USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 50
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(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
149
No.
65 Beal Street, Winthrop
St. { (If death occurred in a hospital or institution, ! give its NAME instead of street and number) )
PHYSICIAN - IMPORTANT
(Was deceased a 3 5. War Veteran, if so specify WAR) No
(a) Residence. No.
65 Beal Street
(Usual place of abode)
St.
(If nonresident, give city or town and State)
None
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
In this community
42 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4
COLOR OR RACE
White
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed or divor on
HUSBAND of
(or) WIFE of
(Give
Richard I. Howard
(Husband's name in full)
6 Age of husband or wife if alive 71 years
7 IF STILLBORN, enter that fact here.
AGE.
8 67 Years
Months
19 Days
If less than 1 day
. Hours
Minutes
Usual
9 Occupation:
Housewife
Industry
10 or Business:
At home
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or Country)
St. John, N. B.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
St. John, N. B.
(State or Country)
15 MAIDEN NAME
OF MOTHER
Mary Sullivan
16 BIRTHPLACE OF
MOTHER (City)
St. John, N. B.
(State or Country)
17 Richard P. Howard ( SOHon, if any ) Informant 38 Pleasant Pk., Rd., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with/me BEFORE the burial or fransit permit was issued: Walter I. alles (Signature of Alot of Board of Water other)
idealti Office
(Official Designation) (Date of Issue of Permy 7/24/47
19 July 15 , 19 to
last saw her
alive on
July
22 , 1947.
have occurred on the date stated above, at 4:45 A m.
Immediate cause of death Carcinoma of liver.
Due to
Due to -
Other conditions
Choleciplitis
(Include pregnancy within 3 months of death)
Major findings:
Cholelithiasis
Of operations
Peter Bent Brigham Date of July 5, 1947
Of autopsy moved
What test confirmed diagnosis?
operation
Duration IMPORTANT
months
10 yrs
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
M. D.
(Signed)
ess) Winthrop Muss Date 24/12
19 47
21
Winthrop Cemetery,
Winthrop
Place of Burial, Cremation or Removal.
(City br Town)
DATE OF BURIAL
July 25th
19 47
22 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS
Boston, Massachusetts
19
Received and Filed JUL 2 5 1947 ( Registrar)
See instructions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to insert a recital to that effect.
100M-7-46-19068
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Month)
23 (Day)
1947 (Year)
HEREBY CERTIFY,
That I attended deceased from
Andy 2.3. 1947.
ath is said to
13 NAME OF
FATHER
William Robicheau
PLACE OF DEATH
2 FULL NAME
Sarah M. Howard ( Robicheau )
(If deceased is a married, widowed or divorced woman, give also maiden name.)
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, furnisb for registration a standard certificate of death, stating to the best of his kuowledge 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 tbis 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 hoard 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 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 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 he 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 bis county the hody of such a person, he shall forthwith go to the place where the hody lies and take charge of the same; . . . - General Laws, Chap. 38, See. 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 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 following 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 phy- sician is absent from home wben the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably 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 .- Cause of death means the disease, or complication which causes deatb, not the mode 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
M R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. Winthrop Community Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 150
Registered No.
St & (If death occurred in a hospital or institution,
" give its NAME instead of street and number)
2 FULL NAME
Roselle (Killam) Lythgoe
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Rasidence. No.
23 Fairview Street
(Usual piace of abode)
Hosp.
Length of stay: In hospital or institution
( Before death)
( Specify whether)
years
months
3
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEO Married
5a If married, widowed, or divorced
HUSBANO of
Albert w Lythgoe!
( Husband's name in rull)
full)
6 Age of husband or wife if aliva 58
years
7 IF STILLBORN, enter that fact hera.
8
AGE
55 Years 10 Months
.26 Days
-
if less than 1 day
Hours
Minutas
Usual
9 Occupation :
Housewife
Own Home
11 Social Security No.
029-05-2607
Yarmouth.
12 BIRTHPLACE (City)
( Siate or country)
Novia Scotia
13 NAME OF
FATHER
Unable to obtainkia ... )
14 BIRTHPLACE OF
FATHER (City)
Unable to obtain
(State or country)
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF
MOTHEP. (City)
Unable to obtain
(State or country)
17 Albert W, Lythgoe Huabbandy 23 Fairview St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the Burai ar tranglt germit was issued : Walter
(Signature of Agent of Board of Health or other)
7/25/97
( Date of Issue of Peymit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
24
1947
( Month)
(Day)
(Year)
19
D HEREBY CERTIFY.
July 21
19.47
July 24. 1947
to ........
Mast sawher aliva on
July 23. 1947, death is said to
hava occurred on the date stated above, at 2:33 A. m.
Immediata causa of death. a. Bronchopneumonia
(terminal)
Que to Cerebral hemorrhage
3 days
years
Other conditions.
( include pregnancy within 3 months of death)
Major Andinga:
Oi oparatione
Oata of
Of autopsy
What test confirmed diagnosis ?
clinical
20 Was disease or injury in any way related to occupation of dacaused ? 22o if so, spaolfy ......... Arthur @ murray ( Signa
(Address) Nunkprof Heeft
Data 24/4/br 1947
Everett
21
... Woodlawn
l'lace of Burial, Cremation or Removsi.
OATE OF BURIAL.
July
(City or Town)
26
47
19.
...
Howard Surwold
19
......
Received and fiad JUL -2.5.10.17
(Registrar)
IMPORTANT .... .......... 18 hrs
Due to
Hubertension
IMPORTANT
Physician
Underline the cause to which death should be charged sta. ustically
M. O.
22 NAME OF
FUNERAL DIRECTOR
ADORESS
/ l alta (Omtelai Designation)
100m-(g)-1-45-15510
1 3 SEX Female (or) WIFE of informant ( Address) If decessed was a U. S. War Veteran, Q. L. Chap. 46, Seotlon 10, requires physicians to Insert a recital to that offoot. PARENTS should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain Industry 10 or Business : extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
(If nonresident, give city or town and State)
30
That I aftendad deocasad from
Duration
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 hy section one, where saine 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 bundred 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 hoard, 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 tomh 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 hoard, agent or clerk, as the case may he, 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 and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall he 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 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 person sball bury a human body or the ashes thereof which have been brought into the commonwealth until be 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 suchi 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 hy recognized disease unrelated to any form of injury, have died without recent 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 not only deaths caused directly or indirectly hy 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 .- Cause of death means the disease, or complication which causes death, not the mode 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 .- Precisc 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 bome 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
1
X
ORM R-302
1
Essex (County) Danvers CERTIFICATE OF DEATH (City or Town) No. Danvers State Hospital, Hathorne, Mass give its NAME instead of street and number) - PLACE OF DEATH
Danvers
(City or town making return)
Registered No.
151
(If death occurred in a hospital or inetitution,
2 FULL NAME
Etta Winchester (Maiden name unknown)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoc. No.
97 Circuit Road, Winthrop, Masg.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or institution.
(Before death)
(Specify whether)
years
7
months
1 9 days.
in this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
5
1947
(Month)
(Day)
(Year)
19 J HEREBY CERTIFY,
NOv.
16
1941
to
That I attended deceased from,
July
5
19
47
1 last saw h ... e.L ...... alive on
July 4, 19 47 death Is said to
have occurred on the date stated above, at .... 5 .:. 2.0.
a ..... m.
Duration
immediate cause of death. Arteriosclerotic heart disease
5 yrs.
8
80
AGE
Years
.Months.
Days
-
if less than 1 day Hours Minutes Due to
Usual
Unable to work
11 Soolal Security No ..
12 BIRTHPLACE (City)
Nova Scotia
(State or country)
Canada
13 NAME OF
FATHER
Cannot be learned
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Cannot be learned
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
Cannot be Learned
(State or country)
Relation, if any
17 Informant .. Mary ............ MicPhillips. ( (Address) Hathorne , Mass.
A TRUE COPY.
ATTEST :
WinterChan
(Registrar of city or town where death occurred)
DATE FILED
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
Israel Winchester
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if allve ... Unknown.
years
7 IF STILLBORN, enter that faot here.
3 SEX Female (or) WIFE of 9 Ocoupation: PARENTS of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD industry 10 or Business :
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