USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 60
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8:30A.m.
Duration
Immediate oeuse of death acute mephutis
Due to
Hypertension Cardiac Disease
IMPORTANT 3 month 1 year
Other conditions ( Include pregnancy within 8 moutba of death)
IMPORTANT
Physician
Underline the cause to which death should be charged sta. tistically.
20 Was discesa or injury in any way relatad to occupation of daoaased ? If so, speolfy ........... Samuel B. Haldberg ( Signad).
. M. D. (Address) 270 Shelly Withany Date 9/27/ 1945
21 Winthrop
Place of Burial, Cremstion or Removal.
(City or Town)
DATE OF BURIAL
September
27
19.4 ....
22 NAME OF
FUNERAL DIRECTOR
Kirby Bros. MITirla
ADDRESS
210 Wenthy St, withde
Received and Aled
SEP-28 1945
........
19
( Registrar)
100m-(2)-1 45.15510
If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to insert a recital to that effect.
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.
PARENTS
Major findings:
Of operations
Data of.
Of autopsy
What test confirmed diagnosis ?.
no
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
(If nonresident, give city or town and State)
(Give maiden name of wife in full)
Due to
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 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, 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 relicf 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 hody 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 110 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 tomh 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 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 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 .- 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 lics 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 practicc:
(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 deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs 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 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
1
Essex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
179
5
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
2 FULL NAME
Bessie N. Dicks
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
(Usual place of abode)
68 Johnson Ave
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution ..
(Before death)
(Specify whether)
years
months
27 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dep. 28 1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Se.p .............. , 19 ...... 45
to
That I attended deceased from
I last saw h ............ allve on
S.e.p.
2.8
19 ..... 45death Is sald to
have occurred on the date stated above, at
4 ... 1.51
.. m.
6 Age of husband or wife Cannot be learned years
7 IF STILLBORN, enter that faot here.
8
AGE
69
Years
Months.
Days
If less than 1 day Hours. .Minutes
Housework
Industry 10 or Business :
11 Social Security No. cannot be learned
12 BIRTHPLACE (City)
(State or country)
Athol
13 NAME OF
FATHER
Henry French
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Waltham
Caryline Mokel
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Athol
17 M.K.McPhillips
Relation, if any
1011
A TRUE COPY.
.
ATTEST :
eBetsey ff filesor town where death occurred)
DATE FILED 19
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Rube (Give maiden name of wife in full)
(Husband's name in full)
Immediate cause of death. Chronic myocarditis before
Duration 9/1/45
Due Generalized arteriosclerosis
Bronchopneumonia
¿ days
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Physician Underline the cause to which death should be charged sta- tistically.
Of autopsy
autopsy
What test confirmed diagnosis ?
20 Was disease or injury in any way related to oocupatlon of deceased? If so, speolfy
(Signed)
DorisM ...... Bidwell
M. D.
(Address)
Do11
Date.9./.28 ... 19.45 ...
21 PLACE OF BURIAL,
Mt. Feake
Waltham
CREMATION OR REMOVAL
( Cemetery)
10/1/45
19
(City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOAL11am R .Miller
ADDRESS
Waltham
Received and filed OCT - 1942 19
( Registrar of City or Town where deceased resided)
25M-(0-11-42 10746
3 SEX female PARENTS Informant (Address) 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 be made forthwith and transmitted on Form R-802 to the clerk ... curu during the moth which occurred in your city or town in case the deceased Usual 9 Occupation :
M R-302
1
PLACE OF DEATH
(County) Danvers
(C'ity or Town) Danvers State Hospital
No.
(If U. S.
War Veteran,
speolfy WAR)
4 COLOR OR RACE|
white
Dep ..
28 ..... , 19.45 ..
١٠
٢
: R-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) No. . 117 Highland Ave.
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.
180
St. § (If death occurred in a hospital or institution. § give its NAME instead of street and number)
2 FULL NAME
Emily A. Fryer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN- IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
117 Highland Ave
St
(Usual pláce of abode)
(If nonresident, give city or town and State)
30
In this community
yrs.
-
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4
COLOR OR RACE
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Female White
5a If married, widowed or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8 AGE76 Years Months - Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Housekeeping
Own
Home
11 Social Security No.
Canton
12 BIRTHPLACE (City)
(State or Country)
Mass
13 NAME OF
FATHER
John 0, Fryer
14 BIRTHPLACE OF
Leicster
FATHER (City)
(State or Country)
England
15 MAIDEN NAME
OF MOTHER
Bridget M. Hogan
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
Ireland
17 Informant
Dr. Patrick, H. McCar "Relation, if any ) (Address)
Cliff Avec
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit/permit was issued: Www. S. Child sigature of Green of Board of Bed Sydthe other) W Healthe Officer 10/1/45
(Official Designation) (Date of Issue of Permits
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
30
(Month)
(Day)
1945 (Ycar)
19
I HEREBY CERTIFY,
That I attended deceased from
April 21
, 19
. to
40
September 30
19 35
I last saw h
En
alive on
September 30, 1945 de
death is said to
have occurred on the date stated above, at 4-40 P.
m.
Duration
IMPORTANT 12 hours
IMPORTANT
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 Patrick Henry mc Cannte
(Signed)
s) 315 Harrod Cambiala Date 0~20
. M. D.
19 45
21
Woodlawn
Everett
16 - 1
-
1945°
22 NAME OF
FUNERAL DIRECTOR
Place of Burial, Cremation or Betray
DATE OF BURIAL
John F ( Maler
ADDRESS
Winthrop
Received and Filed
19
OCT 1 1945 (Registrar)
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.
100m-9-44-14955
Due to
Due to
Myocarditis
Arterio- Selevais
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis?
Physical Examination
3 SEX PARENTS pani ichins, so that it may be properly classified. Exact statement of OCCUPATION is very important. Industry 10 or Business:
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
years
Immediate cause of death
Edema of Cump
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 helief 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 ariny, 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 fortyseven 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 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 hody 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 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 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 hody 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, & satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, hy 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 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 heen sooner obtained hereunder. If the death certificate contains a recital, as required
by section teu 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 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 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 suchi board, 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. ... 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 hy recognized disease unrelated to any forum 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 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 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 houseworky 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
-301 A
1
PLACE OF DEATH
Suffolk (Cointy) Winthrop
...... (City or Town) 23 Wave Way Gens
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. 181
{ (If death occurred in a hospital or institution, give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
no
U. S. War Veteran,
if so specify WAR)
(If nonresident, give clty or town and State)
Length of stay: In hospital or Institution
( Before death)
100
years
months
days.
In this community3 0 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE!
female white
5 SINGLE
(write the word)
Daniel
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
( Husband's namein full)
6 Age of husband or wife if alive
6$
yeers
7 IF STILLBORN, enter that fact hera.
8 67 Years - Months AGE - Days
If less than 1 day
Hours
Minutas
Usual
9 Occupation :
Industry
10 or Business :
Long
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Aussia
15 MAIDEN NAME
OF MOTHER
Zlatta marks
16 BIRTHPLACE OF
1
MOTHER (City)
(State of country )
Fussia
17 ressal Peloksky
Informant ( Address) 23 Wave Way Sax Wurde
I HEREBY CERTIFY that a satisfactory tandard certificate of death was filed with me BEFORE the burial or transit Desmit was issued :
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