229 230 231 State of New York Department of Health of the City of New York, Bureau of Records Certificate of Death 27233-Registered No. 1. Place of death, Borough of Manhattan. No., Manhattan-General Hospital. Character of premises, 8. Occupation, Theatre manager. 9. Birthplace, United States. 9a. How long in U. S., Life. N. Y. C., Life. 10. Name of father, Wm. DeVellier. 11. Birthplace of father, France. 12. 13. 14. Maiden name of mother, Charlotte White. Special information, etc. Usual residence, 96-08 42nd Ave., Corona, L. I. 15. Date of death, Dec. 20th, 1932. 16. I hereby certify that the foregoing particulars (Nos. 1 to 15 inclusive) are correct as near as the same can be ascertained, and I further certify that I have this 21st day of December, 1932, taken charge of the body of deceased found at City Mortu 234 233 232 Death certificate, Dec. 22, 1932 ary and that I have investigated the essential facts concerning the circumstances of the death. 17. I further certify that I have viewed said body and from autopsy and evidence, that he died on the 20th day of December, 1932, at 12:10 P. M. and that the chief and determining cause of his death was embolus to right ventricle and pulmonary artery ten days after right inguinal herniotomy. Milton Helpern, Assistant Medical Examiner. Filed Dec. 22nd, 1932. Chief Medical Examiner. 18. Place of burial, Flushing Cem. Date of burial, Dec. 23rd, 1932. 19. Undertaker, Joseph Urban, Inc. Address, Winfield, L. I. John H. Possimiede, 2382. This is to certify that the foregoing is a true copy (photographic) of a record on file in the Bureau of Records, Department of Health, City of New York. John T. Walsh, M.D., Assistant Registrar of Records. Proof of death, Dr. Bohrer, Jan. 13, 1933 1. Name of the deceased in full, William DeVel- & lier; address, 96-08 42nd Ave., Corona. 2. Age at death, 24 years. Married or single? Single. 3. Name of employer, Century Circuit, Inc.; address, 152 W. 42nd St. 4. How long have you been medical adviser of deceased? Dec. 8th, 1932. 5. Date of accident, Sept. 5th, 1932. Date of death, Dec. 20th, 1932. 6. Date of your first visit, Dec. 8th, 1932. Date of last visit, Dec. 20th, 1932. 7. Place of death, Manhattan General Hospital, & Lex. & 90th St., N. Y. City. 8. Who engaged your services? Aetna Life Insurance Co. 9. State in patient's own words how the accident occurred, He picked up a woman who had fainted and carried her up a flight of stairs. 237 240 239 238 Proof of death, Dr. Bohrer, Jan. 13, 1933 10. Give a complete and accurate description of nature and extent of injury, as you found it upon first and subsequent examinations, Indirect inguinal hernia. 11. State the direct cause of death, Pulmonary embolus. 12. In your opinion was the accident as above described a cause either directly or indirectly of the death? A. Ind. 13. Give contributory causes, if any, Operation followed by pulmonary embolus. 14. If coroner's inquest held, give coroner's name and address, Medical examination for City of New York. 15. Was deceased attended by any other physician during last illness? If so, name and address, None. 16. I am a physician duly licensed in the State of New York, and graduated in the year 1914 from Cornell Medical College. J. V. Bohrer, Attending Physician. Dated, Jan. 13, 1933. State of New York, County of New York, ss. J. V. Bohrer being duly sworn, deposes and says: That he is the physician who subscribed to the above (or attached) report; that he has read the same and knows the contents thereof; that the same is true to the knowledge of deponent, except as to the matters Proof of death, March 3, 1933 241 therein stated to be alleged on information and belief, and as to those matters he believes it to be true. Subscribed and sworn to before me this 13th day of Dec., 1933. K. L. Sullivan, Notary Public. PROOF OF DEATH, MARCH 3, 1933 Form C-64 1 .. 242 243 State of New York Department of Labor Office of the Industrial Commissioner Syracuse Office: 214 South Warren Street Case No. 3225468 Ins. Carrier's No............ 1. Name of the deceased in full, Devellier, Wm. Address. 2. Age at death, 22 or 23 years. single? Single. Married or 3. Name of employer, Schwartz Bros. Cent. Circ. Address. 4. How long have you been medical adviser of deceased? Dec. 9th to Dec. 20th, 1932. 5. Date of accident, Dec. 5th, 1932. Date of death, Dec. 20, 1932. |