USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 49
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d conditions, ing rise to the e (a) stating lying cause
tions contrib- death but not he disease or ausing death.
OV (A). 12.49 900722
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death .. . years.
(Day)
That I attended deceased from
I last saw h
alive on .....
19 ., death is said to
have occurred on the date rated about at 9 H.m.
Winthro 52 Mars (If nonresident, give city or town and State)
(Was deceased a U. S. War Veteran, if specify WAR)
daybly
DATE OF BURIAL
20
J'ai
Board
Nec
12
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 behef the name of the deceased, his supposed age, the discise 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 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 hest 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 Sand chapter one hundred and fourteen, the word "war" shall inchide the China relief expedition and the Philippine insurrection, which shall, for said purposes, bt deemed to have taken place between February fourteenth, eighteen hundred and - ing rules of practice: ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder 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 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 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 bbard, 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 heu 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 selectinen 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 pernuit 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 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 inedical 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 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 follow-
(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 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
1
PLACE OF DEATH
SUFFOLK 1 ·BOSTON (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
56131 31.
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.)
a
21 Farrest
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years
months
1
2
days. In place of residence
.years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June 18/51
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
4 I HEREBY CERTIFY,
June 18
51
19
to ..
June 18
51
19
I last saw h
...... er ... alive on
June 18
51
19
death is said to
have occurred on the date stated above, at
m.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Acute myocardial
infarct
?
13 Usual
Occupation:
Housewife
14 Industry
or Business:
At Home
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Russia
17 NAME OF FATHER Abraham Hurwitz
PARENTS
18 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Leah ----
20 BIRTHPLACE OF
MOTHER (City)
Russia
Sharon Mass. (State or country)
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
June 20/.
19
7 NAME OF
FUNERAL DIRECTOR
E L Levine
Brookline Mass.
ADDRESS
Received and filed 19
JUN 2 9 1951
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE
75
Years
Months
.Days
If under 24 hours
.. Hours .. ..
Minutes
ANTE
Due To
CEDENT (b)
Hypertension
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation.
None
Was autopsy performed? Yes
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? If so, specify. M I Klayman
(Signed)
Beth Israel Hosp bate.
6-18'
.19.51
(Address)
Sharon Memorial Park
M. D.
25m-(b)-11-49-900,475
6 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES
M R-302 1
No.
Beth Israel Hospital
Celia Mindel
(Was deceased a
U. S. War Veteran,
Winthrop Mass.
(a) Residence. No.
(Usual place of abode)
(Month)
(Day)
(Year)
deceased from
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Louis Mindel
(or) WIFE of.
(Husband's name in full)
WRITE PLAINLY. WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
21 Albert Mindel
Informant
(Address)
. A TRUE COPY Charles & Znacki
ATTEST:
(Registrar of City or Town where death occurred) June 21/51
DATE FILED
19
(write the word)
That
t I attended
7
PM
(Kind of work done during most of working life)
M R-302 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
Worcester
(County)
RuTLAND
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
Registered No. 132
Rutland State Sanatorium
Gordon Francis Berridge
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 25 Pearl Avenue
St.
WintHr
if so specify WAR) p, Mass.
(a) Residence. No. (Usual place of abode) 7
O.
20
Length of stay: In place of death .... years.
months. days. In place of residence. .years.
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
wal¢
9 COLOR OR RACE White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Widowed
(Month)
(Day)
(Year)
4 INSEBABEFERT 11943 Thihettendey deceased from
im 19 June 19. 51
I last saw h
.. alive on
3:30
death is said to
have occurred on the date stated above. at m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADIRQ Imonary tuberculosis TO DEATH (a)
ANTE Due To CEDENT (b) CAUSES
Due To (c)
rbc.meningitis
OTHER SIGNIFICANT CONDITIONS
Major findings: Of operations
No
Date of operation.
Microscopema' x-ray
What test confirmed diagnosis ?.
ivo
5 Was disease or injury in any way related to occupation of deceased? If so, specify rmand ... Laroche
(Signed) State.San.Rutland June 20. 51 (Add Verside tem. Forth Reading Mass
6 Place of Burial or Cremation Juffėy &Town) 51
DATE OF BURIAL 19
7 NAME OF Ellsworth Crosswell FUNERAL DIRECTO St. , N.Reading, Mass. ADDRESS
Received and filed
JUL 5 1951 19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
Pembroke,
FATHER (City) (State or country)
Meine
19 MALDEN NAME
OF MOTHER
Rose 0'Neil
20 BIRTHPLACE OF
Charlestown,
MOTHER (City) (State or country)
Mass
21
Informant
(Address)
Rutland State Sanatoruim Rutland, Mass.
A TRUE COPY Linda citants
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED June 20 , ......... 19. 51
25m-(b)-11-49-900.475
June
20,
1951
3 DATE OF
DEATH
10a If married, widowed.barth Carder HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
17 71812
47
C
19
AGE
.Years
.Months
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation:
Gua rd
(Kind of work done during most of working life)
14 Industry
or Business:
030-09-1415
15 Social Security No.
Roxbury
16 BIRTHPLACE (City)
MA98.
-2 WAS . (State of country)
17 NAME OF
FATHER
Thomas W. Berridge
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
No.
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
(Was deceased a U. S. War Veteran,
(If nonresident, give city or town and State)
19
JUL -1551 0:
+
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
To be filed for burial -permit with Board of Health or its Agent.
133
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Evelyn . Bridgeman ( Jacobs ).
(If deceased is a married, widowed or divorced woman, give also maiden name.)
55 Wilshire.
Winthrop
St.
(a) Residence. No.
(Usual place of abode)
(If nonresident. give city or town and State)
Length of stay: In place of death. years. months. days. In place of residence 25 years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCEMarried
10a If married, widowed, or divorced
HUSBAND of ..
(Give maiden name of wife in full)
(or) WIFE of. John T. Bridgeman
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE64
Years
.Months
.Days
If under 24 hours
.Hours
Minutes
6 years
ANTE
Due To
arterial hypertension
CEDENT (b)
CAUSES
Coronary sclerosis
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
.. Was autopsy performed?
What test confirmed diagnosis?
6kg
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed)
(Address) 447 Shirley At De Mi Maris Date 6-21 19 51
M. D.
Malden
6 Holy Cross
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
June 25,
Porcellino
19 51
7 NAME OF
FUNERAL DIRECTOR
Michael Hacella
ADDRESS 10 No.
Bennett St., Boston Bonntt
19
Received and filed
JUN 25 1951
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City) Rochester
(State or country)
N.Y.
19 MAIDEN NAME
OF MOTHER
Ann Nolan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
John .T ..... Bridgeman.
21 Informant (Address) 55 Wilshire St., Winthrop, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Walter & Baker
(Sigmature of Akent of Board of Health or other)
Health Officer (Official Designation) (Date of Issue of Permit)
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. ications which ath.
bid conditions. ving rise to the se (a) stating erlying cause
itions contrib- he death but not the disease or causing death.
50M (8). 1-51 903586
3 DATE OF
DEATH
June
(Month)
21
1951
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
april
19 45.
to
June
1951
I last saw hcm alive on
greve
10
19.5.1, death is said to
have occurred on the date stated above, at 1:20 A.m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) Coronary thrombosis
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
at home
15 Social Security No ...
none
16 BIRTHPLACE (City)
(State or country)
N.Y.
Rochester
17 NAME OF FATHER John R. Jacobs
no
No. 55.Wilshire
À R-301A 1
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, ( if so specify WAR) NO
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 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 by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the ‹leceased, 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 imme- 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-cight 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 hody is buried. No such permit shall be issued until there shall have been delivered to such board, agent or elerk, 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 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 m 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 whoni the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can he obtained as to the deceased, or as to the manner of 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 persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. . - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
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 from the board of h alth 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 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 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 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.
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