USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 55
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U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
No.
M R-301A
PLACE OF DEATH
Winthrop ~ (County)
Suffolk
(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:
130
No.
198 Cottage Park Road
j(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
2 FULL NAME ..
Herbert Clayton Dow
(If deceased is a married, widowed or divorced woman, give also maiden name.)
198 Cottage Park Road
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. years. . months days. In place of residence35
.. years
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
nov.
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
1947 to nov. 5 1949
I last saw h .W.www. .. alive on
nov. 4
1949. death is said to
have occurred on the date stated above, at
.. m.
INTERVAL BE- TWEEN ONSET ANO DEATH
11 IF STILLBORN. enter that fact here.
12
AGE
Years
68 8
Months
7
Days
Hours
Minutes
13 Usual
Occupation :
Haberdasher
(Kind of work done during most of working life)
14 Industry
or Business:
Store
15 Social Security No ..
010-03-1878
16 BIRTHPLACE (City) Albany (State or country) Vermont
17 NAME OF FATHER Alfred Dow
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER
May Coonerty
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Vermont
21 Rosamond E Dow
Informant
198 Cottage Park Rd. Winthro
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Natur A. Making (Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit) 1/2/49
RUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease. ications which ath.
id conditions. ring rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
100M.(D)-10-48-24656
6 Winthrop Place of Burial or Cremation
Winthrop
(City or Town)
DATE OF BURIAL ..
Nov. 7
,49
7 NAME OF FUNERAL DIRECTOR Seward SParnoldo
ADDRESS Winthrop muss.
Received and filed NOV 8 1940
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male White
9 COLOR OR RACE
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
10a If married, widowed, or divorced
HUSBAND of
Rosamond Benner
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Chronic Miocardio
ANTE CEDENT (b) CAUSES
Due To Chronic
3 0.
Due To (c) ..
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed? no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ....
(Signed) .
(Address) 175 Rieusement 5
turis 7 Savino
M. D.
Date nev.6
49
If under 24 hours
3 400
144
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. ( if so specify WAR)
(a) Residence. No. (Usual place of abode)
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 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 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 of 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-302 -
PLACE OF DEATH
SUFFOLK
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON ..... (City or town making return)
Registered No.
94.65131
No.
Palma ...... Mom Hosp ( N E D H)
· J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME Mary Terry (If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. 138 Bowdoin
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.... years ..
.months.
2.
days. In place of residence.
3.5.years.
.. months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Noy 9 1949
(Month)
(Day)
(Year)
8 SEX
female
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED-
(write the word)
widowed
4 I HEREBY CERTIFY,
That I attended deceased from
Nov .... 8. 19 ... 4.9 ...
to.
NOT 9
19.
49
I last saw h ............ alive on ..
NOT 9
. 194.9 ... , death is said to
have occurred on the date stated above, at
7:35 Pm.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)Aout ....... coronary ..... thrombosis
2das
Due To
CEDENT (b) Arteriesalerotic heart
dises
2yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Diabetes mellitus
4yrs
Major findings:
Of operations.
Date of operation
. Was autopsy performed ?.... MO
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?.... AQ. If so, specify ...
(Signed)
C C Bailey
M. D.
(Address)
Brookline
Date
11/9
19.49
6
.Winthrop ... Com
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Nov 12 1949
19
7 NAME OF
FUNERAL DIRECTOR
T F Foley
ADDRESS
Dorchester
Received and filed.
NOV 2.5-1949
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country) Ireland
19 MAIDEN NAME
OF MOTHER
Mary Joy co
20 BIRTHPLACE OF
MOTHER (City)
(State or country) Ireland
21
Informant
Walter J Terry (son)
(Address)
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred) Nov 14 1949
DATE FILED
.19
L
ANTE Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time 50m-(e)-10-48-24658 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
11 IF STILLBORN, enter that fact here.
12
AGE ... 66 Years.
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At home
15 Social Security No ....
... Rane
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
John Gavin
Winthrop
Winthrop
(Usual place of abode)
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Walter J Torry
(Husband's name in full)
١ ك
.
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.
182
No.
15.Wilshire Street ... Winthrop.
.
j (If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran, if so specify WAR) Spanish American
(a) Residence. No. (Usual place of abode)
15. Wilshire Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death 22 years. months days. In place of residence
22 years
months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX male white
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
4 I HEREBY CERTIFY,
That I
attended deceased from
UN. 19 38 ... to 11- 10 1949
I last saw h. W. alive on 11-10 .... 19 49, death is said to
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET AND DEATH
2 hrs.
12
AGE
79Years
11
Months
15 Days
If under 24 hours
Hours .. ... Minutes
ANTE
Due To
Hypertensive heart
CEDENT (b)
CAUSES
disease.
2 yrs.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
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,
Michaud Litriche
(Signed)
M. D
(Address) 640 Boulevard De Date.
11-12 1949
6 HolyCross
Place of Burial or Cremation (City of Town)
DATE OF BURIAL .. November ..... 14 1949
7 NAME OF FUNERAL DIRECTOR Richard C. Kirby
ADDRESS East Boston Mass
Received and filed NOV 1 4 1949 : 19
(Signature of Agent of Board of Health or other)
Health Officer (Official Designation)
(Date of Issue of Permit) 18/12/49
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease. ications which th.
id conditions. ing rise to the se (a) staling rlying cause
itions contrib -- e death but not the disease or causing death.
PARENTS
18 BIRTHPLACE OF
Wales
FATHER (City) (State or country) England
19 MAIDEN NAME
OF MOTHER
Ellen Cannon
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
Mrs. Mary E. Gray wife
21 Informant (Address) 15 Wilshire St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was Med with me BEFORE the burial or transit permit was issued: Walter & Bakes &
...
(Registrar)
10a If married, widowed, or divorced HUSBAND of .. Mary E, Grady.
(Give maiden nante of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
13 Usual
Occupation :
Master Mariner (Retired).
(Kind of work done during most of working life)
14 Industry or Business: Ferry Dept. ...... City ... of Boston
15 Social Security No ... ..
none.
East Boston
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF FATHER John Gray
100M-(D)-10-48-24656
M R-301A 1
2 FULL NAME ..
Edward R. Gray (If deceased is a married, widowed or divorced woman, give also maiden name.)
49 (Year)
3 DATE OF
DEATH
11
10
(Month) (Day)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cormary Therating
:9.30
' m.
.Malden
Registered No.
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
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