USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 2
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CEDENT (b) Major findings: Of operations. 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 OTHER SIGNIFICANT CONDITIONS after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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
Accident
ANTE
Due To
Jan. 8,
50
Saugus, Mass.
Due To
(c)
Date of operation.
Was autopsy performed?
What test confirmed diagnosis?
No
LERESTELEDINf face.
Abrasion
TO DEATH La right mee.
I last saw h alive op. 19 death is said to
Fracture of skull with assoc have occurred on the date stated above, at m. INTERVAL BE-
DISEASE OR CONDITION .
Contusion of
TWEEN ONSET
AND DEATH
of
PLACE OF DEATH
ORM R-302 1
Registered No.
No. Lynn Hospital
25 minutes
ATTEST:
150
Portland
NECKINN ?
FEB -* 1950 AM
1
PLACE OF DEATH
Suffolk' (County)
Winthrop (City or Town) No. 157 Grovers Ave. James Clayton Ray
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
157 Grovers
Ave .
St.
(If nonresident, give city or town and State)
Length of stay: In place of death 20
years .months. days. In place of residence .years. .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
That I attended deceased from
26 Sept
19
49
to
8 January
1950
10a If married, widowed, or divorced
HUSBAND of
Anna R Kelleher
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
62
· AGE
Years
3
Months
6
Days
If under 24 hours
Hours .. . Minutes
13 Usual
Occupation :.
Retired
(Kind of work done during most of working life)
14 Industry
or Business:
Draftsman
15 Social Security No.
015-09-3052
16 BIRTHPLACE (City)
(State or country)
Penn.
17 NAME OF
FATHER
James W ray
18 BIRTHPLACE OF
FATHER (City) White Haven
(State or country)
Penn.
19 MAIDEN NAME
OF MOTHER
Koontz
20 BIRTHPLACE OF MOTHER (City) White Haven
(State or country)
Penn.
21 Informant Anna R Ray (Address) 157 Grovers Ave. Winthrop,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial on transit permit was issued: Walter A. Makers. (Signature of Agent of Board of Health or other) !
Heatthe Office (Official Designation)
(Date of Issue of Permit)
1/ 10 /50
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean de of dying, such failure, asthenia. means the disease. plications which death.
orbid conditions, giving rise to the ause (a) staling derlying cause
nditions contrib- the death but not to the disease or n causing death.
100M-(D)-10-48-24688
Received and filed.
19
JAN 11 1950
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?. .
If so, specify
h 7 Victims
(Signed)
M. D.
(Address)
Winthrop
6
Place of Burial or Cremation
Jan.
11
1950
7 NAME OF
FUNERAL DIRECTORY
Howard Spurnull
ADDRESS Winthrop muss
(City or Town)
DATE OF BURIAL.
Date 9 Jan 1950
Winthrop
White Haven
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Canfeel of Esophagus
Date of operation Oct 1949 Was autopsy performed? no
Metastatic Facts AND DEATH
TO DEATH
Cayunning of State
Intesting
Due To
ANTE CEDENT (b) CAUSES
Due To
(c)
.alive on
1949
leath is said to
have occurred on the date stated above, at 8.32A m. INTERVAL BE- TWEEN ONSET
DISEASE OR CONDITION
DIRECTLY LEADING
Januar 8 1950 (Year)
3 DATE OF
DEATH
(Month)
(Day)
PHYSICIAN - IMPORTANT
-
1
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
I last saw him
28
20
To be filed for burial permit with Board of Health or its Agent.
RM R-301A 1
What test confirmed diagnosis?
Binjegy
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 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
+
PLACE OF DEATH
auffach County
(City of Towns
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
5
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME ..
(If deceased is a Tharried, widowed of divor ed woman, give also maiden name.) 27 Belcher AV
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years ..
months. .days. In place of residence
€ 35 years
months
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
11
1950
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Halled
4 I HEREBY CERTIFY,
That I attended deceased from
1050
I last saw h
.. alive on
have occurred on the date stated above, at 12. 30A m.
INTERVAL BE- TWEEN ONSET AND DEATH
1950
12 AGE 71 Years
Months Days
If under 24 hours Hours . . Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
US Post Office
15 Social Security No.
16 BIRTHPLACE (City) (State or country)
Cast Boston
17 NAME OF FATHER
Manuel quistad
18 BIRTHPLACE OF FATHER (City) (State or country)
Irland.
19 MAIDEN NAME OF MOTHER Margaret Trainor
20 BIRTHPLACE OF MOTHER (City) (State or country)
Inland.
Muss how Honestalt
21 Informant (Address) 24 Belcher fo
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(alter I Balper. (Signature of Agent of Board of Health or other) ʻ Healtre Aplicar
(Official Designation) (Date of Issue of Permit)
1/13,50
1
Received and filed JAN 16 1950
19
(Registrar)
1948
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings: Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
E.C.G.
5 Was disease or injury in any way related to occupation of deceased ?...... If so, specify Linde Gately (Signed) (Address) (24) Brand no Date 1-11
M. D.
1950
6 Piece of Burial or Cremation
DATE OF BURIAL Un/ 14
7 NAME OF FUNERAL DIRECTOR, Ss 210 Functions OF
Fowysy
5
50M-2-19-25666
ORM R-301A 1
INSTRUCTIONS FOR DICAL CERTIFICATE In giving USE OF DEATH do not enter nore than one ause for each (a), (b) and (c)
This does not mean node of dying, such art failure, asthenia, It means the disease, omplications which d death.
Morbid conditions. y, giving rise to the cause (a) stating underlying cause
Conditions contrib- to the death but not i to the disease or tion causing death.
No. ..
Yahu Harristall
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence/ No. (Usual place of abode)
50
to Jam 11
HUSBAND of. Marie Kinley
(give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary Thrombosis
ANTE CEDENT (b) CAUSES
Due To arteriosclerosis
Letter Carrier
Hoeman
V
PARENTS
50 death is said to
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 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 persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. . - General Laws, Chap 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
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 deathsonly 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 occup :- 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
×
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No.
11 Court Rd.
[(If death occurred in a hospital or institution. St. ¿ give its NAME instead of street and number)
2 FULL NAME. George William Ray (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
Noll Court Rd. (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. 3.5 years .months. days. In place of residence .years .months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January
11
1950
(Year)
(Month)
(Day)
That I attended deceased from
19
I last saw h -
.alive on.
19 ....... , death is said to
have occurred on the date stated above, at
6:45 P.
m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
10
TO DEATH (a)
Natural Causes
ANTE
Due To
CEDENT (b)
CAUSES
Presumably
Due To
(c)
Coronary Occlusion
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed? no
What test confirmed diagnosis?
clinica
5 Was disease or injury in any way related to occupation of deceased? MO If so, specify foarte Health M. D. (Signed) Ca > Mutan Bad Date 12/Jan 1950
6 Woodlawn
Everett
Place of Burial or Cremation
U
(City or Town)
DATE OF BURIAL.
Jan
13
1950
7 NAME OF
FUNERAL DIRECTOR
Winthrop mars
Received and filed ..
JAN 13 1950
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED Married
10a If married, widowed, or divorced
HUSBAND of
Florence DeMott
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 7.8 Years 1
Months
19 Days
If under 24 hours
Hours .. . Minutes
13 Usual
Occupation :
Salesman
Retired
(Kind of work done during most of working life)
14 Industry
or Business :.
Hardware
15 Social Security No.
023-20-3607
16 BIRTHPLACE (City)
(State or country)
Mass.
Boston
17 NAME OF
FATHER
William Ray
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Elizabeth Acheson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Florence Ray
Informant (Address) 11 Court Rd. Winthrop, Mass
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