USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 24
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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 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 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.
No'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 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 dierk 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). 11
RULES OF PRACTICE
The fulfillment 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 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. deathsonly 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 chan ;ed, 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
X Suffolk
SEATTLE was to ."
4-456
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. ...
5.9
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.)
1815 Washington Avenue
St.
Seattle, Washington
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years ........ .. months. ...... .. days. In place of residence .... .... years months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF DEATH March 31 1956 (Year)
9 SEX
male
10 COLOR OR RACE
white
11 SINGLE
MARRIED
WIDOWED
or DIVORCEDivorced
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
11a If married, widowed, or divorced
HUSBAND of
Clara Massovetsky
(Give maiden name of wife in full)
ACUTE PULMONARY EDEMA
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 5.8 .... Years.
Months.
Days
If under 24 hours
Hours ...
.Minutes
14 Usual
Occupation:
Cantor
(Kind of work done during most of working life)
15 Industry
or Business :.
16 Social Security No ...
17 BIRTHPLACE (City).
(State or country)
Russia
18 NAME OF
FATHER
Leon
Schlossberg
19 BIRTHPLACE OF FATHER (City). (State or country) Russia
20 MAIDEN NAME
OF MOTHER
Julia Elkin
21 BIRTHPLACE OF MOTHER (City) (State or country) Russia
22
Joseph Schlossberg
Informant. (Address) 163 Warrenton St. Providence B.T
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter f. Makers
(Signature of Agent of Board of Health or other)
4/1/56
(Official Designation) (Date of Issue of Permit)
50M-10-53-910621
Lincoln Park. Warwick. R.I.
7 Place of Burial, or Cremation. (City or Town)
April 1, 1956
DATE OF BURIAL
8 NAME OF FUNERAL DIRECTOR Max Sugarman Funeral Home
ADDRESS Hope St. Providence RI
Received and filed.
APR 2 1958
19
(Registrar)
PARENTS
6 Was disease or injury in any way related to occupation of deceased?
(Signed)
25 Shallwek St Date 24/
.. M. D.
....
1956
Injury Nature of Injury If so, (Address) If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. Manner of
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in piain terms, so that It may be properly classified under the International Classification of Causes Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of MARGIN RESERVED FOR BINDING
PLACE OF DEATH
(County) Winthrop (City or Towy) 130 Washington At live. No.
Schlossberg
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
(Month)
(Day)
ARTERIOSCLERITIC HEART
DISEASE
5 Accident, suicide, or homicide (specify)
Date and hour of injury
.19
Where did Injury occur? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Specify type of place)
(How did injury occur?)
While at work?
Was autopsy performed? 1 ......
ORM R-303 A 1
(a) Residence. No. (Usual place of abode)
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 effeet. 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 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 or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. L. as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received 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., as amended.
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.
The medical examiner certifies the cause and manner of death to the best of his knowledge and behef .:
RULES OF PRACTICE
The fulfillment of the parpose 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 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 deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of in jury, 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 sudder deaths of persons not disabled by recognized disease, and those of persons found dead . -
TUSTATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage. hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
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. ORGANIZATION AND QUTFIT
SERVICE NUMBER
I R-302 1
SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTONY ... (City
1138
59
Registered No.
$(If death occurred in a hospital or institution,
.. St. { give its NAME instead of street and numher)
(Was deceased a
U. S. War Veteran,
inthrop Mass.
St
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years ............ months.
........... days. In place of residence.
.......... years.
... months ............ days.
PERSONAL AND STATISTICAL PARTICULARS
00
8 SEX
9 COLOR
10 SINGLE
(write the word
Married
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or Margedion Howland 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
62,
8
Months.
27
Days
If under 24 hours
Hours ........
Minutes
13 Usual
Machinist
Occupation :
(Kind of work done during most of working life)
Printing
14 Industry
or Business :
010-05-9184
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country )
England
17 NAME OF
FATHER
Henry Prinsley
PARENTS
18 BIRTHPLACE OF
ingland
FATHER (City). (State or country)
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
England
MOTHER (City)
(State or country)
wird
21
Informant
(Address)
A TRUE COX
Charles H. Macke!
1
ATTEST:
(Registrar of City or Town where death occurred)
2/8 19 56
DATE FILED
(Registrar of City or Town where deceased resided)
(Year)
CERTIFY,
That
I attended deceased from
2/2
56
19.
19
death is said to
INTERVAL BETWEEN ONSET AND DEATH
3 dys
3 dys
yrs.
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify.
M. D.
2/2
.56
19
Date
Winthrop
"City or Town) ,56 19
7 NAME OF
FUNERAL DIRECTOR
Winthrop Ness.
ADDRESS
Received and filed. APR 12 1956 19
Howard S Reynolds
M:S.
50M .11.55.916145
-
PLACE OF DEATH
No.
Mass. General Hospital
(If deceased is a married, widowed or divorced woman, give also maiden name.)
821 Shirley St.
Alfred Brinsley
2 FULL NAME
(a)
Residence. No ...
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Feb 2 1956
DEATH
(Month)
(Day)
4 I HERE
19
to ...
I last saw }
im live on
2/2
56
11.15 A
have occurred on the date stated above, at
.. m.
Due To
Excision of iliac nymph
(b)
nodes
metastatic from skin
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
yes
What test confirmed diagnosis?
autopsy
c C Clay
(Signed)
MGH
(Address)
Winthrop
6
Place of Burial or Cremation
2/4
DATE OF BURIAL.
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town
Due To
Squamous cell carcinoma
(c)
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. )
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Peritoneal and retroperit-
(a)
oneal hemorrhage
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
1
Edith Tredwell
AGE
Tears
RECEIVEL
OF TO !!
"
HROB
APR12 AM
M R-302
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Due To (b) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)
50M -11.55-916145
PLACE OF DEATH
JEFOLK OSTOR(County)
(City or Town)
Massachusetts General Hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON ....
(City or Town making this" return)
245260
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 woman, give also maiden name.)
94 Fremont
Winthrop, Mass.
St
(If nonresident, give city or town and State)
Length of stay: In place of death ............. years.
.. months.
5
66
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Feb
12
1956
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Feb. 8
19 56
That I attended deceased from Feb. 12
56
19
I last saw
hamalive on
to Feb. 12
,56 death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH
4 Yrs
71
12
AGE
Years
5
Months.
6
Days
If under 24 hours
Hours ........ Minutes
Typewriter Mechanic
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
Underwood Corp.
or Business :
013-05-4779
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Provincetown
Mass.
17 NAME OF FATHER Frank Freeman Cook
18 BIRTHPLACE OF
Provincetown
FATHER (City)
(State or country)
Mas's.
19 MAIDEN NAME
OF MOTHER
Lydia Small
20 BIRTHPLACE OF
Provincetown
MOTHER (City)
(State or country)
Mass.
21
Informant.
(Address)
Mrs
Leon W. Cooke
94 Fremont St .. Winthrop
TRUE COPY,
ATTEST:
Polar
(Registrar of City or Town where death occurred)
DATE FILED
Feb. 20, 1956
.19 ...
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widoweNeldied Payne HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arteriosclerotic Heart
(a)
Disease
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed).
c. Clay Asst. Dir. MGH
M. D.
(Address) Woodlawn
Date
19
Everett
6 Place of Burial or Cremation Feb. 15 ,56
(City or Town)
DATE OF BURIAL
7 NAME OF
Alfred B. Marsh FUNERAL THE Winthrop St. , Winthrop, Mas's ADDRESS
Received and filed. APR 20 1956 19
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