USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 51
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Informant
(Address)
76 Bowden St., Winthrop
Date A Br11 1945
Underline the cause to which death should be charged sta- tistically.
Of autopsy
--
What test confirmed diagnosis? Clinical Signs
No
13 NAME OF
FATHER
Harold H. Cook
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
19
1
Registered No.
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and State)
attended deceased
from
AGE.
3 SEX
٠٠١٢٠
AUG141015 AM
RM R-305 +
26m (b)-1-41-4667
17 Informant ( Address)
Mrs Bessie Niles ( Daughter
1470 Beacon St Brookline
A TRUE COPY.
ATTEST :
John 9. Jaun
(Registrar of city or town where death occurred)
DATE FILED
Aug
4 1945
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
4
1945
(Month)
(Day)
(Year)
19 1 HEREBY CERTIFY that I have Investigated the death of tha person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Natural causes Coronary Thombosis
20 Accidant, sulcide, or homlolde (specify)
Date of ooourrenoe.
19
Whera dld Injury occur ?
(City or town and State)
Did Injury ooour In or about the home, on farm, In Industrial place, or In
publlo placa?
(Specify type of place)
Manner of Injury
Nature of Injury
While at work ?
Was there an autopsy?
21 Was disease or Injury In any way related to ocoupation of deoaased ? If so, specify
(Signed)
A. Vincet Smith
M. D.
(Address)
Middleboro
Data 3/4/
19
45
22
Lounttoule
Wobern ..... Lass
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Aug
5
19
45
23 NAME OF
FUNERAL DIRECTOR
Clarence H. Hayward
ADDRESS
35 Oak St. Middleboro Mass.
0 Auf 4-1945
19
Received and filled
John h. Pour
(Registrsf of Clty of, Town where deceased rexlded)
5 1945
1
PLACE OF DEATH
Plymouth (County)
Lakeville (City or Town)
No. County Rd
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No.
( If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Nathan Israle Lovin.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
Winthrop Mass
(If nonresident, give city or town and State)
mos.
10 days.
years
months
days.
In this community
yrs.
(a) Rasidenoa. No.
11 Hawthone Ave
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
Male
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
about
59
7 IF STILLBORN, enter that fact here.
8
AGE
5 Years
Months
Days
Usual
9 Occupation :
Merchant
10 or Business:
11 Soolal Seourlty No.
none
12 BIRTHPLACE (City)
Unknown
(State or country)
Russia
13 NAME OF
FATHER
Henry Lemelman
14 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Unknown
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
Russia
occurred (See Chap. 46. Sec. 12, G. L.)
of the city or town in which the deceased resided as soon as possible after the close of the month in which the death
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-305 to the clerk
Copies of return of deaths recorded during the previous month which occurred in your city or town in case the deceased
Industry
Millinery Supplies
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
Annie Shair
6 Age of husband or wifa If allve yaars
If less than 1 day
Hours.
Minutes
-
.
St.
(If U. S.
War Veteran,
specify WAR)
M R-301
Suffolk
(County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered 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? ..
2 FULL NAME
.......
(If deceased is a married, widowed of divorced woman, give also maiden name.)
Cote St., Lowand PH Concer n.M
10
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ...
(Before death)
Hospital
years - months
7
days. There In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
5
1945
Month)
(Day)
(Year)
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Carl .......... Ericson
(Husband's name in full)
7.3
years
8 Age of husband or wife if alive
Z IF STILLBORN. enter that fact here.
ÅGE ...
70 Years 5
Months
13 Davel
If lese than 1 day
Hours
.Minutes
· Occupation :..
Housewife
Industry
10 or Business :.
Own .... Home
11 Social Security No .....
None
12 BIRTHPLACE (City)
(State or country)
Sweden
13 NAME OF
FATHER
? Hedman
Major findings:
Of operations.
none
Of autopsy ..
see above (was done)
What test confirmed diagnosis Clinical &
pathological
20
Was disease or injury in any way related lo occupation of deceased?
If so. specify ..
a ação Lebranco M.D.
(Sig
(Address) 62 aulas 7
2.Pato
aBlossom Hilferuf
Concord N .H
Place of Burial, Cremation or Removal.
City or Town)
45
19
August
8
Quy's
M. D.
19.55.
17 Relation, if any Son
Carl D Ericson
Informa
(Address)
25 Bates Ave. Winthrop
I HEREBY CERTIFY thet a satisfactory standard certificate of death way filed with me BEFORE the burial or transit permit wes inmued: Nu. D-Children (Signature of Agent of Board of Header or other)
8/6/45
textile Eller (Official Designationy (Date of Issue of Parmit)/
July 28
IHEREBY CERTIFY. 19 70 10
That I attended deceased from
Ciujust 5
1945
I last saw her alive on.
Courant 49 4 death is said to
have occurred on the date stated above, at.
5
m.
Immediate cause of death.
Lobar pneumonia (left)
Duration Important 10 days
10 days
Due to ..
Pulmona
Other conditions
(Include pregnancy within 3 months of death)
none
10 minutes Important
PHYSICIAN Underline the cause to which death should be charged sta- tiatically.
(State or country)
Sweden
18 MAIDEN NAME
OF MOTHER
Unable to obtain
18 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
Mass DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR ....
Howard S Reynolds
ADDRESS
Winthrop, Mais
Received and filed
AUG 6 - 1945
19
A TRUE COPY ATTEST: (Registrar)
1 3 SEX F. 8 Usual PARENTS mation should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician 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. 100m(h)-1-41-4695 N. B .- WRITE PLAINLY, WITH UNFADING DLAGA INK ITTO DO A TERMIANENT KLOVAV. LYWY ILLAIT VI MITVI 14 BIRTHPLACE OF FATHER (City) ...
PLACE OF DEATH
O.N.
9/7/4.
(City or town making return)
Winthrop Community Hospital
No .. anna
Ericson
(If nonresident, give city or town and State)
4 COLOR OR RACE
W.
5. SINGLE
(write the word)
MARRIED
WIDOWED
OF DIVORCEDMarried
Due
Pleurisy with effusion
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, tbe duration of bls last illness, when last seen allve hy the physlclan 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 bundred and fourteen, shall, If the deceased, to the best of his knowledge and helief, 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 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 pro- vision 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 sald purposes, he 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 bundred and seventeen .- General Laws, 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 hody which has not heen huried, until he has received a permit from the hoard 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 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 he issued until there shall have heen delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to be returned and recorded, which shall he 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 hy it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall inake 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 he 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 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 bealtb, or Ite 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 sball thereafter furnisb for registration any other necessary Information which can be ohtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chop, 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within bls county the body of such a person, he shall fortbwith 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 tbereof 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 calls for the observance of tbe following rules of practice:
(1) Attending physicians will certify to sucb deatbs 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 hy traumatism (including resulting septicemia), and hy 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 hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of deatb means the disease, or complication which causes death, not the mode of dying, e. g., beart failure, asphyxia, asthenia, etc. As principal cause name tbe disease causing death. As related causes, name earlier morhid 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 he 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 husiness, 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 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
R-301 K
Suffolk
(County)
Winthrop
(City or Town) 16 Otis
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. St{ {If death occurred in a hospital or institution, "{ give its NAME instead of street and number)
2 FULL NAME Daniel Blackley ( If deceased fa a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 262FellswayWest
St
Med ford ......
Nass
(ff nonresident, give city or town and State)
Length of stay: In Aneoltal or Institution ( Before death)
-
years
months
days.
In this community
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Male
4 COLOR OR RACE
white
5 SINGLE
MARRIED
Married
WIDOWED
or DIVORCED
5a If married,
HUSBAND of
Loomis Bischicy
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive 63.
years
7 IF STILLBORN, enter that fact here.
AGE72. Years 3 Months 3 Days - If less than 1 day Hours Minutea
Usual
9 Dccuoatlon :
Meat cutter
10 or Business :
Industry
Meat market
11 Social Security No. 011-10-A1811A
12 BIRTHPLACE (City)
( Siste or country)
Scotland
13 NAME OF
FATHER
James Blackley
14 BIRTHPLACE OF
FATHER (City)
( State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Agnes Calder
16 BIRTHPLACE OF
MOTHER (City)
(State or country ) Scotland
17 Informal Minnie Blackley Rotation If any (Address) 2Ga Fellsway West Medford,
I HEREBY CERTIFY that a satisfactorystanderd certificate of death was mo BEFORE the burlar or trapsit farmit was Issued ? Nau D. Chil delay ( Signature of Agratype Board of Herah or other) Healthe Office 8/4/45 ...
(Official Designation) ( Date of Issue of Permits
18 DATE OF August
10
1945
DEATH ..
(Year)
7( Sfonth)
(Day)
That I attendad daosasad from
19 | HEREBY CERTIFY,
Jamay.
36.
to august 10, 1945
I Ist saw h. han alive on
august 90, 19 42 death Is said to
have occurred on the date stated above, at ..
955PM
m.
Immediate oause of death ..
liver. ascites. Hypostatic
conjuction of the lungs.
Duration 10 yrs. IMPORTANT .... 3 days.
IMPORTANT
Physician Underline the cause 10 which death should he charged sta. istically.
20 Was disease or injury in any way ralatad to oooupation of deosasad ?........... ": If so, specify
( Signed)
Serge C. Rush
. M. D.
( Address)
136 Front St Week Roky Cany 11 1949
2Oak Grove Can. Medford less. Place of Burial, Crematinn or Removal. (City or Town)
DATE OF BURIAL
August 13th.
1945
22 NAME OF
Allen Funeral Home
FUNERAL DIRECTOR Conrad- Z. Granath Prop.
ADDRESS49 Dudley St. Medford , Mass ...
Received and fled
JUL 1 4 1945
19.
....
( Registrar)
100m(:) -1.44-13634
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot. PARENTS
P
millor hatfer 9/714
OVIRTEM
1
PLACE OF DEATH
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(Usual place of abode)
( Specify whether)
MEDICAL CERTIFICATE OF DEATH
Due to
Due to
Other conditiona.
Chiain myoradita
( Include pregnancy within 3 months of death)
coronary thrombosis
Major findIngs:
Of operations
Date of.
Of autopsy
What test confirmed diagnosis? Chemical and X Ray
(write the word)
mislowed .; og divoroed
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 persou 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 hest of his knowledge and helief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired 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.
A physician or officer furnishing a certificate of death as required hy 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, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder 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 hody in a town, or remove therefrom a human body which has not heen 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 hoard, from the clerk 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 tomh other than the receiving tomh to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the hody is buried. No such permit shall he issued until there shall have heen delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall he 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 hoard of health, or employed by it or hy 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 he obtained early enough for the purpose, the certificate of death made as ahove 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 hody has heen 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 heen 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 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 only such persons as are supposed to have died hy 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 hrought 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 hoard, from the clerk of the town where the hody is to he 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. . . . 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 hedside 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 hy recognized disease unrelated to any forun of injury, have died without recent medical attendance or whose phy- sician is ahsent 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 hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled by recognized disease, and those of persons found dead.
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