USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 13
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have occurred on the date stated above, at 8:05P m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Brain Tumor
(metastatic)
Due
(b)
Carcinoma of Lung
Due To (c)
-
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?.
biopsy
5 Was disease or injury in any way related to occupation of deceased? no If so, specify
(Signed)
arthur C. Murray
Winthrop Mass Date 6 Feb
-
50M-11-56-918978
R-301A 1
ICTIONS OR CERTIFICATE iving OF DEATH t enter han one for each b) and (c)
es not mean of dying, eart failure, c. It means or compli- which caused
s, if any, ve rise to ause
(a), the under- ause
last.
ons contrib- eath but not the terminal dition given
hapter 137, 54, requires to print or cause or death on
locates.
f(If death occurred in a hospital or institution, St. (give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
(Was deceased a
U. S. War Veteran,
if so specify WAR)
2
3 DATE OF
DEATH
February
5
1958
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
June 25
1957
to.
5 February
INTERVAL BETWEEN ONSET AND DEATH 3 mo.
1 yr.
011-02-3697
Anna Soffan
(Official Designation) LL
(Date of Issue of Permit)/
X
St
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME
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 cleath 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 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, 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 [ 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 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 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 fo do'from the board of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
L 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 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 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 of the town where the body is buried. No such permit shall be issued until there 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
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
To be filled for burial permit with Board of Health or its Agent.
Registered No. 31
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
Annie Little ( DALZELL)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
105 Sunnyside Avenue
St
(If nonresident, give city or town and State)
Length of stay: In place of death 34 years.
_. months.
days. In place of residence.
34
.years
months.
. days
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
7
1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
JAN 25
19.57, to.
FEB 7
19.528
I last saw
he alive on
FEB 6
1958, death is said to
have occurred on the date stated above, at
3:25 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
ACUTE MYOCARDIAL
INSUFFICIENCY
- (b) ARTERIOSCLEROTIC HEART DISEASE
(c)
Due To
ARTERIOSCLEROSIS
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ? Va If so, specify
(Signed).
Dorothy Chanmy appleton
M. D.
(Address). 197 Woodside Live Date. Feb. 8 1958
Winthorpe , Man
Winthrop Cemetery Winthrop., MasBy 6
DATE OF BURIAL February 10 1958 19
7 NAME OF
FUNERAL DIRECTOR
Cupied R. March
ADDRESS
174 Winthrop St. Winthrop,
Received and filed 2-10-58
(Registrar)
8 SEX
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
Widowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William Little
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 84 Years.
3 Months 6 Days
If under 24 hours
Hours_
Minutes
13 Usual
Occupation :
housewife
(Kind of work done during most of working life)
14 Industry
or Business :
own home
15 Social Security No.
none
16 BIRTHPLACE (City)
Wishaw
(State or country)
Scotland
17 NAME OF
FATHER
Robert
Dalzell
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Christina Scott
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
Informant
(Address)
Christina S. Little
I HEREBY CARTRYPANYEARS
atisfactory Pasta LAHinch Of death
was filed with me BEFORE the burial or transit permit was issued :
Mass. (Signature of Agent of Board of Health or other) 1
(Official Designation) (Date of Issue of Permit)
1
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure, tc. It means e, or compli -- which caused
ns, if any, ave rise to cause (a), the under- cause
last.
ions contrib -- > death but not the terminal ndition given
Chapter 137, 1954, requires as to print or cause OT of death on tificates.
5
SOM-5-57-920345
[ R-301A 1
PLACE OF DEATH
No.
105 Sunnyside Avenue
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
NO
(Usual place of abode)
That I attended deceased from Female
INTERVAL
BETWEEN
ONSET AND
DEATH
1 DAY
tyCARS
loyes
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 scen 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 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 decmed 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 sixtcen 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 casc 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., (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 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 call's 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 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
K PLACE OF DEATH
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
To be filled for burial permit with Board of Health or its Agent.
130 Grovers Ave No.
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
(a) Residence.
No.
130 Grovers
Ave St . Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death. 3. .... years. 6 months days. In place of residence. 3 years 6 months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
That I attended deceased from
1958
January 2, 1958
to_
January 30
I last saw heralive on
January 30, , 19 20 , death is said to
have occurred on the date stated above, at
4:30 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Coronary Occlusion
(a)
recurrent attack
Due To (b) Hypertensive Heart Disease
Due To (c)
OTHER
Myocardial Infarction
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(SignedJohn F. Popi .. , M. D.
(Address). East Boston, Mass. _ Date Feb. 7, 158
6
King Solomon Lodge, Place of Rarial or Cremation
W. Rox (City or Town)
DATE OF BURIA Feb 9. 1.58
7 NAME OF
FUNERAL DIRECTOR
Aaron Golov
ADDRESS 1668 Beacon St. B'klno
Received and filed FEB 10 PER 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Grace (C.B.L.)
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
21 Benjamin W. Morris
Informant
(Address)
130 Grovers Ave Winthro
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kalpe & Sercan (Signature of Agent of Board of Health or other)
Til. 9, 1958
(Officiaf Designation)
(Date of Issue of Permit)
×
R-301A 1
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure, tc. It means e. or compli- which caused
ns, if any, ave rise to cause (a), the under- cause last.
Medical Examiner Clearance
3 DATE OF
DEATH
Februay 7,1958
(Month)
(Day)
(Year)
10a If married, widowed, or divorced
HUSBAND of
Benjamin W. Morris
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 66 Years.
Months.
Days
If under 24 hours
Hours ......
Minutes
13 Usual
Occupation :
House wife
(Kind of work done during most of working life)
14 Industry
or Business:
At home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Boston
Mass
17 NAME OF
FATHER
Abraham Finkelstein
ions contrib -- > death but not the terminal ndition given
Chapter 137, 954, requires as to print or e cause or of death on tificates.
S
50M.5-57.920345
Registered No. 32
2 FULL NAME Mary
Morris (nee finkelstein)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Usual place of abode)
INTERVAL
BETWEEN
ONSET ANO
DEATH
sudden
5yrs.
Le
Oct.57
6
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 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 seventecn. G. L. Chap. 46, Sec. 10.
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