USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 68
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(Official Designation)
9/25/48
(Date of Issue of Pernyt)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
september
23-1948
(Month)
(Day)
(Ycar)
19
HEREBY CERTIFY,
That I attended deceased from
8
4
19
.
to
Lept 23
. 19 48
20
1900 death is said to
have occurred on the date stated above. at
m.
9.33A
Duration
IMPORTANT
Immediate cause of death 1 Chimie Myocarditis
6 years
Due to internosclerosis
indefinite
Due to
senility
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
200
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Stru
(Address)
Kiren mars
Date Kijel 24 1948
21 Piece of Burial, Cremayhoy Removal.
DATE OF BURIAL
24.25/
( Cityfor Town 19 48
22 NAME OF
FUNERAL DIRECTOR
ADDRESS 210 Winetrap 24 Minetrop 19
Received and Filed SEP 2 7 1948
(Registrar)
1
2 FULL NAME
Katherine Heures (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 78 Ingleside ar St.
(Usual place of abode)
Rest Here
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months 10 days.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. Deniz li plan tens, so that it may be properly classified. enact statclient of Devos alta is very important. PARENTS See instructions and extracts from the laws on back of certificate.
100M-7-46-19068
. M. D.
I last saw her
alive on
éget
2
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
Har
A physician or registered hospital medical officer shall forthwitb, 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 hy section one, where same was contracted, the duration of bis last illness, when last seen alive by the physician or othcer 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, 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 sball bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he bas 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 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 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 sball 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 wbo 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 tbe 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 hody 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 body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten or 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 hody lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human hody 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 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 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 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
RM R-305
Suffolk
(County)
Boston
(City or Town)
No.
Peter B.Brigham Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
8379 1
(If death occurred in a hospital or institution, give ite NAME instead of street and number)
2 FULL NAME
Katie Wolfe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18 Beach Road
Winthrop
(If nonresident, give city or town and State)
Length of stay: in hospital or Institution.
(Before death)
(Specify whether)
years
months days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
(write the word)
Widow
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(Give maiden name ofrice
Samuel ...
(Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that faot here.
8 AGE Years Months. Days
If less than 1 day
Hours.
.Minutes
Housework
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Harry Gill
14 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Goldie ----
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Informant (Address)
A.Doaker.
10 Copley St. Brookline
RUE COPY.
(Registrar of city of town where death occurred)
DATE FILED
Sept. 28 19 48
MEDICAL CERTIFICATE OF DEATH
Sept. 24/48
(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.) Arterio sclerotic heart disease fractured It.humerus
20 Acoldent, sulolde, or homlolde (specify)
accidental
Date of ooourrenoe
Sept.22
19
48
Where did
Winthrop Mass.
Injury ooour?
(City or town and State)
Did Injury ooour In or about the home, on farm, In Industrial place, or In XXXXXXXX (Specify type of place)
Manner of
inJury
Fell accidentally at her home
Nature of
on Sept. 22/48
InJury
While at work ?.
Was there an autopsy ?.
No
21 Was disease or Injury In any way related to oooupation of deceased ?.
If so, speolfy
(Signed)
W J Brickley
(Address)
Boston.Mass
Date
9-24 19
....
22
Sons .... ofIsrael So,Lawrence
Place of Burial, Cremation or Removal. City or Town)
DATE OF BURIAL
Sept. 26/18
19
23 NAME OF
FUNERAL DIRECTOR
B.Birnbach
ADDRESS
Dorchester. Mass
Received and
OCT 4 1948
19
(Registrar of City or Town where deceased resided)
25m. (d) -6-43-12056
3 SEX F (or) WIFE of 75 Usual 9 Occupation : PARENTS 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-805 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased Industry 10 or Business:
PLACE OF DEATH
1
St.
(If U. S.
War Veteran,
speolfy WAR)
Mass.
(a) Residence. No.
(Usual place of abode)
St.
18 DATE OF
DEATH
(Month)
M.
48
At ... Home
~ PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 60 Orlando 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.
192
St. { {If death occurred in a hospital or institution, ! give its NAME instead of street and nun.ber)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, WWI
if so specify WAR)
(a) Residence. No. 60 Orlando Ave. St.
(Usual place of abode)
None
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4
COLOR OR RACE
White
5 SINGLE (write the word)
MARRIED
WIDOWED
Or DIVORCE
Single
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 years
7 IF STILLBORN, enter that fact here.
8 AGE 56 8 Years Months 15 Days
If less than 1 day
.. Hours
Minutes
Usual
9 Occupation:
Clerk
Industry
10 or Business:
Soldier's Relief Dept.
11 Social Security No. None
12 BIRTHPLACE (City)
East Boston,
(State or Country)
Mass.
13 NAME OF
FATHER
Charles J. Nugent
14 BIRTHPLACE OF
FATHER (City)
Fairfield
(State or Country)
Vermont
15 MAIDEN NAME
OF MOTHER
Jane V. Farley
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
Mass.
17 Miss Gertrude B. Nugent Sister Informant 60 Orlando Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of ffransit permit was issued: Watter & Kalleex (Signature of Agent of Board of Health or other) Health Officer (Official Designation) (Date of Issue of Permit)
9/28/48
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
September
(Month)
(Day)
27
1948 (Ycar)
19
I HEREBY CERTIFY,
That I attended deceased from
, 19 -- , to
, 19
I last saw h
- alive on
3:20 P.
m.
Duration
Immediate cause of death
natural causes
Due to
Probable coronary occlusion- hours
Due to
-
Other conditions none (Include pregnancy within 3 months of death)
Major findings:
f operation
none
Date of
Of autopsy
none
Clinical
What test confirmed diagnosis?
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? no
(Signed)
If so, specify
arthur C. murray
(Added Winthrop Brand of Health
M. D.
Holy Cross' Cem.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
September
29,
1948
22 NAME OF
FUNERAL DIRECTOR Richard C. Kirby
ADDRESS17 Bennington St., E. Boston
Received and Filed
OCT 4 1948
(Registrar)
100M-7-46-19068
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. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
R-301 A 1
No. .
2 FULL NAME
William B. Nugent
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If nonresident, give city or town and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
8
, 19 -, death is said to
have occurred on the date stated above, at
IMPORTANT
Date Sekt 28 19 48
Malden
Salem
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer aball 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 hy 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 hy 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 heeu engaged, insert in the certificate a recital to that effect, speci- fying 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 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 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 hury or otherwise dispose of a human hody 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 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 hody is buried. No such permit shall be issued until there shall have been delivered to such hoard, agent or clerk, as the case may he, 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, 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 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 hy the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused hy 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 hody 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 been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten 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 hoard 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 hodies 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 hury a human hody 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 hoard, from the clerk of the town where the body 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 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 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 hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut 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 hy the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
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.
193
St. { (If rleath occurred in a hospital or institution, ! give its NAME instead of street and nun.ber)
No PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
"(If nonresident, give city or town and State)
In this community
25
yrs.
mos. days.
MEDICAL CERTIFICATE OF DEATH
September
(Month)
27 (Day)
1948 (Ycar)
19 I HEREBY CERTIFY, Rapt. 14 , 19
I last saw hewn alive on
Dept.
27
, 19 to, death is said to
have occurred on the date stated above, at
Immediate cause of death IMPORTANT Lobar Pneumonia (left)2 weeks acute Coronary Thebrain 1/2 hour
Due to
Other conditions non e
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