USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 61
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
+
R-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (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. .
172
St.
{ (If death occurred in a hospital or institution,
give its NAME instead of street and number) §
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
15 Seymour St.
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months days.
In this community
31 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4
COLOR OR RACE
female
white
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
single
5a If married, widowed or divorced
HUSBAND of .
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive ... years
7 IF STILLBORN, enter that fact here.
8 AGE 73 Years 1 Months
16
Days
If less than 1 day
. Hours
Minutes
Usual
9 Occupation:
private secretary
Industry
10 or Business:
F.S. Webster Co, Cambridge, Mass
11 Social Security No. ..
011-03-5129
Chelsea
12 BIRTHPLACE (City)
(State or Country)
Mass.
13 NAME OF
FATHER
John Witham
14 BIRTHPLACE OF
York
FATHER (City)
(State or Country)
Maine
15 MAIDEN NAME
OF MOTHER
Olive Cushing
16 BIRTHPLACE OF
MOTHER (City)
unable to ascertain
(State or Country)
Relation, if any
17 Informant Mrs. John R. Countaway, Friend (Address) 15 Seymour St, Winthrop, Mass. I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or Dansit-permit was issued: Waller GBake (Signature of AgghtfBankof Health or other)
HO
aug 30/19+8 (Date of Issue of Permit)
(Official Designation)
Other conditions
Parchal Hemenhage 12 hrs.
(Include pregnancy within 5 months of death)
Major finding Love Of operations
Date of
Of autopsy Une
clinical x
What test confirmed diagnosis larnating
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
Jacob . Uhrams m.
(Signed)
M. D.
les 562 Plus A Date 8/30/1945
York Cemetery ,York, Maine
Place of Bunal, Cremation or Removal.
(City or Town)
August 31 1948
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS
174 Winthrop St ,Winthrop
Received and Filed SEP . 2 1948 19
(Registrar)
IMPORTANT
Physician Underline the cause to which death should be charged sta- wwwrally.
100M-7-46-19068
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. PARENTS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
27
1948
(Month)
(Day)
( Ycar)
March
31
10
47.
to
HEREBY CERTIFY,
That I
Attended deceased from
august 27
,
I last saw
august 27 1047,
, death is said to
alive on
have occurred on the date stated above, at
50
m.
Duration
Immediate cause of death Carcinoma of regler break° 1 year
Due to
Several Concinnatino 4 mos.
-
No ..
15 Seymour St.
2 FULL NAME
Ella, Moulton Witham
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Usual place of abode)
..
21
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 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 iu 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 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 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 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 or chapter forty-six, tuat 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 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 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 physiclans 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 forun 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 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 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 .- 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
R-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City of Town)
No.
30 Sargent Street
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.
Registared No.
173
[ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Zoa Extina (Carter) Carlton
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
30 Sargent Street
st.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death )
( Specify whether)
yearo
months
days.
In this community .
30
yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE;
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5e If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Alfred Car1" oh wie In full)
( Husband's name In rull)
80
yeers
7 IF STILLBORN, enter that fect here.
8
AGE 8Q Yeers 8.
Months
7 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupetion :
Housewife
Industry
Own Home
10 or Business :
11 Social Security No.
None
12 BIRTHPLACE (City)
Port Mulgrave
( Siate or enuntry)
Novia Scotia
13 NAME OF
FATHER
James E Carter
14 BIRTHPLACE OF
FATHER (City)
Port Mulgrave
(State or country)
Novia Scotia
15 MAIDEN NAME
OF MOTHER
Rebecca M Hunson
16 BIRTHPLACE OF
MOTHER (City)
Port Mulgrave
(State or country )
Novia Scotia
17 Lucy B Carlton Daughter
Informent
( Address)
30 Sargent St Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit) permit was issued : Watter & Baker
HO
(Signature of Agept off Dofrd of Health or other) aug 31/48.
(Official Designation) - · (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Cinq
28
48 (Year)
19 | HEREBY CERTIFY.
July 2. 1948.
to
Cung 28
1940
I last saw h Ry
alive on.
aux
f. 19 zł, daith is said to
have occurred on the date stated above, at.
11 :5 1Pm.
Duration
immediate oause of death Edema y Lungs
IMPORTANT
2 days
Due to
Due to
Other conditions
Checking Huenenkunz
( include pregnancy within 3 months of death)
Mejor findings :
Of operetions
Date of
Of eutopsy
What test confirmed diegnosis?
30 0gs IMPORTANT
Physician Underline the cause to which death should be charged st.t- tistically.
20 Was disease or injury in ony wey related to occupation of deceesed ?
If so, specify.
(Signed)
Have a Treli
(Address)
200 Pleurant Date 10/30
Winthrop
21
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
31
48
DATE OF BURIAL
Aug
22 NAME OF
FUNERAL DIRECTOR
Howard 5 Propriveds
ADDRESS
Received and fled
SEP ...
mun
19
( Registrar)
....
. M. D. 19 44
100m-(g) -1-45-15510
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a reoltal to that effect. extracts from the laws on back of certificate. wtmto, w łaty it may be properly crossed. baast Matemgat er VeberATION is very important. See instructions and PARENTS
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
.......
( Month)
(Day)
That I attended deceased from
6 Age of husband or wife if alive
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered bospital medical officer shall forthwith, after the death of a persou 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 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, Cbap. 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 helief, 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 hundred and fourteen, the word "war" shall include the China relicf 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 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 deatb 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, tbe 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, tuat 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 aud 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, Cbap. 38, Sec. 6.
No undertaker or other person shall bury a buman body or the asbes 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 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 deatbs 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 sucb 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 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 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 death, not the mode of dying, e. g., beart 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
R-303-A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) 29 Talfare No. Walter S. Dacen
The Commantoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or Its Agent.
Registered No.
174
St. { { If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give, aleo maiden name.)
(a) Residence. No. 29 Talsara Wuttrop
(Usual place of abode)
Length of stay: In hospital or Institution ..
(Before death)
( Specify whether)
years
months days.
(If nonresident, give city or town and State)
In this community / yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE| 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH
aug - 28 - 1948
( Month)
(Day)
(Year)
5a If marrled, widowed./os dlygroet HUSBAND of
hey/2 le rood / Doherty
(Give maiden name of wife in full)
(or) WIFE of
/ (Husband'e name in full)
6 Age of husband or wife If allve
7 IF STILLBORN, enter that fact here.
AGE.
Months. .......... Pays
if less than 1 day .Hours ..... .Minutes
Usual 9 Occupation :
Lateral Prison officer
Industry
Slate Persons
10 or Business:
11 Soolal Security No ...............
12 BIRTHPLACE (City)
(State or country )
13 NAME OF
FATHER
Thenia
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Helenavon
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Informant, ( Addres)
Tables Pacey Relation, if any DATE OF BURIAL.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Watter & Raker (Signature of Attat of Board of Health or other) H.O aug. 31/48
.... (Official Designation) (Date of Issue of Permft)
20 Accident, sulolde, or homlolde (specify)
Suicidal
Date of ooourrence.
aug - 28
1968
Where did
Weletter mans.
(City or town and State)
Did Injury ooour in or about home, on farm, In Industrial place, or In pubilo
place?
Ma
Manner
(Specify type of place) \
1
Injury
Found dead 2 Langues un
Nature of
his garage
Injury
While at work?
Was there an autopsy ?.
200
21 Was disease or Injury In Any way related to occupation of deceased?
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