USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 46
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HUSBAND of ..
Charles
Coin maiden Come of Quiper
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGE Years
Months
Days
If under 24 hours
Hours .. .. Minutes
13 Usual
Occupation :
Thome wife (Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No. nova Sutia
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Tough maclean
18 BIRTHPLACE OF FATHER (City) (State or country)
Nova Scotia
19 MAIDEN NAME OF MOTHER
Ann Angeh
20 BIRTHPLACE OF Mana Scotia MOTHER (City) . (State or country)) Charles & Cooper 22 Ballett 99 inchof
21 Informant (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Baker (Signature of Agent of Board of Health or other)
Healthe prices "Official Designation)
9/30/40
(Date of Issue of Permit)
100M-(D)-10-46-24656
DATE OF BURIAL.
19
7 NAME OF
FUNERAL DIRECTOR Manque Manly
ADDRESS Кешемор
Received and filed SEP 3 0 1949
19
(Registrar)
27 1449 (Year)
(Day)'
4 I HEREBY CERTIFY,
That I attended deceased from
9-14- 19
49
...
to
9-27
19
49
I last saw heen alive on
9-27-
.. 194.9., death is said to
12:45Pm.
have occurred on the date stated above, at INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)
Chra myocardetas.
ANTE
Due To
artenos dennis
CEDENT (b)
CAUSES
Due To Diabetes mellitus
(c)
OTHER
SIGNIFICANT
CONDITIONS
Branches Premania
Major findings:
Of operations.
Date of operation.
.Was autopsy performed?
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? ?
If so, specify .... .
(Signed)
a.n. Caplan
M. D.
(Address) 186 Princeton St. E.S. Date 9-29
1999
No. .
2 FULL NAME ..
Muchas Com those. Florence a Cooper (If deceased is a married, widowed or divorced woman, give arso maiden name.) 22 Bartlett
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death ... years months
14 days.
In place of residence
9 COLOR OR RACE
3 DATE OF
DEATH
Sept (Month)
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- ne death but not the disease or causing death.
PARENTS
Place of Burial of Cremation Selx 30
(or) WIFE of
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 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 shallexhume 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 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 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
RM R-301 A
5
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.
1 Suffolk (LA (y)
Winthrop (City or Towr/ 209 Somerset ave No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Bal
To be filed for burial permit with Board of Health or its Agent.
Registered No. .
149
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)
no
(If nonresident, give city or town and State)
In this community
6
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE White
5 SINGLE (write the word) MARRIED WIDOWED Married
5a 'If married, widowed or divorced HUSBAND of .
anna
Jane
(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
62
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual 9 Occupation:
Retired Fireman
Industry 10 or Business:
Boston Fire Dept
11 Social Security No. 015-20-2244
12 BIRTHPLACE (City). (State or Country) Boston
mass
13 NAME OF
FATHER
John J. Marshall
PARENTS
15 MAIDEN NAME
OF MOTHER
Mary Josephs
16 BIRTHPLACE OF MOTHER (City) (State or Country)
Prostindetoren
17 Informant (Address'
209 towersel ave
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
. Kal (Signature of Agent of Board of Health or other) Healthe Officer 10/2/49
(Official Designation) (Date of Issue of Permit)
18 DATE OF DEATH Left.
(Month)
30 (Day)
1949 ( Ycar)
I HEREBY CERTIFY,
Left 25.
69.
7. to
19
That I attended deceased from
Left. 30
.
19
I last saw h
En alive on
Left 30
19
/. death is said to
have occurred on the date stated above, at
Immediate cause of death
Cerebral formanhose
Due to artemonlerois
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Fred ofegen.
(Address) 670 Saratoga 95
Date 9/38
. M. D. 1944
21
Winthrop
winthrop
DATE OF BURIAL Oct
3
19
49
22 NAME OF
FUNERAL DIRECTOR
Charles H . Treanor
ADDRESS East Boston 19
Received and Filed
OCT 4
1949
(Registrar)
Duration IMPORTANT 5 Days 2 years
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically,
anna Marshall Relationif any ) Place of Burial, mation or Removal. City or Town)
100M-7-46-19068
PLACE OF DEATH
2 FULL NAME
Joseph Jesse Marshall (If deceased is a married, widowed or divorced woman( giye also maiden name.) 209 tomersch are St.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution (Before death)
(Specify whether)
years
months
days.
MEDICAL CERTIFICATE OF DEATH
104 m.
14 BIRTHPLACE OF FATHER (Cit). (State or Country)
azores
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF
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 helief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired hy 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 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 hody 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 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 hy violence. If a medical examiner has notice that there is within his 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 hury 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 hoard, from the clerk of the town where the body is to he 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 forin of injury, have died without recent medical attendance or whose phy- sician is ahsent 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 hy 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
NONRESIDENT
BIRTH NO. STATE OF
(1949 Revision of Standard Certificate) CERTIFICATE OF DEATH MAINE
Form approved. Budget Bureau No. 68-R375. 150
STATE FILE NO.
1. PLACE OF DEATH
a. COUNTY
PENOBSCOT
b. COUNTY
2. USUAL RESIDENCE (Where deceased lived. If inasgation: residence before
a. STATE -
prase
b. CITY (If outside corporate limita, write RURAL and give
OR
TOWN
township)
c. LENGTH OF
STAY (in this place)
c. CITY (If outside corporate limita, write RURAL and give tovesbio)
OR
TOWN
Winthrop
d. FULL NAME OF (If not in hospital or institution, give street address or location)
HOSPITAL OR-
STITU
N Home Priv. Hock.
d. STREET
ADDRESS
(If rural, give location)
3. NAME OF
DECEASED
( Type or Print )
a. (First)
Vesa
b. (Middk)
c. (Last)
Small Silva
(Month)
(Day)
(Year)
5. SEX
6. COLOR OR RACE 20
7. MARRIED, NEVER MARRIED.
WIDOWED, DIVORCED (Specify)
8. DATE OF BIRTH
Lung. 14, 1904
1/44
9. AGE (In CATS| IF UNDER | YEAR |"IF UNDER 2 HRS. last birthday) Months | Days Hours Min.
10a. USUAL OCCUPATION (Give kind of work done duting most of working life, even if rotired)
10b. KIND OF BUSINESS OR IN-
DUSTRY
11. BIRTHPLACE (State or foreign country)
Old Town Maine
12. CITIZEN OF WHAT
COUNTRY?
Z. S. a.
Honcewife 13. FATHER'S NAME Harry Wilder Small 15. WAS DECEASED EVER IN U.S. ARMED FORCES? | 16. SOCIAL SECURITY (Yes. no. or unknown) (If yes, give war or date= o'scrvice!
14. MOTHER'S MAIDEN NAME
Mande Duplasa
17. INFORMANT 005-22-4208 Nurse. Mand Campbell
18. CAUSE OF DEATH Enter only one cause per line for (a), (b), and (c)
DIRECTLY LEADING TO DEATH* a Essential hypertension.l
ANTECEDENT CAUSES
Morbid conditions, if any, giving DUE TO (b) rise to the above cause (a) stating the underlying cause last.
DUE TO (c)
II. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition causing death.
19a. DATE OF OPERA- TION
19b. MAJOR FINDINGS OF OPERATION
20. AUTOPSY?
YES
NO
21a. ACCIDENT
SUICIDE
HOMICIDE
(Specify)
21b. PLACE OF INJURY (e.g., in or about home, farm, factory, street, office bldg., etc.)
21c. (CITY. TOWN. OR TOWNSHIP)
(COUNTY)
(STATE)
21d. TIME
OF
INJURY
(Month) (Day) (Year)
(Hour)
m.
AT WORK
22. I hereby certify that I attended the deceased from
alive on
19_
-, and that death occurred at
19 , to , 19 ___ , that I last saw the deceased m., from the causes and on the date stated above.
23a. SIGNATURE Tonie I Thenault m.D.
(Degree or title)
23b. ADDRESS
Old Town maine
23c. DATE SIGNED June 29,194 (State)
24a. BURIAL, CREMA- TION REMOVAL (Specib) Durial
24b. DATE 24c. NAME OF CEMETERY OR CREMATORY July 1, 1949 Forest Hill
24d. LOCATION (City, town, or county)
Old Town Tenodacot me.
-
DATE REC'D BY LOCAL June 30 19409
REGISTRAR'S SIGNATURE
25. FUNERAL DIRECTOR
ADDRESS
Cierett V. Healey Old Town Juvel
PHS-798(VS) REV. 4-48 FEDERAL SECURITY AGENCY PUBLIC HEALTH SERVICE
U. S. GOVERNMENT PRINTING OFFICE 16-55457-2
OCT 14 1949
=
INTERVAL BETWEEN ONSET AND DEATH
Cerchiale hemorrhage,
*This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the dis- ease, injury, or complica- tion which caused death.
1. DISEASE OR CONDITION
MEDICAL CERTIFICATION
1
21e. INJURY OCCURRED
WHILE AT
WORK
NOT WHILE
21f. HOW DID INJURY OCCUR?
ad.vissigen.
Suffolk
4. DATE
OF
DEATH
June 29 1949
REC .. Y
F
OCT1418 14
CIDEVLI
1
PLACE OF DEATH
Suffolk (County)
Revere
(City or Town)
Resthaven
·
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Permelia C. Hatch
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