USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 53
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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
JUL13
×
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
(City or town making return)
STANDARD CERTIFICATE OF DEATH
Registered No.
158
77 Marshall Street No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Katherine M (Dame ) Robinson
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
77 Marshall Street
St.
(If nonresident, give city or town and State)
22
Length of stay: In place of death years months. .days. In place of residence.
22
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
7
16
54
(Year)
(Month)
(Day)
That I attended deceased from
4 I HEREBY CERTIFY.
6/20.
19
54
to
7/16
1954
I last saw h eralive on
7/16/
19 58
death is said to
A
INTERVAL BE-
TWEEN OHSET
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
AID DEATH
11 IF STILLBORN, enter that fact here.
Years
AGE66
0
Months.
1
.Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Masg
Boston
17 NAME OF FATHER John Dame
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Germany
19 MAIDEN NAME
OF MOTHER
Eliza:Kness
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
France
21
Informant
Elizabeth Grattan
(Address)
77 Marshall St.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
Walter &. Bakery
(Signature of Agent of Board of Health or other) Healthy White 7/19/54
(Official Designation) (Date of Issue of Permit)
A TRUE COPY ATTEST:
(Registrar)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Walter A Robinson
(or) WIFE of
(Husband's name in full)
Cerebral Hemorrhage 7/13/4/12 Einterstitial Nephritis
arteriosclerosis
ANTE
Due To
CEDENT (b)
CAUSES
@ Hypertension
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?. no
What test confirmed diagnosis?
NO
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
(Signed) ..
authory a Forziati
M. D.
(Address) 116 Lauder St Date
2/16. 1954
6
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July
19
19.54
7 NAME OF
FUNERAL DIRECTOR ..
winthus mars
Varvara S Persaldo
ADDRESS
Received and filed. JUL- 19 1954 19
,5.
50M-(A)-11-51-905807
R-301 1
CTIONS OR CERTIFICATE iving F DEATH t enter han one or each ) and (c)
oes not mean dying, such are, asthenia, -) s the disease, tions which
d conditions, g rise to the (a) stating ying caus
ions contrib- death but not e disease or using death.
Winthrop
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEWidow
(write the word)
have occurred on the date stated above, at. .m.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, after the death of a person whom he bas 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 ot 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, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of deatb 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 Cbina 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, ninetcen hundred and two, and the Mexican border "service of nineteen hundred and sixteen and nineteen hundred and seven- teen. 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 tbe attending physician, if any, as required hy 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 tbe selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of deatb 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 sball 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 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 sball bury a human body or the ashes thereof which have been brought into the commonwealth until be 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 following rules of practice :
(1) Attending physicians will certify to sucb 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, hut also deaths from disease resulting from injury or infection related to occupa- tion, 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
JUL19
PM
TARDE NASC ..
6
5
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
M R-302 1
PLACE OF DEATH
SUFFOLK (Bourne 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 £2.72
159.
f(If death occurred in a hospital or institution, xxl give its NAME instead of street and number)
2 FULL NAME
DORA .... E .... SCHRESKY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
45 .... Sea .... R.o.am ... A.v.e.
xxxWinthrop
.. Masg
(If nonresident, give city or town and State)
Length of stay: In place of death
... years ............ months .. 5 ...
.... days. In place of residence .. 30.years ..
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Moduly
(Day)19
(Yeab954
4 I HEREBY CERTIFY,
That I attended deceased from
7/14. 19 to 7/19 19 5.4
I last saw h
ealive on
7.48
19
.Sofath is said to
have occurred on the date stated above. at.
F
6.409.
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ..
.Cerebrovascular om
bolus e left homiparesis
6days
ANTE
Due To
CEDENT (b)
CAUSES
Hypertensive arterio-6mos
sclerotic heart of
plu
Base with auri culas
fibrillation
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Diabetes mellitus
Malignant papilloma
3yrs
6yrs
Major findings:
Of operations.
bladder
Date of operation.
Was autopsy performed ?.
no
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed) E D Bouchard
M. D.
(Address) 81 Bay State Rd 7/19 19
6 Fammiderof Boston
(City ofTWIYn
DATE OF BURIAL 19 .... 5
Jul -19
7 NAME OF
FUNERAL DIRECTOR
B Schlossberg & Sons
ADDRESS
Mattapan
19
Received and filed
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Myer Wapner
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Gussie
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russi a
L Schresky
21
Informant
(Address)
A TRUE COPY
ATTEST: Karles 21 Machin
(Registrar of City or Town where death occurred)
Jul 21
54
DATE FILED
...... ......
.19
.....
V.D. V
WNIETLAINET, WITH UNTADING BLACK INK - THIS IS A PERMANENT RECORD
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,
25M-3-53-909098
M. S.
8 SEX
F
9 COLOR OR RACE
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Widow
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Morris Schresl
(Husband's name in fun,
11 IF STILLBORN. enter that fact here.
12
AGE ..... 69Y
Months.
Days
If under 24 hours
Hours ........
Minutes
13 Usual
Occupation :.
Housewife
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No ...
At home
16 BIRTHPLACE (City)
(State or country)
.Now York
NY
(Usual place of abode)
N E Deaconess Hospital
No.
-
AUG-2
PLACE OF DEATH
Suffolk (County)
Winthrop (City of Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
160
No. Winthrop Community Hospital FAWIN Francis E! Homer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
107 Winthrop Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .years. months. 14
47
days.
In place of residence.
.years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
20
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 14
1954
to ..
July 20
1954
10a If married, widowed,
HUSBAND of.
France
Emma Knights
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
6.7 Years
2
Months
5
Days
If under 24 hours
Hours
Minutes
13 Usual
Candy Mfg.
Occupation:
(Kind of work done during most of working life)
14 Industry
Wholesale & Retail
or Business:
15 Social Security No.
024-03-1437
16 BIRTHPLACE (City).
Providence R.I.
(State or country)
17 NAME OF
FATHER
Edward Hallett Homer
18 BIRTHPLACE OF
FATHER (City)
Providence
(State or country)
K. I.
19 MAIDEN NAME
OF MOTHER
Annie M. Noonan
20 BIRTHPLACE OF
1954
MOTHER (City)
Quebec
(State or country)
Canada
21
Informant
(Address)
234 Bowdoin St.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial ør transit permit was issued:
Walter.
(Signature of Agent of Board of Health or other)
Healthy
fficer
7/22/54
(Official Designation) (Date of Issue of 'Permit)
V. V. V
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 ith.
id conditions. ing rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
50M-5-52-907046
Place of Burial or Cremation
DATE OF BURIAL July 221 / 1954 .19.
7 NAME OF
FUNERAL DIRECTOR
Grollhed B. March
ADDRESS
174 Winthrop St. Winthrop
Received and filed.
JUL 22 1954
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIEMid owed
WIDOWED
of DIVORCED
I last saw h 1 km alive on
July 19, 1954, death is said to
have occurred on the date stated above, at ..
3:30 A. m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)
Ugronchapneumonic
(terminal)
ANTE
Due To
Carcinoma of
CEDENT (b) CAUSES, large bowel with metast
asis rollbar
Due To
(c)
OTHER SIGNIFICANT CONDITIONS
obesity
Major findings:
Of operations ..
Ceremonia of intestine
Ylive
Date of operation
July 17
.. Was autopsy performed? 120
What test confirmed diagnosis? Biopsy of fever
5 Was disease or injury in any way related to occupation of deceased? If so, specify Daype 2 evane M. D.
(Signed).
(Address) 194 Wasbunlar Date 7-20
6 Winthrop cemetery
Winthrop (City or Town)
PARENTS
2 days
2 years
To be filed for burial permit with Board of Health or its Agent.
f(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 so specify WAR)
(a) Residence. No. (Usual place of abode)
2 FULL NAME
T.M.M.
M R-301A 1
Edward H. Homer
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 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-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventecn. 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 hody, 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 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 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 he 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.
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