of Burial or Cremation (City or Town)
DATE OF BURIAL. June 23 1955
7 NAME OF
FUNERAL DIRECTOR
Alfred 73 Marite
ADDRESS.
174 Winthrop, Sty winthrop,
Received and filed. 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
white
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of.
Minnie A. Douglasifj
(or) WIFE of
(Husband's name in full)
Due To Cerebral Arteria-
ANTE
CEDENT (b)
CAUSES
sclerosis
Due To Generalized Arterio-
(c)
sclerosis
Yrs
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
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