USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 57
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To be filed for burial permit with Board of Health or its Agent. 171
Registared No.
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME William 1. Murray
( If deceased Is a married, widowed _or divorced woman, give alao maiden name.)
179 +fetchtown SH
(a) Residence. No. (Usual place of abode)
Length of stay: In Anspital or Institution
( Before death)
( Specify whether)
yeers
months/
days.
(If nonresident, give clty or town and State) In this community yrs.
mos.
days.
PERSONAL ANO STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male white
4 COLOR OR RACE!
5 SINGLE ( write the word) Marked
MARRIED
WIDOWED
or DIVORCED
Kelly
{ Husband's name In nm)
6 Age of husband or wife if allve
20 years Immediate oouse of death.
7 IF STILLBORN, enter that fact here.
AGE 75 4 Years Montha 8 00 Days
If less than 1 dey Hours
Bridge Tender-(Retired)
Met. District Gomme.
11 Social Security No. 010-20-2075
12 BIRTHPLACE (City) ....
( State of in
1) Mi Brunswick - Canada
13 NAME OF
FATHER
Samuel Murray
14 BIRTHPLACE OF
FATHER (Clty)
(State or
M. Brunswick- Canada
15 MAIDEN NAME
OF MOTHER
agnes Rotation
16 BIRTHPLACE OF
MOTHER (City)
(State of
M Brunswick - Coura
I Mro William Murray Relation, Je any Informant (Address) 179 Hutchlow Lot C.
I HEREBY CERTIFY that a satisfactory standard certificata of death was filed with me BEFORE the burial os transit permit was Issued: later f. Bakerex
(Signature of Agreat of Board of Which or other)
Health
éfficer
9/5/47
(Oficial Dealgnattony ( Date of Inoue of Permit)
18 DATE OF DEATH September 3 194) (Year)
( Month )
(Day)
19 | HEREBY CERTIFY, Thet I attended deosased from Trung 15, 194), to. 1942 last saw h/ a alive on eget ? 19 .. >death is cald to
heve oocurred on the date stated above, at.
IMPORTANT
Minutes Que to
Due to
Other conditiona.
Bronchio Primaria
.
( Include preguancy within 3 months of death)
Major findings :
Of operations
Oata of ...... -
Of eutopsy.
Whet test confirmed dlegnosls ?.
Chausse Sejas
200
( Signed)
M. O.
(Address)
21
Wordtown
l'lace of Burial, Cremation op Removal.
OATE OF BURIAL
Sept le
ACity or Town)
1947
22 NAME OF
FUNERAL DIRECTOR
Edith Mersom
ADDRESS 305 Beach dt. Revere
Received and flad SE 1947 19
( Registrar)
100m- (g)-1-49-19510
1 (or) WIFE of Usual 9 Occupation : PARENTS If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to insert a recital to that offoot. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain Industry 10 or Business :
PLACE OF DEATH r
(County) Winthrop (City or Town) Nonstop Community Hoop st No.
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WARY C
St.
Revere
6.50 $
.m.
Duration
IMPORTANT
Physician Underline the cause to which death should be charged sta. tistically.
20 Was discese or injury in eny wey related to ogoupation of deceased ? If so, apaoify .. Daniel DOraum 200
K
5a If married, widowed, or divorced
HUSBAND of
(Cive mayden name of wife In (1)
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 hy 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 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- eal 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 teu of 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 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 hody 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 forin 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 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 eause.
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
M R-303-A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a reoltal to that effect extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, $0m. (f) -6-43.12056 M
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) Hinterp. Commento Hospital No.
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or Its Agent.
Registered No.
172
St. [ { If death occurred in a hospital or institution, ( give its NAME instead of street and number)
2 FULL NAME generere yudour
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
go Share Drive Withro Pst.
(Usual place of abode)
Hosp
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
F
4 COLOR OR RACE|
W
5 SINGLE
( write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a if married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Joseph .... Yudow.
(Husband's name in full)
6 Age of husband or wife If allve 44
years
7 IF STILLBORN, enter that fact here.
8
AGE 39 Years 1
Months ...
.2.9.Days
If less than 1 day
Hours
.....
Minutes
Usual
9 Occupation :
None
Industry
10 or Business :
None
11 Social Security No.
none
12 BIRTHPLACE (City) ... Reno
(State or country)
Nevada
13 NAME OF
FATHERJames A. Trefrey
14 BIRTHPLACE OF
FATHER (City)
Yarmouth
(State or country)
Nova Scotia
15 MAIDEN NAME
OF MOTHER
Sarah E. Curtis
16 BIRTHPLACE OF
MOTHER (Clty)
Reno
(State or country)
Nevada
17
Informant.
Joseph ... Yudow
Relation, if any. .... Husband
( Address )
90 Shore Drive, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was find with me BEFORE the barlal or transit permit was Issued : Valter A.
(Signature of Agent of Board olfhealth or other)
9/5/47
(Official Designstion) (Date of Issue of permit)
18 DATE OF
DEATH
Sept
(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.) mettefile luxuries including ៛
Fractured Skull &
Fractured Pelo
20 Accident, sulolde, or homiolde (specify).
Decimal Suicidal
Date of ocourrenoe .... ₾
1947
Where did
Winthrop
Injury coour ?
(City or (town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In pubilo
place?
(Specify type of place)
Manner of
of Seen to jump from a borch
Injury
Nature of
at her home
Injury
While at work?
Was there an autopsy?
2000
21 Was disease or Injury In any way related to ocoupation of deceased?
if so, speolfy.
M. D.
(Signed)
(Address)
Bunter
Sepat-4-
19
22
No
Beverly
Beverly
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
.....
6
19.47
23 NAME OF
FUNERAL DIRECTOR
Harold St. Lee
ADDRESS
9 Dane St. Beverly ...
Mass
Received and filled
SEP 51947
19
(Registrar)
PHYSICIAN-IMPORTANT
( Trefrey).
(Was deceased a
U. S. War Veteran,
If so specify WAR)
10 mins
(If nonresident, give city or town and State)
3-1947
PARENTS
-..
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 undertsker or other suthorized person or of any mieniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of bis knowledge and belief the naine of the deceased, his supposed age, the disease of which he died, 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. 16, 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 canse 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 purposea of thia sec- tion and of sectiona forty-five, forty-six and forty-seveut of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the l'hilippine 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 Mexi- can border service of nineteen bundred and sixteen and nineteen hundred and seventeen. G. L. Cbap. 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 perinit froin 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 ltuman 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 be haa received a permit from the board of health or its agent aforesald or from the clerk of the town where the body is buried. No such perinit shall he issued until there shall bave been delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he 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 hy violence. the medical examnlner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as ahove provided and in the pos- session of the undertaker desiring to make such removal shall constitute a perniit for such removal; provided, that such hody shall he returned to the town from which it was removed within thirty-six hours after such re- moval, unless a permit in the ususl form for the removal of such hody has heen sooner obtained hereunder. If the desth certificate contains a recital, aa required by section ten of chapter forty-six, that the deceased served in the ariny, 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, ujuin receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for regis- tration. The person to whom the perinit is so given and the physician cer- tifying 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 manter or cause of the death, which the clerk or registrar may re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashee thereof which have been brought into the commonwealth until he has te ceived a permit so to do front the hoard 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 per- son appointed to have the care of the cemetery or burial ground in which the interimneut is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Medical examincra shall mske 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 hody lies and take charge of the sanie; ... - General Laws, Chap. 3S, 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; otherwise a description as full as ntay he, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
.. The medical examiner certifles the cause and manner of death to the best of hia 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 persona to whont they have given bedside care during a last illnesa from disease unrelated to any forin of injury.
(2) Board of Health physicians will certify to such deaths only aa those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died withtout recent medical attendance or whose physi- cian is absent from home wlien 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 In- directly by 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 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: "Com- pound fracture of the femur with ensuing septicemia (gas hacillus) caused hy a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have heen due to disease, specify : (1) Under cause its known or presumahle nature; and (2) umuler manner, indicate the circum- stances lesding to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia ) ( found dead in hed)." "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
..
RM R-302
Suffolk
(County)
Boston
(City or Town)
No.
74 Corey Road
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
36 Hawthorne Ave
St.
Winthrop Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ..
(Before death)
...
years 10months
days.
In this community
yr$10
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
5ª If married, widowed, or divorcedMay Messinger
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
yours
'7 IF STILLBORN, enter thedt fact here.
8' 69 AGE
Years
Montha
Days
If less than 2 day .Hours.
Minutos
Usual
9 'Occupation :
Fish Market
Industry
10 of Business :
Prop.
11 Soolai Security No.
None
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF FATHER Abraham Goloboy
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Informant (Address)
C Goloboy
Relation, if any Son
A TR
ATTEST :
(Registrar of chy or toyn where death occurred)
DATE FILED
.Sept ...... 8/47.
19
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Dec . 24
194.6.
to ...
That I attended deceased from
Sept.
.. 5.
19 ..
47
I last saw h ... im
..... allve on.
Sept/4
1947
death Is sald to
have occurred on the date stated above, at
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