USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 34
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Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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, however, 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
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town). 45 Highland
The Commantoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agent.
Registered No.
89
Ave (rear) St. { (If death occurred in a hospital or institution, { give its NAME instead of street and number)
Mc Vey
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR).
ves
WWI
(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 12
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
Louise Mills
(Give maiden name of wife in full)
(Husband's name in full)
years
7 IF STILLBORN, enter that fact here.
8
AGE .65 .... Years ... 2 ...
Months.
18
.. Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
retired soldier
11 Soolal Security No ..
no
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
FATHER
John McVey
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
unable to obtain
16 BIRTHPLACE OF
MOTHER (City)
England
Informant
( Address)
45 Highland Ave rear
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial er transit permit was Issued : Walter
(Signature of Agent/of Board of Health & other) 4/24/5/
(Officin Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
23
1951
V ( 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 infolved, state fully.) Coronary occlusion
20 Accident, sulolde, or homlolde (specify)
Date of ooourrence
19
Where did
Injury ooour ?
(City or town and State)
Did Injury coour In or about home, on farm, In Industrial place, or In publio
place?
(Specify type of place)
Manner of Injury
Nature of Injury
While at work?
Was there an autopsy ?.. no
21 Was disease or Injury In any way related 16/ccoupation of deceased ?
If so, speolfy ..
(Signed)
ichand for
M. D.
(Address)
Date
4-23 1951
22
P.o.s.t ..... Cemetery.
Ayer Mass.
Place of Burial, Cremation or Removal.
(City or Town)
17 John McVey whtre if any DATE OF BURIAL. April .... 2.5. 1.9.51 19
23 NAME OF
FUNERAL DIRECTO
Lehed BMarch
ADDRESS
174 WinthropSt,Winthrop
Received and filed.
APR 2 5 1951
.. 19
(Registrar)
1 No. John 2 FULL NAME (a) Residenoo. No. (Usual place of abode) 3 SEX male 5a If married, widowed, or divorced HUSBAND of (or) WIFE of 6 Age of husband or wife If allve PARENTS (State or country) If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 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, 50m. (i)-1-45-15510 N. B .- WRITE PLAINLT, WITH UNADING BLACK INK-THIS IS A PERMANENT REVVRV. bVe Till VI mgfmellen Industry 10 or Business: U.S.Army ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
45 Highland Avenue (rear)
St.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physiclan or registered hospital medloal offioer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertsker or other authorized person or of sny member of the family of tite decrased, furnish for registration a standard certificate of death, stating to the best of bis knowledge and bellef 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 last illness, when last seen alive by the physician or officer and the date of hie death . .. Gen. Lawe, 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 humulred 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 nr immediate cause of death we nearly as be can atate 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 aec- tion and of sections forty-Ave, forty-six and forty-seven of said chapter one hundred and lourteen, the word "war" shall include the China relief ex- pedition and the l'hilippine insurrection, which shall, for said purposes, be deemeil to have taken place between February fourteenth, eighteen hundred and ninety-eight aud July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and aixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shali bury or otherwise dispose of & human body in a town, or remove therefrom a human body which bas not been buried, until he has received a perinit froin the board of beaith, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person dled; and no undertaker or other person shall exnume 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 hae received a permit from tite board of health or its agent aforesald or from the cierk of the town where the bndy is buried. No such permit shall be issued until there ahall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by iaw 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, ss 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 phyei- cisn who is a member of the board of health, or employed by it or by the selectmen for the purpose, shtail upon application make the certificate re- quired of the attending physician. If desth is caused by violence, the medical examiner shall · make such certificste. If such a permit for the removal of a buman 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 make such removal shall constitute & 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 obtained hereunder. If the death certificate containa a recitai, as required by section ten of chapter forty-alx, that the deceased served in the sriny, navy or marine corps of the United States in any war in which
it has been engaged, such recitai shali appear upon the permit. The board of health, or. ins agent, upon receipt of anch statement and certificate. shalt forthwith cuundersigu it andt transmit It to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cet- 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 manner 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 ashes thereof which have bren brought into the commonwealth until lie 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 huried or the funeral ie 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 ).
Bfedical exsmincra shaii 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 bis county the body of such a person, he shall forthwith go to the place where the body iies and take charge of the same; ... - General Laws, Chap. 3S, Sec. 6.
... ile 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 .- General Lawe, 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 fuififiment of the purpose of these laws calls for the obeervance of the following rules of practice :
(1) Attending physioians will certify to such deathe oniy ae those of persone to whom they have given bedside care during a last illnese from discase unrelated to any forin of injury.
(2) Board of Health physicians will certify to such deaths oniy an those of persons wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phys- cian is absent from home when the certificate of death ie 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 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 oocupation, 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 tbe 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 witlt ensuing eepticenila (gae bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicldai." "Syncope while under the influence of ether administered an 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 been due to disease, specify : (1) Under cause ite known or precumable nature; amt (2) umler manner, indicate the circum- atancea leading to medico-legal Inquiry. For example: "Hemorrhage spon- taneous of the brain ( basal gangla) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
Sept.17.1907
DATE OF DISCHARGE
May 31,1936
RANK, RATING
Ist sargent
ORGANIZATION AND OUTFIT
U. S. Coastvartillery
SERVICE NUMBER
K
R 343603
M R-301 1
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
90
Pleasant Street
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Harry Allen Davis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
23 Woodside Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years.
.. months 1
days. In place of residence years .months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED WIDOWED or DIVORCED Married
10a If married, widowed, or diværetdi on Thurston HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGI
45
Years
1.1 Months.
1 Days
If under 24 hours
.Hours .....
Minutes
13 Usual
Occupation :
Pressman
(Kind of work done during most of working life)
14 Industry
or Business:
Publishing House
15 Social Security No.
362-09-2050
Fruitland
16 BIRTHPLACE (City)
(State or country)
Missouri
17 NAME OF
FATHER
John B Davis
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Missouri
19 MAIDEN NAME
OF MOTHER
Mona D Caldwell
20 BIRTHPLACE OF MOTHER (City) (State or country) Missouri
21
Informant Marion pavis (Address ) Woodside Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was Gled with me BEFORE the burial or transit permit was issued:
Walter & Bakery (Sigurature of Agent of Board of Health or other) Health Officer 4/26/51
(Date of Issue of Permit)
IRUL COPY ATTEST
25 (Day)
1951
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
1018
to
amil 25
1951
Mast saw
h.
alive on
april 25
1951
death is said to
have occurred on the date stated above, at. INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Uremia
TWEEN ONSET AND DEATH 2 weeks
ANTE
Due To
Polycystic kid
CEDENT (b)
CAUSES
(congenital ) emoved 10 years ago
Due To (c)
te
OTHER SIGNIFICANT ( CONDITIONS
Cerebro Vascular accident
3 weeks
Major findings: Of operations.
Date of operation.
Was autopsy performed ?.
What test confirmed diagnosis?
clinical
5 Was disease or Injury in any way related to occupation of deceased? If so, specify Que P. Weinsaft (Signed) 238 Shore Drie
(Address) Winthrop Was
Date 19 50
6 Winthrop
Place of Burial or Cremation
Winthrop (City or Town) April 26 19 51
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR award S Phynobelo
ADDRESS
Received and filed APR2-6 -1951
.. 19
(Registrar)
COM (A). 12.49.900722
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, cations which th.
id conditions. ing rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
No.
2 FULL NAME
(Was deceased a U. S. War Veteran, if so specify WAR>
(a) Residence. No. (Usual place of abode)
4
3 DATE OF
DEATH
april
(Month)
im
231 Am.
4/25
M. D.
(Official Designation)
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 thiscase of which he chied, defined as required 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 hy the preceding section or by section forty-five of chapter one hundred and four- tecn. 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, specifying the war, and shall also certify in such certificate both the primary and the secondary or imine- diate 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 section 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 nineteen 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 inter- ment, 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 physician 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 required 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 another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death niade as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying 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 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 persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do froni 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 ohservance of the follow- ing 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 deathsonly as those of persons who. though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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, however, 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-301 1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) No. 41. Washington Ave Edna I Eaton
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
91.
J(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.)
41 Washington Ave.
St.
(If nonresident, give city or town and State) 4
Length of stay: In place of death. years. 4
months. .days. In place of residence. years .months. ... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
april (Month)
25 (Day)
1951 (Year)
8 SEX
Female
9 COLOR OR RACE
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
1
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
acute coronary occhimen
1/2 hours
11 IF STILLBORN, enter that fact here.
12
AGE 65 Years
Months.
Days
If under 24 hours
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