USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 1
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கூ. சர்வர்
சரிவரச் மீ திடம்
++ 4
பிரதேச #
44-40-
ஆண்டுக்குக்ப்பு -
பீ பீஸ்காரர்ரேஷுக்குட் ஜர்
மீ.+
*-
Y
ஆடம்
4.அதை4
* **
-
ஆன் ட்டிஸ் சிறந்தபே
பஞ்ச
சத்த
J. L. FAIRBANKS DIV. Thomas Groom & Co. Stationers 105 State St., Boston
To duplicate this book order No. 1115-4 O.U.7
RM R-301 A
PLACE OF DEATH No.
Suffolk
County)
ametap
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH (
4
To be filed for burial permit with Board of Health or its. Agent.
1
uth occurred in a hospital or institution, give its NAME instead of street and number) )
2 FULL NAME
Annie Blanch (Cropley ) Moody
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
70
Somerset are, S. Writhing
(Usual place of abode)
6 days
Length of stay: In hospital or institution
(Before death)
(Specify whether in hopital
-
months
days.
In this community
mos.
days.
PERSONAL ANO STATISTICAL PARTICULARS
3 SEX
Finale
4
COLOR OR RACE
chite
5 SINGLE (write the word)
MARRIEO
WIOOWEO
or DIVORCED
Div.
5a If married, widowed or divorced
HUSBAND of ..
(Giye maiden name of wife in full)
Frederick
body
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that tact here.
8
75
Years
0
Months
8
Oays
If less than 1 day
. Hours
Minutes
at Home-
11 Social Security No.
none
12 BIRTHPLACE (City)
(State or Country)
nova Scotia
estainte - cropley
13 NAME OF
FATHER
England
15 MAIOEN NAME
OF MOTHER
Not Known
16 BIRTHPLACE OF MOTHER (City) (State or Country)
Herbert P. Moody ( Relation, if any To Somenet are-unchop
I HEREBY CERTIFY that a satisfactory standard tertiticate of death was Med with me BEFORE the burial or fransiz permit was issued: Walter f Baket (Kignature of vent /Boardof Health or other)
irealty; (Official Designation (Date of Issue of Perwuf
Officer
1/2/47
MEDICAL CERTIFICATE OF DEATH
18 OATE OF
DEATH
January.
(Mith)
1
(Day) /
1947
(Ycar)
19 47
I HEREBY CERTIFY.
That I attended deceased from
July
30
19
46.10
January!
19
47
I Tast saw h.Q
alive on
December
31 . 19 96 death is said to
have occurred on the date stated above, at
Duration
Immediate cause of death
Peritonitis
Que to
acute gangrenous appendicitis
with perforation
Due to
Other conditions.
cholelithiasis-kydropsof
(Include pregnancy within 3 months of death),
gall bladder. 2 Carcinoma of it-treat IMPORTANT
Major findings:
Peritonitis. acute ganquenous
Of operations
appendicitis-perforated Date of DEC. 26, 1946
Ot autopsy
none
What test confirmed diagnosis? Clinical + Laboratory
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury In any way related to occupation ot deceased?
It so, specify
(Signed) Maurice Traunstein
-.
M. D
.
(Address) 562 Shirley St. Winther
19 47.
21 Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
OATE OF BURIAL
January
3
19 47
22 NAME OF
FUNERAL OIRECTOR_
ADDRESS
Winthrop meus.
Received and Filed JAN 3 1347
19
(Registrar)
N. B.
100m-0-44-14955
(or) WIFE of AGE Usual 9 Occupation: PARENTS 17 Intormant (Artdressı If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF WRITE PLAINLY, WITH UNFADING BLACK INK. TRES D A PERMANENT MVVAV. LYCry ICIN Of Industry 10 or Business:
1
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give dity or town and State)
50 yrs.
A. m.
IMPORTANT 6 days
8 days
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
able to obtain
England
pate fame !,
inthrop
1
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer sball forthwitb, 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 be died, defined as re- quired by section one, where same was contracted, the duration of bis last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Cbap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by tbe preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate hoth the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourtb, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen bundred 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 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 he 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 hody, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody shall 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 bas been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten 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 and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Cbap. 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 sball bury a human body or the ashes thereof which have been brought into the commonwealth until be 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 beld, 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 sucb deatbs only as those of persons who, though disabled by recognized disease unrelated to any fort of injury, have died without recent medical attendance or whose pby. 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, astbenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased bad 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 bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
ORM R-301 A
-
PLACE OF DEATH
Revere notified 2/7/47
The Commonwealth of Massachusetts Suffolk (County) OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS Winthrop (City or Town) STANDARD CERTIFICATE OF DEATH 104 Hilland Avenue-Fisher Rest Home No. .
To be filed for burial permit with Board of Health or its Agent.
Registered No.
2
St. { (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Jacob Mendoza
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(a) Residence. No. 1510 North Shore Road, (Usual place of abode)
7
months
days.
In this community
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
fanny
3
1 HEREBY CERTIFY,
That I attended deceased from
dec 26,
1946. to
. com. 3
1947
I last saw him
alive on
. , 19 75 death is said to
have occurred on the date stated above, at
7a . m.
Immediate cause qt death
Coronary Thronhans
Due to Chrome Myo carditis
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
20000
Date ot
Of autopsy
What test confirmed diagnosis?
Chiave op Sega
Duration
IMPORTANT Sunday
Precio
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation ot deceased? It so, specity
(Signed)
, M. D.
(Address)
21
TAbramson ;~ W. Box.
XXXXXXX
Place of Burnu, Cremat at of Removal.
YElly of Town)
January 5,
19
4,7
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
Benj. F. Solomon.
ADDRESS
420
Harvard Street/ Brookline.
Received and Filed
JAN 7
1947
19
(Registrar)
Rest Home
Length of stay: In hospital or institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4
COLOR OR RACE
white
male
5a It married, widowed or divorced
HUSBAND ot .
(or) WIFE of
(Give maiden name of_wife in full)
Olive Elwell
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
AGE
78 Years
Months
Days
Industry
10 or Business:
11 Social Security No. .
none
12 BIRTHPLACE (City)
London
(State or Country)
England
13 NAME OF
FATHER
Abraham Mendoza
14 BIRTHPLACE OF
FATHER (City)
London,
15 MAIDEN NAME
OF MOTHER
Abagail Lyons
16 BIRTHPLACE OF
MOTHER (City)
London,
(State or Country)
England
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
See instructions and extracts from the laws on back of certificate.
DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
(State or Country)
England
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Divorced
6 Age ot husband or wife if alive years
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Cigar-Packer (retired)
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD. Every item of PARENTS
100M-7-46-19068
17 Judah Mendoza ( Relagorif any )
Intormant
(Address)
1510 N.Shore Road, Revere.
I HEREBY CERTIFY that a satisfactory standard certificate ot death was filed with me BEFORE the burial or transit permit was issued: Walter Af Baller (Signature of Agent of Board of Healthy "Kor other) Health Officer 1/3/47 Official Designation (Date of Issue of Permis)
1947 (Year)
( Months
(Day)
PHYSICIAN- IMPORTANT
Revere, Mass.
(If nonresident, give city or town and State)
years
Date for 3
1947
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and 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 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 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 ten ut 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, auch recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to tbe manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . .. Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deathis caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation by the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT .
SERVICE NUMBER
Dr.Daniel O'Brien-78 Washington Ave-Winthrop.
FORM R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of MARGIN RESERVED FOR BINDING
T
1 Suffolk (County) Winthrop "City or Towny Winthrop Community Hosp. No PLACE OF DEATH
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.
3
Registered No.
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number) )
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
26 Beacon
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution 2.
(Before death)
(Specify whether)
years
months
1
days,
In this community
6
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX male
4 COLOR OR RACE
white
5 SINGLE
(write the word)
Married
5a If married, widowed or divorced HUSBAND of ..
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
62 years
7 IF STILLBORN, enter that fact here.
AGE
8 66 Years 8 Months
18
Days
If less than 1 day
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