USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 38
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Due to .coronary thrombosis
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?
20 Was disease or Injury in any way related to occupatico of deceased ?
If so, specify.
(Signed)
E C Malewitx
M. D.
(Address)
Boston
Dat 6/23/11
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Anahe .... Labovitz
(Cemetery)
WEbyTAwn)
DATE OF BURIAL ..
June 13-1941
22 NAME OF
FUNERAL DIRECTOR
M .... L .... Torf
ADDRESS
Boston
Received and filed 19
(Registrar of City or Town where deceased resided)
-
No.
Beth Israel Hospital
Hyman
Rubin
(If U. S. War Veteran, specify WAR)
(a) Residence. No.
(Usual place of ahode)
Length of stay: In hospital or institution.
(Specify whether)
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
6 Age of husband or wife if alive.
50m-10-'39. No. 8427-f
PARENTS
Underline the cause to which death should be charged sta- tistically.
Date of ..
PHYSICIAN
17 Informant ..... W.1.111am Rubin
JUL 141941 71
RM R-302
1
Chelsea (City or Town)
No. Soldiers' Home Hospital
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
Daniel L.Sullivan
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
31 River Rd.
St.
Winthrop Mass.
(Usual place of abode)
Hosp.
1
20
(If nonresident, give city or town and State)
Length of stay : in hospital or Institution ...
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Divorced
(Month)
(Day)
(Year)
19
-
RAFBY CERTI F41
ThatTtaattended "deceased from 1
19
Yuno-17.
19
I last saw h
alive on
have occurred on the date stated above, at.
m.
Duration
Immediate cause of death
Carcinoma of lung
3 1 yr.
7 IF STILLBORN, enter that fact here.
53
2
5
If less than 1 day Hours. Minutes Due to.
Painter
Industry
10 or Business :
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
Charlestown, dass.
John W.
Major findings:
Of operations
Date of.
Underline the cause to which death should be charged sta- tistically.
Of autopsy
clinical
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
John .... F.,Conlin
M. D.
(Address)
Soldiong. ...... Homo Date.6. .. 17 ... 19 ..... 41
21 PLACE OF BURIAL
CREMATION OR RENOVAross Falden Mass.
DATE OF BURIAL
JGenetery18, 1941
(City or Town) .19
r. J. McGlinchey
22 NAME OF
FUNERAL DIRECTOR
583 Broadway, Chelsea, Mass.
ADDRESS
Received and filed.
19
DATE FILED
(Registrar of city or town where death occurred) June 17, 1941 19
Relation, if any
17 Informant. (Address )
(
A TRUE COPY.
ATTEST :
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea 145
(City or town making return)
372
Registered No.
Copics of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should he made forthwith and transmitted on Form R-802 to the clerk
50m (e)-1-41-4667
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Father A. Rowe
Mass.
15 MAIDEN NAME
OF MOTHER
England
16 BIRTHPLACE OF
MOTHER (City)
(State or country),
Neepitel Lecords
Due to.
Other conditions
Rheumatic and coronary
(Include pregnancy within 3 months qf gethse
? yrs .
XXXX Chronic duodenal ulcer
12:10
19.
death Is-sald to
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
18 DATE OF
DEATH
June 17, 1941
(If U. S.
War Veteran,
speoify WAR)
orld 'ar
-
5a If married, widowed, or divorced ces Lupin
HUSBAND of
(Give maiden name of wife in full)
8
AGE
Years
Months.
Days
Usual
9 Occupation :
13 NAME OF
FATHER
(Registrar of City or Town where deceased resided)
JUL 1-1941 M
M R-301 A
PLACE OF DEATH
Suffolk (County)
No. 4.Belcher
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. [ (If death occurred In a hospital or institution, · { give its NAME instead of street and number) St.
2 FULL NAME.
Manti Cora [Belcher)Davison
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4 Belcher
St
(If nonresident, give city or town and state)
months
days.
In this community 77 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
HUSBAND of
(Give maiden name of wife in full)
Gaetano Lanza Davison
(Husband's name in full)
6 Age of husband or wife if alive. .years
7 IF STILLBORN, enter that fact here.
ÅGE
72
.Years
Months.
Days
If less than 1 day
Hours.
Minutes
(State or country)
Massachusetts
13 NAME OF
FATHER
Frederick W. Belcher
FATHER (City) ..
winthrop
(State or country) Massachusetts
15 MAIDEN NAME
OF MOTHER
Eliza
Poor
Unknown
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wir D. Childress
(Signature of Agentiof Board of Health or other)
Healthe Office 7/3/41
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
2.
(Month)
(Year) (Day) That I attended deceased from
19 I HEREBY CERTIFY. Since 15, 191929 to Que ........ , 19.5.1.
I last saw her alive on July 8:20 pm. 19 .. 444 death is said to have occurred on the date stated above, at ..... Immediate cause of death. Cerebral Hemorrhage
Due to Get exis Sului
Due to.
Other conditions. (Include pregnancy within 3 months of death)
Major findings: Of operations.
.Date of.
Of autopsy.
What test confirmed diagnosis? Physics & ani
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
(Signed)
M. D.
(Address) 120 Sheely St.
Date Jul 3/ 1941
21.
Winthrop Cemetery
winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
July 5, 1941
19
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR.
ADDRESS !!
inthrop Mass
Received and filed.
19
(Registrar)
-
.
-
Duration IMPORTANT 7 days 1 day
IMPORTANT
12 BIRTHPLACE (City).
winthrop
Informant:
Eunice B. Belcher
Relation, if any cousin
(Address) 339 Winthrop St Winthrop Mas
1
Winthrop
(City or Town)
3 SEX
Female
5a lf married, widowed, or divorced
(or) WIFE of
Industry
10 or Business :.
11 Social Security No.
14 BIRTHPLACE OF
16 BIRTHPLACE OF
PARENTS
MOTHER (City).
(State or country)
17
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Usual
9 Occupation :.
At home
(If U. S.
War Veteran,
specify WAR).
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
years
1941
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail 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 helief the name of the deceased, his supposed age, the disease of which he dled, defined as required hy 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.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been huried, 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 cierk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing tomh 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 28 hereinafter provided. If there is no attending physician, or if, for sufficlent reasons, his certificate cannot he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed 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 shail 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 re- movai of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required hy section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war lu which it has been engaged, such recital shali 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 necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the cierk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
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 hoard, from the clerk of the town where the hody is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or hurlai 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 wili certify to such deaths only as those of persons to whom they have given bedside care during a last Iliness 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 discase unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principai 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 Important, 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 iliness. 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, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION.
M R-303A
1
3 SEX
male
(or) WIFE of
AGE
Usual
PARENTS
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Industry
10 or Business :.
PLACE OF DEATH
Sullock County) Knitterof (City or Town) No 53 Centre ST
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY 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
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
home
(If deceased is a married, widowed or divorced woman, give also maiden name.)
53 Centre St. Winthrop
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ..
years
months
days.
In this community /3 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
Sa If married, widowed, or divorced mary Luz HUSBAND of.
(Give maiden name of wife in full
(Husband's name in full)
6 Age of husband or wife if alive.
5/
years
7 IF STILLBORN, enter that fact here.
8
55 Years
Months
Days
If less than 1 day
Hours
Minutes
9 Occupation :..
Longshoreman
11 Social Security No 021-10-9125
12 BIRTHPLACE (City)
(State or country)
Portugal
13 NAME OF
FATHER Quithony Camacho
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Portugal
15 MAIDEN NAME
OF MOTHER
Charlotte augustus
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Portugal.
17 Nuo mary Camacho (Wife
Informant.
(Address)
53 Centre et Winthrop
I HEREBY CERTIFY that a gatisfactory standard certificate of death was filed with me BEFORE the barjal or transit permit was issued:
(signature of Agent of Boardof Health or other)
Health Officee 7/8/41
(Official Designation) (Date of Issue of Permits
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
5
-
1941
(Month
(Day)
(Year)
19 | 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.) Hubertensure theart Disease chronic Interstitial hephatin
contusions 1 Scalp
20 Accident, suicide or homicide (specify)
Date of occurrence.
19
Where did
Injury occur?
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place?
(Specify type of place)
Injury ..
natural Causes
Manner of
Nature of
Injury
While at work ?.
no
....
.. Was there an autopsy ?.
21 Was disease or injury in any way related to occupation of deceased ?.
200
If so, specify
Hai Buckley
(Signed)
M. D.
(Address)
Relation, if any
22
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town
DATE OF BURIAL
July 8
41
19
23 NAME OF
FUNERAL DIRECTOR
R.C. Kindly
ADDRESS
Boston
Received and filed
19
1
.
(Registrar)
25m-2-'40-D-729-b
St.
2 FULL NAME ..
Louis g. Camacho
(a) Residence. No ...
(Usual place of abode)
(Specify whether)
-
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.
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 receiv- ing 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 in- sufficient, a physician who is a member of the board of health, or em- ployed 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 re- moval 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 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 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).
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 burlal ground in which the interment Is made. . . . Chap. 114, Sec. 46, 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.
. . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 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
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 femnur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated 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 presuinable nature; and (2) under manner, indicate the cir- cumstances 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.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid. or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-301 A
suffolk
(County)
Winthrop
(City or Town)
No. 125 Cliff re
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No
§ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Altrude ( Phillips) Reed
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
48 Sargent st
(Usual place of abode)
OurHome
Length of stay: In hospital or institution ....
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