USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 66
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(Signature of Agent of Board of Health or other)
H.C.
Sent 1452
(Official Designation)
(Date of Issue of Permit)
S
CATE
ATH
h (c)
mean such ienia, sease, which
ions. o the ating cause
trib- it not se or eath.
100M-(D)-10-48-24856
PLACE OF DEATH
No.
PHYSICIAN - IMPORTANT
¿ ¿ Was deceased a U. S. War Veteran. if so specify WAR)
(a) Residence. No. (Usual place of abode)
That I attended deceased from
I last saw her alive on
Sept 12, 195 death is said to
have occurred on the date stated above, at / 2.40.A
m.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Heart disease
arteriosclertic
2 years
over
3 years
14 Industry
or Business:
15 Social Security No ..
16 BIRTHPLACE (City). (State or country)
Clerk
13 Usual
Occupation :.
(Kind of work done during most of working life)
17 NAME OF
FATHER
Walter 18
18 BIRTHPLACE OF FATHER (City) (State or country)
Hael Prisen
..
no
22
3 DATE OF
DEATH
September 13
1A 1
(City or Town)))
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 deceased, to the best of his knowledge and belief, served in theht Sfthere is no such board; from the clerk of the town where the body is to be buried army, navy or marine corps of the United States in any war in which it has been or the funeral is to be held, or from a person appointed to have the care of the cemetery ot burial ground in which the interment is made. 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 7 769hap 114, Sec.46, G. L., (Tercentenary Edition). 1. 12 RULES OF PRACTICE 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 "He falfillment of the purpose of these laws calls for the observance of the follow- pues of practice. deemed to have taken place between February fourteenth, eighteen hundredand ninety-eight and July fourth, nineteen hundred and two, and the Mexican Morfe service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
8
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 be 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 cle of the town where the body is buried. No such permit shall be issued until theP th 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 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 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 fromithe board of health or its agent appointed to issue such permits, or
Attending physicians will certify to such deaths only as those of persons h they Ive arven bedside care during a last illness from disease unrelated arts of Injury Hetkhiphysicians will certify to such deaths only as those of tho though disabled by recognized disease unrelated to any form of
red menout recent medical attendance or whose physician is absent gru the certificate of death is needed.
THE Het Examiners will investigate and certify to all deaths supposably 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 deaths wom disease tesulting from injury or infection related to occupation, the sadden 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
PLACE OF DEATH.
Suffolk
(County)
Winthrop
(City or Town)
No. 68 Hermon St
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registrar's No.
194
St. § (If death occurred in a hospital or institution, { give its NAME instead of street and number)
PHYSICIAN-IMPORTANT .
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
6
months
days.
In this community
TTB. 6
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
Single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
" Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8
AGE
Years.
6
Months
1
Dayı
Ií less than 1 day
Hours ..
Minutes
Usual
9 Occupation :
Industry
10 or Business:
11 Social Security No.
Boston
12 BIRTHPLACE (City)
(State or country)
Mass
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Doris Calderbank
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
17 Gordon MacGillvray, Felttheifany Informant (Address[II] N Main St Randolph Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was fied with me BEFORE the burial or transit permit was issued: Walter . Wakes8
(Signature of, Agent of Board of Health or other) Health (Officer)
9/16/52
(Official Designation)
(Date of Isine of Permit)
20 Was disease or injury in any way related to occupation of deceased ? KO If so, specifyQ Maurice Trannefin de (Signed) M. D. (Address) SerCheley SP. Winhogy Leef141952
21 Winthrop Winthrop
Place of Burial, Cremation or Removal.
(City or Towa)
DATE OF BURIAL
Sept. 16
22 NAME OF
FUNERAL DIRECTOR Calicut S figutel:
ADDRESS
Received and filed SEP 1 6 1952 19.
A TRUE COPY ATTEST:
(Registrar)
X
Duration IMPORTANT 6 mes.
Due to.
Dne to.
Other conditions
Spina Bifida
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of
Of autopsy
hace
What test confirmed diagnosis?
Clinical + Tab.
6 mes. IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
100m-(1) - 1-45-15510
-
Robert Gordon MacGillvray
1 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
68 Hermon St.
(a)
Residence. No.
(Usual place of abode)
18 DATE OF
DEATH
September 14
(Month)
1952
(Day) /
(Year)
19 I HEREBY CERTIFY,
That I attended deceased from
July 16
1952
Sept.14
1952
I last saw himalive on Sept. 10, 1952, death is said to
-
have occurred on the date stated above, at 12: heave
Immediate cause of death
Hydrocephal-marked
13 NAME OF
FATHER
Gordon MacGillvray
Boston
Boston
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46. Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine. teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided snd 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 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 registar may require .-- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will ceftify to nich 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 .!. .,7
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized distase, unrelated to any forin of injury, have died without ferent 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 got only deaths caused directly or indirectly by traumatism (including hg. septicemia), and by the action of chemical (drugs or potion. theman electrical agents, and deaths following abortion, but on Gprsease resulting from injury or infection related to occupation pourRi deaths of persons not disabled by recognized disease, and those persons found dead.
Statement of Cause of Death of death means the disease, or complication which causes death de 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
PLACE OF DEATH
Suffered County) Winther fo (City or Towr
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
C
To be filed for burial permit with Board of Health or its Agent.
195
Registered No.
Wanhoop Community /trop. No.
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if & specify WAR)
St. .
(If nonresident, give city/or town and State)
Length of stay: In place of death years ... . months ..
days. In place of residence
23years
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 DIVORCÉfarried
10a If married, widowed, or divorced
HUSBAND of ..
Elizbeth
Henrichs
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGE ... 6.4 Years
. Months
Days
If under 24 hours
.Hours .. . Minutes
13 Usual
Occupation :.
Sheet metal worker
(Kind of work done during most of working life)
14 Industry
or Business:
Shop
15 Social Security No ...
030-09-3024
16 BIRTHPLACE (City).
(State or country)
Cambridge Mass.
17 NAME OF FATHER Henry Nicolas
18 BIRTHPLACE OF FATHER (City) (State or country)
Holland
19 MAIDEN NAME
OF MOTHER
Louise Simmons
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ca ... bridge.
Mass
21 Mrs. Elizbeth Nicolas
Informant (Address) 15 Grover Ave., Winthrop
7 NAME OF
FUNERAL DIRECTOR
Michael & Porcella
ADDRESS .876 Winthrop Avel, Revere
Received and filed
SEP 17 1952
19
(Registrar)
PARENTS
M. D. .1952
6 .Winthrop
Place of Burial or Cremation
DATE OF BURIAL .Sept .. 17, 1952
Winthrop
(City or Town)
19
SOM (B)-1-51 903586
OF September (Month)
14
(Day)
1952 (Year)
4 I HEREBY CERTIFY. Sept 13 52 19
52 That I attended deceased from sept 14
to ...
I last saw h C. alive on
.,
19 .. , death is said to
have occurred on the date stated above, at .m.
INTERVAL BE- TWEEN ONSET AND DEATH
ANTE CEDENT (b) CAUSES
Due To
Heart Auchace
funeral year
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
What test confirmed diagnosis?
. Was autopsy performed?
5 Was disease or injury in any way related to occupation of defeat?to
If so, specify.
(Signed)
(Address)
hume
contrib- but not ease or death.
ONS FICATE 3 EATH ter one ach d (c)
of mean 1g, such sthenia .. disease, which
ditions, e to the stating cause
L
301A 1
2 FULL NAME ..
(If deceased is a married, wmowed or divorced woman, give also maiden name.) 15 Juve are
(a) Residence. No. (Usual place of abode)
2 /2 Hours
3 DATE OF DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Thanks
3.00A
52
Due To
(c)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter S. Haberz.
(Signature of Agent of Board of Health or other)
Health Office 9/16/52
(Official Designation) (Date of Issue of Permit) /
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 clisease 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 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, specifying the war, and. shall also certify in such certificate both the primary and the secondary or i'mme | cemetery or burial ground in which the interment is made.
(liate cause of death as nearly as he can state the same. For neglect tocomply 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, Lie deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sce. 10.
No undertaker or other person shall bury or otherwise dispose of a human body Hpand who though disabled by recognized disease unrelated to any form of in a town, or remove therefrom a human body which has not been buried, untilhe has received a permit from the board of health, or its agent appointed to issue mary, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed. such permits, or if there is no such board, from the elerk of the town where the person dicd; and no undertaker or other person shall exhume a human body (3) Medical Examiners will investigate and certify to all deaths supposably remove it from a town, from one cemetery to another, or from one grave or Proud to injury These include not only deaths caused directly or indirectly by traumatism "(cluding 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.
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