USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 67
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other than the receiving tomb to another in the same cemetery, until he nas received a permit from the board of health or its agent aforesaid or from the elerk 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 inay 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 seleetmen 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 elerk 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 elerk or registrar may require .- Chap. 114, See. 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, Aets of 1945.
RECENTundertaker 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 ""50 to-do from the board of health or its agent appointed to issue such permits, or If there is no such board, from the elerk 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
Chạp. 114, Sce. 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:
Attending physicians will certify to such deaths only as those of persons Phem they have given bedside care during a last illness from disease unrelated Firm of injury.
Board of Health physicians will certify to such deaths only as those of
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.
C
Boston
(City or town making return) 81781.96
Registered No.
§(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.)
30 Hutchinson St
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
.. months
3
.days.
In place of residence
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sept.17/52
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Sept.17
19.
52
Sept.15 19 ... 52 ..
to.
I last saw h ......
... im alive on
Sept.17
10 52
death is said to
have occurred on the date stated above, at.
INTERVAL BE- TWEEN ONSET AND DEATH Immed.
11 IF STILLBORN, enter that fact here.
12
AGE
55
Years.
Months.
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Dist.Manager
(Kind of work done during most of working life)
14 Industry
or Business:
Theatres
15 Social Security No.
025-09-9679
16 BIRTHPLACE (City)
(State or country)
BostonMass.
17 NAME OF
FATHER
Abraham Alexander
18 BIRTHPLACE OF
FATHER (City)
(State or country)
New York New York
19 MAIDEN NAME
OF MOTHER
Sarah Robinson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
New York New York
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Sept. 19/52
19
21
Informant
(Address)
A TRUE COPY
Partes A. Machine
ATTEST:
(Registrar of City or Town where death occurred) Sept.19/52
DATE FILED
19
302
of death should be transmitted on Form K-302 to the clerk of the city of town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m-(b)-11-49-900,475
PLACE OF DEATH
Suffolk (County)
1
Boston (City or Town)
No.
Irving Alexander
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
50
10a If married, widowed, or divorced
Zelda Weiner
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Acute myocardial
TO DEATH (a)
infarction
ANTE
Due To
Arterio sclerosis
CEDENT (b)
CAUSES
Due To
Diabetes mellitus
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations ..
Was autopsy performed?
Yes
Date of operation
What test confirmed diagnosisautopsy
No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify .....
S.L Katz
M.
(Address)
(Signed).
Beth Israel Hosat 9-17"
.19
SharonMemorial Park Sharon Mass
6
7 NAME OF
FUNERAL DIRECTOR
B F Solomon
Brookline Mass.
Received and filed.
OCT.
2-1952
19
(Registrar of City or Town where deceased resided)
PARENTS
Zelda Alexander
ADDRESS
Beth Israel
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH Hospt.
(write the word)
7;35PM
m.
4
RECEIVED
MOL
OF
12
OFFICE
L
5
9
VTI
OCT-2 1952 AM
PLACE OF DEATH
WORCESTER
(County) WORCESTER
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
WORCESTER
(City or town making return)
Registered No.
197
No. Forcestor State Hospital
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME Olive * ( Olberr) Carlisle
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
NO
"Anthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.O.
years.
4 10
.days. In place of residence
.. years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sept 17, 1952
(Month)
(Day)
(Year)
9 SEX
foma le
10 COLOR OR RACE
white
11 SINGLE
(write the word)
MARRIED
WIDOWED -4-
or DIVORCED VOY COC
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
11a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE
Wendell C Carlisle
(Husband's name in full)
Broncho .... pneumonia
primary
12 IF STILLBORN, enter that fact here.
13
AG 64 ... Years ....
Months
Days
If under 24 hours
.Hours .....
Minutes
5 Accident, suicide, or homicide (specify) ..
accident
Date and hour of injury.
7-12
19.52
Where did
Worcester
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Mentalhospital
(Specify type of place)
Manner of all in room
Injury
(How did injury occur?)
Nature offracture right hip
Injury
While at work?
.Was autopsy performed?NO
6 Was disease or injury in any way related to occupation of deceased ?... ...
If so, specify
M. D.
(Signed Johr .C. Ward
(Address)
Lorena
Date ..... 7
7 Forost ilYa Boston Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL .....
Sent 10 1952
.19
8 NAME OF
FUNERAL DIRECTORI.STatomman ..... Sons
ADDRESS Boston
Received and filed.
OGT 10 1952
.19
(Registrar of City or Town where deceased resided)
A TRUE COPY,
ATTESA faleh & Midolo
(Registrar of City of Town where death o curred)
Jussell 1. abel
DATE FILED
Sept 18, 1952 ASSt.19
×
25m-(h)-10-48-24658
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
1
305
PARENTS
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Bouton
20 MAIDEN NAME OF MOTHER Ellen Cochran
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
17 BIRTHPLACE (City).
(State or country)
18 NAME OF
FATHER
John H Olberg
15 Industry or Business:
16 Social Security No.
14 Usual
OccupationPractical Nurse
(Kind of work done during most of working life)
Mindhorn
22
Informant.orcester.StatoHospital
(Address)
insonda
(City or Town)
(a) Residence. No.
19 Loroll Da
(Usual place of abode)
RECEIVED
TOW
7
8
140
THROP
OCT1O
1
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
3 DATE OF DEATH Manner of Injury Nature of Injury ... If so, mediu of Death. vov reverse siga for extracts troni the laws relative to the return of certificates of death. While at work?
5 Accident, suicide, or homicide (specify)
Date and hour of injury 19
Where did Injury occur ?. (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Specify type of place)
(How did injury occur?)
6 WAs disease or inidry in any way related to go upation of deceased?
(Signed) hechael horga, M. D.
(Addr ) 25 Shattered 51 Date 9/221952
7 Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL. 196
8 NAME OF FUNERAL DIRECTOR
amint -
ADDRESS
Received and filed. SEP 23 1952 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
m.
10 COLOR OR RACE
11 SINGLE MARRIED WIDOWED or DIVORCED
(write the word)
€.
11a If married, widowed, or divorced HUSBAND of the
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13 54 Jeremiah R O'Brien) Bro.
AGED 8
Years.
Months.
.Days
If under 24 hours Hours. ... .. Minutest
14 Usual
Occupation :
(Kind of work done during most of working life)
15 Industry
or Business:
E Tel. 1
16 Social Security No. 011 - CV. 2846
17 BIRTHPLACE (City) (State or country)
18 NAME OF FATHER
19 BIRTHPLACE OF FATHER (City) (State or country)
tuland.
20 MAIDEN NAME OF MOTHER
21 BIRTHPLACE OF MOTHER (City) (State or country)
1
22 Informant .. (Address) 2,-
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter if Kaker2
(Signature of Agent of Board of Health'or other)
Thatthe Office
(Official Designation)
(Date of Issue of Permit) 09/23/52
25M (B).8.50.902 592
PLACE OF DEATH
Suffolk County)
03 A 1 Winthrop (City or Town) Elke Home, Washington Care No.
The Sumkenwealth uf Massachusetts EDWARD J. CRONIN HEARETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial pormit with Board of Health or its Agent.
Registered No. 198
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
2 FULL NAME ..
Johan 9. 0'Br
(If deceased is a married, widowed or divorced woman, giye also maiden name.)
35 Man (a) Residence. No. (Usual place of abode)
man Hill Pol S)
(Was deceased a U. S. War Veteran, ( if so specify WAR). e
No
(If nonresident, give city or tows and State)
Length of stay: In place of death. ....... ... years. .. months. ...... days. In place of residence. .. years .months ........ .. days.
MEDICAL CERTIFICATE OF DEATH
(Month)
6521 1952 (Day) (Year)
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
6.7
.Was autopsy performed?
PARENTS
Switch
Permian 2
-
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 a so to do from the board of health or its agent appointed to issue such permits, the deceased, furnish for registration a standard certificate of death, stating to the toLiftHere 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, -Seg. 46 G. L., as amended. 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 of 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 andfour- 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 Gimmie- 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-sever of said chapter one hundred and fourteen, the word "war" shall include the Chifje relief expedition and the Philippine insurrection, which shall, for said purposes, 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.
SEPR
No undertaker or other person shall bury or otherwise dispose of a human bo 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 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. as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931. No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit
Medical examiners shall make examination upon the view of the dead bodies of persons' ias 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 Chap: 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
Lays Eht medical examiner certifies the cause and manner of death to the best chis knowledge and belief.
RULES OF PRACTICE
The fulfillpent of the purpose of these laws calls for the observance of the follow- practice:
Attending physicians will certify to such deaths only as those of persons m 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 shitty, 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
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: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained 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) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING. .......
ORGANIZATION AND OUTFIT
SERVICE NUMBER
......
PLACE OF DEATH
Suffolk (County) Wiltthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
C
To be filed for burial permit with Board of Health or its Agent. 199
Registered No.
15 atlantic No.
2 FULL NAME.
f(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) William Joseph Dempster PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, 15 if so specify WAR) (If deceased is a married, widowed or divorced woman, give also maiden name.) atlantic
St.
(If nonresident, give city or town and State)
months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR OR RACE
8 SEX
male white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
10a If married (widowed, or divorced HUSE
E Connor maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
2%
Years
11
MonthsS
Days
If under 24 hours
.Hours
.. Minutes
13 Usual
Occupation :
Cenk
(Kind of work done during most of working life)
14 Industry
or Business:
Steamship Co.
15 Social Security
020-14-0530
16 BIRTHPLACE (City). (State or country)
Boelon 0.
17 NAME OF FATHER Clarence R. Dempster
18 BIRTHPLACE OF FATHER (City) (State or country)
East Boston
mans.
19 MAIDEN NAME
OF MOTHER
Ethel H. Butler
South Boston
21 Informant (Address)
St. Wielup
I HEREBY CERTIFY that a satisfactory standard certificate of death Was filed with me BEFORE the burial or transit permit was issued: Walter H. Bakug
(Signature or Agent of Board of frealth or other) Healla Office 9/24/52
(Official Designation) (Date of Issue of Permit)
NS ICATE CATH er one ch (c)
i mean g, such thenia,- disease. which
itions. to the stating cause
ontrib- but not ase or death.
OTHER
Several previous temporary
CONDITIONS arrhythmias
Major findings:
Of operations.
Date of operation.
Was autopsy performed? no
What test confirmed diagnosis ?.
clinical
5 Was disease or injury in any way related to occupation of deceased? MO If so, speciarthur . (Signed) Winthrop Board of Health M. D. 20 BIRTHPLACE OF MOTHER (City) Date 23 Saft 1952 (State or country) mars
(Address)
Writtenop Cemetery Winters 6
(City or Town)
DATE OF BURIAL ..
195
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reynold
ADDRESS 180 Winthrop Sto
Received and filed 19
(Registrar)
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Natural causes
Due To Cardiac amhuthmia ANTE CEDENT (b) CAUSES
(Ventricular fibrillation)
Due To etiology unknown
(c)
(Month)
(Day)
4 I HEREBY CERTIFY, 19 52 That I attended deceased from November 1947 to .. 22 Sept
I last saw him alive on 12
Feb
1952, death is said to
have occurred on the date stated above, at 11:30 P. m.
INTERVAL BE-
minutes
50M-2-19-25666
01A
1
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death years months. days. In place of residen 22
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