USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 36
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8
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:
Own Home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
OTHER SIGNIFICANT CONDITIONS
Hypertensive fartEro - Sclerotic Heart Disease
3 years
Major findings:
Of operations ..
Carcinoma of Urinary Bladder
Date of operation Oppil&, 1950 Was autopsy performed!
What test confirmed diagnosis Clinical+ Laboratory
Ko.
5 Was disease or injury in any way related to occupation of deceased? If sc (Sign
M. D.
9 50
Winthrop
6 Winthrop Place of Burial or Cremation
(City or Town)
DATE OF BURIAL .
July 5 1950
7 NAME OF
FUNERAL DIRECTOR.
Favara S Bynolds
ADDRESS Winthrop mais.
Received and filed
19
JUL 1 0 1950
(Registrar)
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Female White
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William J Howard
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a)
Carcinoma of the
Urinary Bladder
ANTE Due To
CEDENT (5) CAUSES
Due To (c) .
PARENTS
17 NAME OF
FATHER
John McAskill
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Margaret Barclay
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
Janet Howard
21
Informant
(Address)
19 Moore Street Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjal or transit permit was issued: Walter J. Balaye Signature of Agent of Board of Healthfor other)
Health Officer /(Official Designation) (Date of Issue of Permit) 7/5/50
NSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter ore than one use for each (a), (b) and (c)
This does not mean ode of dying, such ri failure, asthenia, I means the disease, mplications which death.
forbid conditions, . giving rise to the cause (a) stating underlying cause
Conditions contrib- to the death but not I to the disease or ion causing death.
'50M (B)-12-49-900722
RM R-301A 1
No. .
·
[(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)
(a) Residence. No. (Usual place of abode)
35
Widowed
That I attended deceaserl from
ilyawicz Transfer 562 Shirley St. Wint of bare July 3
Ko.
AGE
. Years
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 inme- 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. antil 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 cen:etery, 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 hody 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 ariny, 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 inay 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 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 dore 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-303-A
PLACE OF DEATH
SuelliCk 1 (County)
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agent.
111
Registered No.
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)
no
(a) Residence. No.
Length of stay : In hospital or Institution
( Before death)
( Specify whether)
yeara
months
days.
In this community
TTO.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE|
Male White
5 SINGLE
MARRIED
WIDOWED
(write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband'e name in full)
6 Age of husband or wife If allve
years
7 IF STILLBORN, enter that fact here.
8
63
Years
Months
Days
If less than 1 day
Hours
Minutes
Saborer.
11 Soolal Security No .. none
12 BIRTHPLACE (City)
(State or country)
maryland
13 NAME OF FATHER Samuel Rielander
14 BIRTHPLACE OF
FATHER (City)
new york
(State or country)
new york
15 MAIDEN NAME
OF MOTHER
Laura Petti
16 BIRTHPLACE OF
Baltimore
MOTHER (City)
(State or country)
maryland
17 Board of Welfare
50m. (i)-1-45-15510
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with ph BEFORE the Surlat of trapalt permit was Issued : Taller talelse
Signature of Agent of Board of Health or other)
7/5 /50
/(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July - 3 -
1950
(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: (Hf an injury was involved, state fully.) Cecule Cardiac failure) A Paralos Coronary Sclerosis
20 Accident, sulcide, or homlolde (specify)
Date of ooourrence.
19
Where did Injury oogur?
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or in publio
place ?
(Specify type of place)
Injury
fund collared in street.
Injury
" dead on arrival at hospital
While at work?
Was there an autopsy ?! wo
21 Was disease or Injury In any way rejated to ocoupation of deceased ?
If so, specify
Hat Tucklen
M. D.
(Signed)
Jaobra - 3 - 2050
(Address)
22
Winthrop
Place of Burial, Cremationo
Remoyst.
Winthrop (City or Town)
150
23 NAME OF
FUNERAL DIRECTOR
ADDRESS
147 Wanthing St Hanthay
Received and filled.
.....
JUL 1-0 1950
... 19.
(Registrar)
×
(City or Town)
No. eu write to Nathrop Community Hospital Frederick Rielander
2 FULL NAME
(If deceased ie a married, widowed or divorced woman, give also maiden name.) 12 Prace ave-92, Shades OF Birthrop (Usual place of abode)
(If nonresident, give city or town and State)
Relation, if any
DATE OF BURIAL
2
1 3 SEX (or) WIFE of AGE. Usual 9 Occupation : PARENTS Informant. ( Address) so that it may be properly classified under the International Classification of Causes of Death. See reverse side for should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physiolans to Insert a reoltal to that effeot extracts from the laws relative to the return of certificates of death. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information Industry 10 or Business :
5
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal offiosr 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 kuowledge and bellef the name of the deceased, his supposed age, the disease of which he diel, defined as required by section oue, where same wss contracted, the duration of his laat Illness, when last seen alive by the physiciau or officer and the date of his death ... Gen. Laws, Chap. 16, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-tive of chapter one hundred and four- teeu, 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 iunnediate cause of death as nearly as he can atate the same. For neglect to comply with any provislou of thia section, such physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-fve, forty-six and forty-seven of said chapter one hunilred aud fourteen, the word "war" shall inchide the China relief ex- pedition and the l'hilippine 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, sud the Mexi- can border service of nineteen hundred and aixteen and niueteen 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 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 exilume a liuman hody 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 asme cenietery, until he has received a permit from the board of health or Its agent aforesald or frou the clerk of the town where the body Is burled. 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 accoinpanled, In case of an original internrent, 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 sufliclent reasons, his certificste cannot be obtained early enough for the purpose, or is Insufficient, a physi- cian who is s member of the board of health, or employed by it or by the aelectmen for the purpose, shall upon application make the certificate re- quired 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 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 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 re- moval, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate containa a recital, as 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 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 trausmit It to the clerk of the town for regis- trution. The person to whom the permit Is so given and the physician cer tifying the cause of death shall thereafter furnish for registration suy 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 ro quire .- Chap. 114, Sec. 45, G. L., ('Tercentenary Edition).
No undertaker or other person shall bury & human body or the ashes thereof which have been brought Into the commonwealth until he has re ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the boily is to be buried or the funeral is to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Terceutenary Edi- tion ).
Medical exsminera 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 hia 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.
... 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 Laws, Chap. 38, Sec. 7.
... The medical examiner certifies 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 observance of the following rulea 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 illnesa from disease unrelated to any forin of injury.
(2) Board of Health physiolans 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 whose phyaf- cian 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 by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortiou, but also deaths from diseasa resulting from Injury or Infeotion related to occupation, ths sudden deaths of persons not disabled by recognized diseass, 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 apecify : (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com. pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, hoinicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether adininstered as a surgical anaesthetic." "Fracture of the skull with aasociated internal injury sus- tained under circuinstsuces unkuown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; anıl (2) under 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
PLACE OF DEATH
Suffolk : (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
112
52 Thornton Park No.
(If death occurred in a hospital or institution, . St. [ give its NAME instead of street and number)
Annie May (Rogers) Cushman 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 52 Thornton Park (Usual place of abode)
St. .
(If nonresident, give city or town and State)
Length of stay: In place of death 30 years .. months. days. In place of residence
30 years months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
That I attended deceased from
Oct- 26, 1949 to
50
I last saw her alive on ..
July 3 1, 1950, death is said to
(or) WIFE of
Leonard Cushmen
(Husband's name in full)
11 IF STILLBOR.V. enter that fact here.
Years
12
AGE56
11
Months
13ays
If under 24 hours
Hours
.. Minutes
.
13 Usual
Housewife
Occupation :.
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No. None
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF FATHER James D Rogers
18 BIRTHPLACE OF
FATHER (City)
Freeport
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Mary L Greenleaf
20 BIRTHPLACE OF
MOTHER (City)
Portland
(State or country)
Maine
21 Informant (Address) 52 Thornton Park Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter A. Makelig. (Signature of Agent of Board of Health or other) lealtre Niech 7/6/50
Received and filed JUL 1 0 1950
19
(Registrar)
PARENTS
6 Mt Auburn /
Place of Burial or Cremation
Cambridge
(City or Town)
DATE OF BURIAL .....
July .. 8
19 50
7 NAME OF
FUNERAL DIRECTOR.
Howard SO Fuynolds
ADDRESS Winthiof mass
,50M (B)-12-49-900722
RM R-301A 1
NSTRUCTIONS FOR CAL CERTIFICATE
In giving SE OF DEATH lo not enter ore than one use for each a), (b) and (c)
This does not mean ode of dying, such rt failure, asthenia. . means the disease, implications which death.
forbid conditions. , giving rise to the cause (a) stating underlying cause
onditions contrib- o the death but not to the disease or ion causing death.
OTHER
SIGNIFICANT
none
CONDITIONS
IL Ch with
Major findings:
Of operations carcinoma o acaer metastaire
Date of operation 13 001. 49, Was autopsy performed? .no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? no
If so, specify.
(Signed)
(Address). Vindarof Mass Date July 6
1950
M. D.
Due To (c)
Due To Carcinoma of blackder
ANTE CEDENT (b) CAUSES
luis (Month)
5 1950 (Year)
(Day)
Female
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