USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 87
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Date of /ooourrence.
19
Where did
Injury boour ?
(City or town and State)
Dld Injury ooour In or about home, on farm, In Industrial place, or In publio
place?
1
(Specify type of place)
Manne
Injury
Rumor Contracción Rt. Portal
Nature of
Injury
While at work?
Was there an autopsy ?..
21 Was disease or Injury In any way related to ocoupation of deocased?
If so, speolfy.
Hund Bricklus
(Signed)
M. D.
(Address)
22
WINTHROP
WINTHROP
Place of Burial, Cremation or Removal.
DEC
(City or Town)
24
19.Yg5:
DATE OF BURIAL
23 NAME OF
FUNERAL DIRECTOR
John F.O Malley
ADDRESS
Winthrop
Received and filed.
DEC 2. 8. 1948
19
(Registrar)
=
(or) WIFE of Usual 9 Occupation : Industry 11 Soolal Security No ... 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF 15 MAIDEN NAME WILBERN E RAY 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 .... (Official Designation) (Date of Issue of Permit)
50m-(f)-6-43-12056
1 3 SEX male PARENTS should be carefully supplied. MEDICAL EXAMINER SIOHIO STATE CAODE AND MANNEN OF DEATH In plain Termis, 10 or Business : If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
St.
(If nonresident, give city or town and State)
PRONTO-24-
1948
BROOKLYN
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital med!oa! offioer 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 nieniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his iast Illness, when last seen alive by the physician or officer and the date of hia 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-tive 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 priniary 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 sectiona forty-five, forty-six and forty seven 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 purposea, be dermed! to have taken place between February fourteenthi, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and niueteen hundred and seventeen. G. L. Chap. 16, 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 haa received a perinit from the board of health, or ita 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 be haa received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued untii there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written atatenient containing the facts required by law to be returned and recorded, which ahal! 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 aa hereinafter provided. If there is no attending physician, or If, for sufficient reasons, bia 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 medical examiner 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 be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to inake such removai shali 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 re- moval, unless a permit in the usual form for the removal of such body has been sooner obtaincd hereunder. if the death certificate contains a recital, as required by section ten of chapter forty-xix, that the deceased served in the army, navy or marine corps of the United States in any war in which
it has hcen engaged, such recital shali 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 regis- tration. The person to whom the permit ia 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 regiatrar may re- quire .- Chap. 114, Sec. 15, G. L., (Tercentenary Edition).
No umulertaker or other person shall bury a human body or the ashes thereof which have bren 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 la to be held, or from a per son appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
Medical examiners shali 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 bia 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. 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 may be, with the cause and manner of death .- Generai Laws, Chap. 38, Sec. 7.
. The medical examiner certifles the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the obaervance of the foliowing rules of practice :
(1) Attending physicians will certify to such deaths only as those of persona to whom they have given bedside care during a last iilness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persona who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physi- ciau is absent from home when the certificate of death ia needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posabiy due to Injury. These include not only deatha caused directiy or lo- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermai, or electricai agents, and deaths following abortion, but also deaths from disease resulting from Injury or Infection related to occupation, the sudden deaths of persona 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 bacillus) caused by'ha steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, auicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated internal injury aus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify : (1) Under cause its known or presumable nature; and (2) umler manner, indicate the circum- ataucea leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) ( found dead in bed)." "Ileart disease, presumably coronary sclerosis. (Suhlen 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
1 A
+
Suffolk (County)
Winthrop (City or Town) 68 Fremont St.
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.
Registrar's No.
248
§ (If death occurred in a hospital or institution, St. [ give its NAME instead of strect and number) PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
2 FULL NAME
Charles William Davy
(If deceased is a married, widowed or divorced woman, give also maiden name.) 68 Fremont Street St.
(a)
Residence. No.
(Usual place of abode)
(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 40 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
18 DATE OF
DEATH
december 24
1948
(Montlı)
(Day)
(Ycar)
5a If married, widowed, or divorced Mary A Evans HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
71
years
7 IF STILLBORN, enter that fact here.
8
AGE 6
Years
4
Months.
5
Days
If less than 1 day
Hours .....
Minutes
Usual
9 Occupation:
Shoe Repair
Industry
10 or Business:
Own store
11 Social Security No.
None
Portland
12 BIRTHPLACE (City)
(State or country)
Maine
13 NAME OF
FATHER
Charles Davy
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Prince Edward Island
15 MAIDEN NAME
OF MOTHER
Margaret McLean
16 BIRTHPLACE OF MOTHER (City) (State or country) Prince Edward Island
17
Informant
Mary A Davy
Wife
Relation, if any
(Address) 60 Fremont St. Winthrop
was filed with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that a satisfactory standard certificate of death Walter L- Makers
(Signature of Agent of Board of Health of other) Malthe Office 12/17/48
(Official Designation) (Date of Issue of Permits
20 Was disease or injury in any way related to occupation of deceased ?/ZLO
If so, specify Arthur Courant (Signed) M. D. (Address) Winthrop Mass Datele 24 1948
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
22 NAME OF
Howends handler
FUNERAL DIRECTOR
ADDRESS
Caminos mais
Received and filed
19
(Registrar)
7 days
Due to ...
arteno-sclerotic heart disease-years
Due to.
Other conditions
(Include pregnancy within 3 months of death:)
Major findings:
Of operations.
none
Date of
-
Of autopsy.
none
What test confirmed diagnosis ?
clinical
IMPORTANT Physician Underline the cause to which death should be charged sta- tistically.
50m-(e)-3-43-11574
1
PLACE OF DEATH
No.
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
Duration
IMPORTANT
Immediate cause of death
Congestive Heart Failure
have occurred on the date stated above, at.
9:45 AM.
6 Age of husband or wife if alive.
19 I HEREBY CERTIFY,
That I attended deceased from
September 46
to_
December 24 19 48
I last saw him alive on
alec. 24
, 1948, death is said to
Dec.
27
1948
21 Winthrop
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 scen 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 deccased, 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 Cliina 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 aforcsaid 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 inedi- cal examiner shall inakc 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 hoard of health, or its agent, upon receipt of such statement and certificate, shall forthwitli 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).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he lias 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 front 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).
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 hody 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.
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 front 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 clectrical 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 .- Canse 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 homc. 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
R-301 A
1
PLACE OF DEATH
Suffolk
Winthrop (City or Town)
No. Winthrop .... Community ..... Hospital
{ {If death occurred in a hospital or institution, st. [ give its NAME instead of street and number)
2 FULL NAME
Elizabeth May .... Bolcher
( If deceased is a married, widowed or divorced
(a) Residence. No.
230 .... Lincoln ..... St ..
(Usual place of abode)
5 hours
St.
(If nonresident, give city or town and State)
Length of stay: In hnepital or Institution
(Before death)
hospital
years
months
days.
In this community
35yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED married
5a if married, widowed, or divoroed
HUSBAND of
(or) WIFE of
Eldridge Főstår Belcher
(Husband's name in full)
6 Age of husband or wife if alive 5.0
years
7 IF STILLBORN, enter that fact here.
8
AGE .51 Years
4 ... Months ..
.2.10ays
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
house wife
Industry
10 or Business :
own ..... home ..
11 Social Security No.
none
12 BIRTHPLACE (City)
( Siate or country)
East .Boston
Mass.
13 NAME OF
FATHER
Otis Sweetland
14 BIRTHPLACE OF
FATHER (Chty)
Boston
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Gretta Laura Kinnear
16 BIRTHPLACE OF
MOTHER (City)
Dorchester
( State or country)
New Brunswick
17 E.Foster .... Belcher ( husband.
Informant
( Address)
230 Lincoln St Winthrop
I HEREBY CERTIFY that a satisfactory standard certiftoate of death was filed with me BEFORE the bartal of transit permit was Issued : Walter - Dakle 2
(Signature of Agent of Board of Health hr other)
Health Officie 12X90 148
(Official Designation) ( Date of Irque of Permits
18 DATE OF
OEATH
DECEMBER
27
1948
(Month)
(Day)/
(Year)
19 | HEREBY CERTIFY,
That i attended deosased from
November
1947, to December 27, 1948
i last saw h ............. alive on.
December 27, 19 48
Is said to
have occurred on the date stated above, at.
9'= P.m.
Immediate cause of death.
IMPORTANT
Cerebral Henryhagy - massive
5 hours
Due to. Hypertension
.... 3 years
Due to
Other conditiona.
( Include pregnancy withio 8 mouthe of death)
Major findings :
Of operations
Date of
Of autopsy.
What test confirmed dlegnosis ?.
clinical + laboration
Htistically.
20 Was disesse or injury in any way related to occupation of deceased?
If to, specify.
(Signed)
Maurice Traunstein Vi
M. D.
(Address) 5625 Ruley St. Winthrop, Date DE. 27
19.4₽
21
Winthrop Cemetery, Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL .... December 301948
... 19
22 NAME OF
FUNERAL DIRECTOR.
alfred B. Marit
ADDRESS
174 Winthrop St., ..... Winthrop
Received and flad
JAN 3 - 1949
19
( Registrar)
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Seotlon 10, requires physicians to Insert a recital to that offoot.
PARENTS
100m. (g) - 1-45-15510
turma, w stor it may of property casted. Exact statement of VecerATION is very unportant. Sse instructions and extracts from the laws on back of certificate.
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. 219
Registared No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR). NO. ...
woman, give also maiden name.)
( Specify whether)
Relation, if any
IMPORTANT Physician Underline the cause to which death should be
Duration
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwitb, 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 tbe physician or officer and the date of his death . . . Gen. Laws, Cbap. 46, Sec. 9.
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