USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 82
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To be filed for burlal permit with Board of Health or Its Agent.
Registered No.
236
St. { { If death occurred in a hospital or institution, give its NAME instead of street and number)
R. Wyman
(If deceased is married, widowed or divorced woman, give also maiden name.)
23 Sturges St. Winthrop
Length of stay: In hospital or Institution.
( Before death)
( Specify whether)
years
months
days.
In this community 20 ma.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If alive years
If less than 1 day
Hours.
.....
.Minutes
Retired office worker
13 NAME OF
FATHER
Ephriam Human
FATHER (City)
not known
(State or country)
nova Scotia
15 MAIDEN NAME
OF MOTHER
mary redford
16 BIRTHPLACE OF
MOTHER (City)
not Manager
(State or country)
nova Scotia
0. manden -Relation, if any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burialfor transit pormit pas Issued: Walter Loader
10.
(Signature of
a free Board of Health or other
14/48
... (Official Designation) (Date of Issue of Permit)"
18 DATE OF
DEATH
Dec - 3-1948
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury /was involvedk state fully.) Hypertensie
Patate Cormary Sclerosis:
acute Cardiac Parlare -
20 Accident, sulolde, or homiolde (specify)
Date of ooourrente.
19
Where did
Injury ooour?
(City or town and State)
Did Injury oocur In or about home, on farm, In Industrial place, or In publio
place?
(Specify type of place)
Injury
Nature of
lodge vias
Injury
While at work ?.
.Was there an autopsy?
no
21 Was disease or Injury In any way related to ocoupation of deceased?
If so, specify.
(Signed)
M. D.
(Address)
Resta
KIRKE-3-
22
Mount Theatre, Waltham 24 ans
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Decenter: 4
1948.
23 NAME OF
FUNERAL DIRECTOR.
Hellian B. Leland
ADDRESS
592 Park ave Harerster Mars
Reoelved and filed
DEC 6 1948
19
(Registrar)
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
St.
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
1
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
3 SEX
4 COLOR OR RACEJ
7
temale
5ª If married, widowed, or divoroed
HUSBAND of
(or) WIFE of
7 IF STILLBORN, enter that faot here.
8
78.
AGE
Years
-
Months.
.Days
Usual
9 Occupation :
11 Soolal Security No ..
12 BIRTHPLACE (City)
Lynn
(Stste or country)
mass
14 BIRTHPLACE OF
PARENTS
17
Leslie
InformantaApanh.
Test Boylston Mais
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physiolans to Insert a recital to that effeot
extracts from the laws relative to the return of certificates of death.
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
Industry
10 or Business :
State House
50m-(i)-1-45-15510
.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registared hospital medloal officer shall forthwith, after the death of a person whom he has attendent during his last illness, at the request of an undertaker or other authorized person or of any nientber 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 laat illness, when last seen alive by the physician or officer and the date of hia death ... Gen. Lawa, Chap. 16, Sec. 9.
A physlelan or officer furnishing a certificate of death as required by the preceding section or by section forty-tive 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, invert In the certificate a recital to that effect, speci- fying the war, wud shall also certify lut such certificate both the primary and the aecondary or inunediate catise of death as nearly as be can atate the aante. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tlon and of aectiona forty five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall Inchide the China relief ex- pedition 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 Mexi- can border service of nineteen bundred aud aixteen and nineteen hundred and seventeen. G. L. Cbap. 46, Sec. 10.
No undertaker or other parson 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 haa received a permit froin the board of bealth, or ita agent appointed to issue auch 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 exiluine a liuman 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 be bas received a permit from the board of health or Ita agent aforesald or from the clerk of the town where the body is burled. No such permit shall be jasued until there ahall have been delivered to sucb board, agent or clerk, as the case may be, a satisfactory written atatenient containing the facts required by law to be returned and recorded, which shall be accompanied, In case of an original interment, by a aatisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate aa hereinafter provided. If there is no attending physician, or If, for sufficlent reasons, his certificate cannot be obtained early enough for the purpose, or Is Insufficleut, a pbysi- 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 ia causeil by vlolence, the medical examiner shall make such certificate. If auch a permit for the removal of a human body, not prevloualy Interred, froin one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and In the poa- seasion of the undertaker desiring to make such rentoval 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 re- moval, unless a permit In the usual form for the removal of auch body has been sooner obtained hereunder. If the death certificate contalus a recitai, aa required by section ten of chapter forty-wlx, that the deceased served in the army. navy or marine corps of the United States in any war in which
it has heen engaged, such recltal shall appear upon the permit. The board of health, or. its agent, upon receipt of such atatement and certificate, shatl forilwith countersign it aml transmit It to the clerk of the town for regis- tration. The person to whom the permit ia ao given and the physician cer- tifying 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 reglatrar may re- quire .- Chap. 114, Suc. 45, G. L., (Tercentenary Edition).
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 sucht permits, or if there Is no such board, from the clerk of the town where the boify is to be buried or the funeral ia to be held, or from a per- son appointed to have the care of the centetery or burial ground In which the intermeut is made. ... Cbap. 114, Sec. 46, G. L., (Terceutenary Edi- tion ).
Medical examinera shall make examination upon the view of the dead bodies of only such persong as are supposed to have died by violence. if a medical examiner has notice that there is within hia county the body of such a person, he shall forthwith go to the place where the body liea and take charge of the sunie; ... - General Laws, Chap. 38, Sec. 6.
. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Lawa, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the best of bis knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deaths only as those of persona to whom they have given bedside care during a fast illnesa from disease unrelated to any forin of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persona who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or wbose phyal- cian ia absent fromn hoine wlieu the certificate of death la needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably dua to Injury. . These include not only deatha caused directly or in- directly by trauinatism (including resulting septicemia), and by the action of clientical (druga or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from diseasa rasulting from Injury or Infection related to occupation, tha sudden deaths of persona not disabled by recognized diseasa, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examinera in certifying to a death wili state the cause and manner thereof, and wili specify: (1) Under cause, the nature of an injury and of ita consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example : "Com- pound fracture of tbe femur with ensuing aeptlcemla (gaa bacillua) caused by a steam railway accident." "Pistol slot wound of the cbest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, sulcidal." "Syncope while under the influence of ether adininlstered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unkuown."
If disease or injury was related to occupation, specify. If investigation sbowa the death to have been due to disease, specify: (1) Under cause its known or presumable nature; antl (2) uindler manner, indicate tbe circum- stances leading to medico-legal Inquiry. For example : "Hemorrhage spon- taneoua of the brain (basai ganglla) (found dead in bed)." "Heart disease, presumably coronary sclerosls. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-303-A + Suffolk. (County) Winthrop (City or Town) 194 Main St
The Commontoralth 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.
237
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 speolfy WAR)
19H main St.
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
( Specify whether)
years
months
days.
In this community
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
8
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER theroof are as follows : /(If an injury wie involved, state fully.) Arteriosclerotic heart disease
Fracture of spine
20 Acoldent. sulolde, or homiolde (specify)
Accident
Date of ooourrenoe
11-242048
Where did
Winthrop.
Injury ooour ?
(City or towy and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In publio
plaoo ?
At home
(Specify type of place)
Manner of
Injury
fell to floor
Nature of
Fracture
Injury
While at work?
.Was there an autopsy ?...
no
21 Was disease or Injury In any way related to ocoupation of deobased?
If so, speolfy.
(Signed). Breffalk Date 12.9 1948
(Address)
....
Holy Cross Cem- Walden -
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURI
Sat. Dec.
11-
19.48
23 NAME OF
John & Macdonald
FUNERAL DIRECTOR
ADDRES
537 Pleasant-ST-Maldin-
Received and filed DEC 1 7 1948 19
(Registrar)
50m-(i)-1-45-15510
PLACE OF DEATH
1
2 FULL NAME ...
(a) Residence. No.
3 SEX
4 COLOR OR RACE;
Female White
7 IF STILLBORN, enter that faot here."
8
90
AGE.
Years
v
Months ..
.Days
Usual
Retired -
9 Occupation :
11 Soolal Security No ....
14 BIRTHPLACE OF
(State or country)
PARENTS
(State or country)
If deceased was a U. S. War Veteran. G. L. Chap. 46, Seotion 10, requires physicians to Insert a reoltal to that effect
extracts from the laws relative to the return of certificates of death.
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
Industry
10 or Business :
AT Home.
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorood
HUSBAND of
(or) WIFE of
Bern Give maiden name evite in full
(Husband's name in full)
6 Age of husband or wife if allve years
If less than 1 day
Hours ............ Minutes
12 BIRTHPLACE (City)
(State or country)
Nova derna
Belliviste
13 NAME OF
FATHER
Seraphim Jacquard
FATHER (City)
france.
15 MAIDEN NAME
OF MOTHER
ME Madeleine Meuse.
16 BIRTHPLACE OF
MOTHER (City)
Nova Scotia
17 Demis A Clarins Relation, if any Informant, (delpes8) 257 Newhale at. Materia
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burlar or transit permit was Issued : Mattle A 1 alle
(Signature of Agent of Board of Health or other)
Health Aplicar 12/10/48
(Official Designation) (Date of Issue of Permit)
Claremont
No. Emily (If deceased is married, widowed or divorced woman, give also maiden name.) ..... St.
(If nonresident) give city or town and State)
20 yra.
PERSONAL AND STATISTICAL PARTICULARS
1948
M. D.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal offioer 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 persou or of any meniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the naine of the deceased, his supposed age, the disease of which he died, defined as required by section one, where samhe was contracted, the duration of his last illness, when last seen alive by the physiciau or officer aud the date of his death ... Gen. Laws, Chap. 16, Sec. 9.
A physleisn or officer furnishing a certificate of death as required by the preceding section or by section forty-tive of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, served in the ariny, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recita! 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 atate the same. For neglect to comply with any provislou of this section, such physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred sud fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eiglit aud July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nlueteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body lu a town, or remove therefrom a human body which has not heen buried, until he has received a permit froin 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 exiume 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 cenietery, until he has received a permit from the board of health or Ita agent aforessid or from the clerk of the town where the body Is buried. No such permit shall be iasued until there ahall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written atatement containing the facts required by law to he returned and recorded, which shall be accompanied, In case of an original internient, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate aa hereluafter provided. If there is no attending physician, or If, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or la 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 la caused by violence, the medical examniner shall make such certificate. If such a permit for the removal of a human body, not previously interred, froin one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to make such renioval shall constitute a perniit for such removal; provided, that suchi body shall be returned to the town from which It was removed within thirty-six hours after such re- moval, unlesa a permit in the ususl form for the removal of such body hes been soolrer obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-xix, that the deceased served in the army, navy or marine corps of the I'nited States in any war in which
It has been engaged, such recital shall appear upon the permit. The board of health, or. ils agent, upon receipt of such statement and certificate, shall forthiwith countersign It aml transmit It to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deccaaed, or as to the manter or cause of the death, which the clerk or reglatrar may rv- quire .- Chap. 114, Sec. 45, G. L., (Terceutensry Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought luto the commonwealth until he has re ceived a permit so to do front the board of health or its ageut appointed to issue suche permits, or If there is no such board, from the clerk of the town where the body is to be buried or the funeral ia to be held, or from a ver son appointed to have the care of the cemetery or burial ground iu which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Medical examincra shsll make examination upon the view of the dead bodies of ouly such persous as are supposed to have died by violence. If a medical examiner has notice that there is within hia county the body of such a person, he shall forthwithi go to the place where the body lies and take charge of the same ;...- General Laws, Chap. 3S, Sec. 6.
. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a descriptiou as full as may be, with the cause and manner of death .- General Lawa, Chap. 38, Sec. 7.
... The medical examiner certifles the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the obaervance 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 forin of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died witlivut recent medical attendance or whose phyel- ciau 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 in- directly hy traumatism ( including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deathis from disease resulting from Injury or Infection related to occupation, the sudden deaths of persona not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify : (1) Under cause, the nature of an injury and of ita consequences; and (2) under manner, the mode of ita production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicemia (gsa bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with 1800- ciated hemorrhage, homicidal." "Asphyxiation by suspension, sulcldal." "Syncope while under the influence of ether adininlstered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unkuown."
If disease or injury was related to occupation, specify. If investigation ahowa the death to have been due to disease, specify : (1) Under cause its known or preaumahle nature; anıl (2) uiler manner, indicate the circum- stances leading to medico-legal Inquiry. For example: "Hemorrhage spon- taneous 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
301 A
1
PLACE OF DEATH
Suffolk : (County) Winthrop (City or Town) 108 Tofts Que No. .
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.
233
St. Į (If death occurred in a hospital or institution ! I give its NAME instead of street and number) )
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(If nonresident, give city or town and State)
In this community
V
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed or divorced HUSBAND of
(or) WIFE of
Satruth
(Husband > name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
&G AGE 73 Years
Months Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
housework
Industry
10 or Business:
at home
11 Social Security No.
none
Charlestown
mans
13 NAME OF
FATHER
andrew ) West
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
unknown
15 MAIDEN NAME
OF MOTHER
Many S Mickel
16 BIRTHPLACE OF
MOTHER (City). .
(State or Country)
valknown
17 min Roth Common Bailey (Address) 10% Tapt aux
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed
with me BEFORE the burial oftransit permit was issued:
Walter A Jakert
(Signature of Agent of Board of Health or other)
Healthe officer
12/9/48
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December
(Month)
(Day) /
1948
(Ycar)
19 48
I HEREBY CERTIFY,
That I attended deceased from
December 2, 1948, to December 8, 1948
I last saw her
alive on
December 8, 1948, death is said to
have occurred on the date stated above, at 12:20 p. m. Immediate cause of death.
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