USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 75
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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 healtbfulness 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 bome. 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-botel, 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
t
2-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
No.
83. Loring Road
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.
229
St.
(If death occurred in a hospital or institution, §
give its NAME instead of street and number) )
PHYSICIAN- IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. 83. Loring Road (Usual place of abode)
St.
"(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 33
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4
COLDR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Tarried
5a If married, widowed onggory A. Hurley 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 72 years
7 IF STILLBORN, enter that fact here.
8 AGE
71
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Dccupation:
Retired
Industry
10 or Business:
Manufacturer Shoe
11` Social Security No.
Boston
12 BIRTHPLACE (City)
(State or Country)
Massachusetts
13 NAME OF
FATHER
Francis A Blais
Major findings:
Df operations
Df autopsy
What test confirmed diagnosis?
Clinical
Duration IMPORTANT
2 days. 14 yrs. 14 yrs
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
Cliples Liberman, M.D.
(Signed)
S 26 Have Hay Que, Will Das 13 hours 47.
21
Holy Cross
Place of Burial, Cremation or Removal.
Malden
(City OF Town)
DATE DF BURIAL
November 15, 1947.
19/
22 NAME DF
FUNERAL DIRECTOR
John F. O'malley
ADDRESS
Winthrop Mass.
Received and Filed NOV 1 7 1947
(Registrar)
See instructions and extracts from the laws on back of certificate. If daceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
100M-7-46-19068
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or Hansit ppemit was issued: Waller At Baker (Signature of Agents of Brand of Health Drenthe) Health Office 11/13/47 Koncial Designation ( Date of Issue of Permit)
19
I HEREBY CERTIFY,
That I attended deceased from
aug 19
47,10
13 kov.
19
47
I last saw had alive on
13 hours, 19 47 death is said to
have occurred on the date stated above. at
2:10 Am.
Immediate cause of death Coronary Thrombosis Coronary artery Heart Disease Due to
Other conditions
(Include pregnancy within 3 months of death)
Date of
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Canada
15 MAIDEN NAME
DF MOTHER
Ellen Grimes
16 BIRTHPLACE OF
MDTHER (City)
(State or Country)
Ireland
17 Informant (Address)
Mary A Blais ( Ris' ' if any ) 83 Loring Road Winthrop
-
2 FULL NAME
Charles A. Blais
(If deceased is a married. widowed or divorced woman, give also maiden name.)
. ......
18 DATE OF
DEATH
how.
(Month)
13,
ʻ
1947
(Day)'
(Ycar)
Male White
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 kuowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .. . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four. teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall 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 ui chapter forty-six, tuat the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- 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 be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . .. Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only 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 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
+
-301 A
PLACE OF DEATH
Suffolk (County )
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. 230
Registerad No.
f (If death occurred in a hospital or institution.
St. ( give its NAME instead of street and number)
2 FULL NAME
Henry Hugo Wilcke
(If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
457 Shirley Street
St.
(If nonresident, give elty or town and State)
Length of stay: In hospital or Institution
Hosp.
yeara
months
6 days.
In this community
30 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACEI
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife In full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if aliva years
7 IF STILLBORN, enter that fact here.
8 65
Yeers
7
Months
2 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupetion :
Fuel Oil Delivery
Industry
Oil truck
11 Social Security No.
12 BIRTHPLACE (City)
New York City
( Sinte or country)
New York
13 NAME OF
FATHERHugo Wilcke
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Marie Grufs
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17 Fred Wilcke
Son
Relation, If any
Informent ( Address) 462 Shirley St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the Burial or transit permit was Issued : Maltes
( Signature of Areas of Board of Health or other)
11/18/47
(Omelal Designation)
( Date of Trque of Permit)
18 DATE OF
DEATH
15 1947
( Month)
(Day)
(Year )
19 1 HEREBY CERTIFY,
That I attended deceased from
NOV.10.47, 194). to.
NYOV. 15, 194)
1 last saw h .. l ...... 1 .. allve on
Nov. 15, 194), death Is said to
have occurred on the date stated above, at.
5.202m.
immediato oause of death
Ruptured Appendicitis
Due to
General Peritonitis
Due to
Other conditiona.
( Include pregnancy within 3 months of death)
Mejor findIngs :
Of operetions
Gute Appendicitis.
Peritonitis Date of Navioi (4)
Of eutopsy
What test confirmed
OperAtion
.
IMPORTANT
Physician Underline the cause to which de.th should he charged vt.I. tistically
20 Was disease or injury in eny way related to oooupation of deceased ? 200
If so, specify.
( Signed )
Dance 10/Jum
. M. D.
(Address) 201n15-012
Date 1/05/2, 194)
21
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Nov .. 18
19.
47
22 NAME OF
FUNERAL DIRECTOR
toward units
ADDRESS
Received and fied
NOV 15 1917
19
( Registrar)
100m.(g)- 1-45-15510
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
1
Winthrop
(City or Town)
No.
Winthrop Community Hospital
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran.
if so specify WAR).
(Usual place of abode)
( Before death)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
Duration
IMPORTANT .......... 8 hours
(EST)
AGE
10 or Business:
Daisy Reid
None
%
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, See. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China 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 buman body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, tbe certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for auch 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 bereunder. 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 lies and take charge of the same; . . . - General Laws, Chap. 38, See. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until be has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be 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 eause 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 bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
-301 A X
PLACE OF DEATH
Suffolk ( County)
Winthrop
(City or Town) 25 Faun Bar 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.
231
Registered No. (If death occurred in a hospital or institution. 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. 25 Faun Bar Ave (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In nocoltel or Institution
( Before death)
(Specify whether)
yeara
months days.
In this community
yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
DIVORCED Widowed
Se If married, widowed, or divoroed HUSBAND of
(or) WIFE of
( Husband's name In full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
AGE
8 88 Yeers 2 Months 15 Days
If less then 1 dey
Hours
Minutes
Usual
9 Occuoation :
House wife
Industry
10 or Business :
At Home
11 Social Security No. None
Natick
12 BIRTHPLACE (City)
( State or ennutry)
Massachusetts
13 NAME OF
FATHER
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