USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 50
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119
1.46 .... Somerset ..... Avenue No.
J(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME .. Benjamin Alden Delano
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 146 .... Somerset .... Avenue (Usual place of abode)
.....
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ... 5.0 years.
.months. days. In place of residence 5.0.years. ..... months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
white
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
10a If married, widowed, or divorced
HUSBAND of.
zora Nute
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
AGE 85 Years
8
.Months
.1.3 Days
If under 24 hours
Hours .. ... Minutes
13 Usual
Occupation :
Treasurer
14 Industry
Fast Boston Savings Bank
15 Social Security No. ..
019-12-0105-4
16 BIRTHPLACE (City)
(State or country)
East Boston
Mass.
-
Major findings:
Of operations.
Date of operation
What test confirmed diagnosis ?.
clinical
5 Was disease or injury in any way related to occupation of deceased? no
If so, specify
specify: thus @ Murray
(Signed)
Winthrop
Date 8 July 1955
6 Mayflower ..... Cemetery Muxbury .... (City or Towny
Place of Burial or Cremation
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS 174 Winthrop St. Winthrop
Received and filed.
JUL .8 1955 19
(Registrar)
Jul 17 1955 19 (Address) 146 Somerset Avenue Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Mass.
Walter 6. Baker
Ho
(Signature of Agent of Board of Health or other) . 7/8/55
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
does not mean of dying, such lure, asthenia. ns the disease. ations which th.
d conditions. ng rise to the e (a) stating lying cause
ions contrib- death but not he disease or ausing death.
Chapter 137. 954, requires is to print or ause or causes h on death es.
50M-3-54-911887
3 DATE OF
DEATH
July
(Month)
7
1.9.5.5
(Day)
(Year)
4 I HEREBY CERTIFY,
September, 51
...
to.
7 July
...
That I attended deceased from
55
I last saw him alive on
7 July, 1955, death is said to
have occurred on the date stated above, at 5:15 P.m.
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Coronary Occlusion
INTERVAL BE- TWEEN ONSET AND DEATH minutes
ANTE
Due To Arteriosclerotic
CEDENT (b)
CAUSES
Heart Disease
years
Due Generalized
(c)
Arteriosclerosis
years
17 NAME OF FATHER Henry Mudge Delano
PARENTS
18 BIRTHPLACE OF
Was autopsy performed?
no
FATHER (City)
Duxbury
(State or country) Mass.
19 MAIDEN NAME OF MOTHER Sarah Elizabeth Pigeon
20 BIRTHPLACE OF
... /M. D.
MOTHER (City) East Boston
Mass. (State or country) Mass.
21 Informant Mrs. Benjamin A. Delano
(Was deceased a U. S. War Veteran. if so specify WAR)
NO.
(Give maiden name of wife in full)
(Kind of w ,rk done during most of working life)
OTHER SIGNIFICANT CONDITIONS
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 deccased, 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 seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be. a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death 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 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
JUL-8
U
RECEIVED
M R-301A 1 Winthrop (City or Town)
No. 28 Trident Avenue
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 so specify WAR)
W. W. 1
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .
years . .
months
2.2 days.
In place of residence
4.Oyears
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July.
7
1955
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED'
Married
4 I HEREBY CERTIFY,
That
I
attended deceased1
from
19 to.
19
10a If married, widowed a divorceMasterman
HUSBAND of ..
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADAS
TO DEATH (a)
8
Death Presumably
ANTE
Due to acute
CEDENT (b)
CAUSE myocardial infarction
Dirath was said to have occurred at 8:10 p.M
OTHER
SIGNIFICANT July 7, 1955.
Winthrop Board of Health.
Major findings:
Of operations.
Date of operation ..
Was autopsy performed?
What test confirmed diagnosis?
INTERVAL BE- TWEEN ONSET ANO DEATH 11 IF STILLBORN, enter that fact here.
12
60
AGE
Years
Months ..
Days
If under 24 hours
Hours .
Minutes
13 Usual
Occupation :
Operator
14 Industry
or Business :.
Cap factory
15 Social Security No.
029-01-3985
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Hyman Korsun
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Ida
c.n.b.l.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Ethel Korsun
Informant
(Address)
35 Woodhaven St., Matt.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter G: Baker
(Signature of Agent of Board of Health or other)
40
July 8/53
(Official Designation)
(Date of Issue of Peymit)
'50M (B)-12-49-900722
PLACE OF DEATH
Suffolk (County) 1.505/020 8-5-55
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.
Registered No. .
150
RUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one e 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.
5 Was disease or injury in any way related to occupation of deceased ?.
No
If So, specificdie Liberuçu
M. D.
(Signed)
Wasthrop/ Mass
Date
7/7/1955
6 Jewish Peoples .... Cemetery
Everett.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July 8,1955
.19
7 NAME OF
B. SCHLOSSBERG & SONS
FUNERAL DIRECTOR ..
ADDRESS
1257 Blue Hill Ave . ,Matt.
Received and filed.
JUL 8 1955
19
(Registrar)
2 FULL NAME Joseph KORSUN (If deceased is a married, widowed or divorced woman, give also maiden name.)
35 Woodhaven
St. .
Mattapan
(Month)
(Day)
I last saw h
alive on.
19
death is said to
have occurred on the date stated above, at
m.
(Kind of work done during most of working life)
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 imine- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one ceinetery 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 perinit. 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 registr ;- 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 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 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 inade.
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 givermup 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 occupato11 by the appropriate terins, 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
October 4, 1917
DATE OF DISCHARGE
June 3,1919
RANK, RATING Pvt. l'st Class
ORGANIZATION AND OUTFIT 2 nd B. & S. Det. Demob . Group FM
SERVICE NUMBER 2389586
JUL-8
NI
A
TOWS
RM 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
7 NAME OF 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, CONDITIONS
25M-10-53-910621
PLACE OF DEATH
Middag9x
Lexington (City of Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Fordination ang return)
Registered No.
151
[(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
2 FULL NAME.
Denning H113
(If deceased is a married) widowed of kom ...... ] ... divorced Woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
{ if so specify WAR) ...
NO
(a) Residence. No.
(Usual place of abode) 35-Birch Road
Length of stay: In place of death.2 ..... years& ......... months .?....... days. In place of residence ..... years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
(Monthy
(Day)
1955
4 I HEREBY CERTIFY,
That I attended deceased from
December .... 1, 19.48 .. , to.July 10;
195.5
I last saw h.i.m ..... alive on ..... Ju.l.y ........ 0 ..........
1955. death is said to
have occurred on the date stated above, a 6.20.
.. m.
INTERVAL BE-
10a If married. widowed, or divorced
HUSBAND of.
Gertrudan Stolje in full
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ... 78 Years ....
Months ..... Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation:
Laborer
(Kind of work done during most of working life)
month
Due To (c)
OTHER
SIGNIFICANT Cirrhosis of liver.
?
Major findings:
Of operations
None
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? If so, specify
(Signed).
Sol Sherman
M. D.
(Address) .. Mot.State Hosp
Date
7/11/ 1955
6
.Holy Cross.Com.
Place of Burial or Cremation
Mal(chor Town)
DATE OF BURIAL.
July 14, 155
FUNERAL DIRECTOR? ... J ........ McGlinchey
ADDRE
583 Broadway, Chelsea
19
Received and filed. AUG 8 1955
(Registrar of City or Town where deceased resided)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
18 BIRTHPLACE OF
Patrick Denning
FATHER (City).
Cannot learn
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
Annie 01Hagen
.. 19.
MOTHER (City)
New Brunswick
(State or country)
Canada
21 InformanRecords Met. State Hospital
(Address
Waltham HASs.
A TRUE COPY
ATTEST:
James
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