USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 4
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A
ANTE Due To
CEDENT (b) CAUSES
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, specify (Signed) (Address) A Date 1-19-519.
PARENTS
21 Informant Richard ............. Hoawrd .... son
(Address) 65 Beal Street Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
alite At. 19 aring. (Signature of Agent of Board of Health or other). /
6. 20,50
STRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH
not enter re than one se for each ), (b) and (c)
is does not mean le of dying, such failure, asthenia, neans the disease. plications which death.
rbid conditions. giving rise to the use (a) stating derlying cause
tditions contrib- the death but not o the disease or n causing death.
100M-(D)-10-48-24656
3 DATE OF DEATH
January CM (Month)
(Day)
18 1950 (Year)
9 COLOR OR RACE
(write the word)
10a If married, widowed, or divorced
HUSBAND of.
Sarah. M.
Robicheau
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEAL
Clarhouse 1 ba
TO DEATH (a)
Chiahaving et deine 1 1949
6.30 A
m.
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR) no
Length of stay: In place of death
DE years .. 2 months. - days. In place of residence 5.0cars
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-301A 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
Registered No.
20
No. Winthrop Nursing Home Warren Wellington Noyes
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 77 Bowdoin Street
(a) Residence. No.
(Usual place of abode)
St. (If nonresident, give city or town and State)
Length of stay: In place of death .years. months. 14days. In place of residence 40 years
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
White
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Wid /
4 I HEREBY CERTIFY.
That I
attended deceased from
19.
50
10a If married, widowed, or divorced
HUSBAND of ..
Mary A Norse
(Give maiden name of wife in full)
have occurred on the date stated above, at
8.10 a.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
, AGE
.7 1Years
Months
Days
If under 24 hours
Hours .. ...
Minutes
13 Usual
Occupation:
Barber
(Kind of work done during most of working life)
14 Industry
or Business:
Own shop
15 Social Security No.
None
Lincoln
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
William E Noyes
18 BIRTHPLACE OF
FATHER (City)
Grey
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Margaret A Gerry
20 BIRTHPLACE OF
MOTHER (City)
Patten
(State or country)
Maine
21
William Noyes
Informant
(Address)
36 North Ave. Winthrop, &
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter & aelig- (Signature of Agent of Board of Health or other)
Health Applicer 1/24/50
(Official Designation)
(Date of Issue of Permit)
X
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Jau.
(Month)
(Day)
1950
(Year)
Dec. 15-
1979
to Jam
22
I last saw him alive on
Dan.
21
19.50, death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cerebral Hemorrhage 38 days
ANTE CEDENT (b) CAUSES
Due
To generalized arteriosclerosis
Due To (c)
OTHER
Gangrene fright foot.
CONDITIONS
about 14 days
Major findings:
Of operations.
none
Date of operation.
Was autopsy performed?
200
What test confirmed diagnosis ?.
clinical"
5 Was disease or injury in any way related to occupation of deceased? To
(Signed)
julie w, aubusson
M. D.
(Address) Winthrop mars
Date Jaw. 2.3 1950
6
Lincoln
Lincoln Me.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Jan. 25
150
7 NAME OF
FUNERAL DIRECTOR.
ADDRESS Winthrop muss
Received and filed. 19
JAN .2.5 1950
(Registrar)
PARENTS
100M-(D)-10-48-24858
ISTRUCTIONS FOR CAL CERTIFICATE
In giving SE OF DEATH o not enter ore than one use for each ), (b) and (c)
his does not mean de of dying, such I failure, asthenia. means the disease, plications which death.
orbid conditions, giving rise to the ause (a) stating derlying cause
nditions contrib- - the death but not to the disease or on causing death.
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME ..
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
.months.
days.
(write the word)
22
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
Every item of
N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD.
of Death. See reverse side for extracts from the laws relative to the return of certificetes of death. DEATH In plain terms, so that It may be properly classified under the International Classification of Causes If deceased was a U. S. Waf Veteran, G.L. Chap,46, Section 10, requires physicians to insert a recital to that effect. Body at north chanque Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF Nat
50m-(g)-10-48-24658
PLACE OF DEATH
+ Sellilk (County) Winthrop. (City or Town) Fort Banks
The Commonwealth 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.
Registered No.
11
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Reginald Ruffini Jyvercon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
WWII
(a) Residence. No. (Usual place of abode) forte 3, Dallas, Texas
(If nonresident, give city or town and State)
Length of stay: In place of death. .. years ........ .. months. .days. In place of residence. ........ ... years. .. months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Jan - 26 - 1950
(Month)
(Day)
(Year)
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
SINGLE
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN. enter that fact here.
13
AGE 24 Years 4
Months
0
.Days
If under 24 hours
.. Hours ....
.Minutes
5 Accident, suicide, or homicide (specify)
Date and hour of injury.
19
Where did
Huithol
wars
Injury occur?
(City of town and State)
Did injury oocur in or about home, on farm, in industrial place, or in public
place?
(Sarracks 1 away
(Specify type of place)
Said to have willagreed during
Injury
(How did injury occur?)
@ scuffle atout Bank Wetterd
Injury
While at work? Tam-26-1450
as autopsy performed?
17 BIRTHPLACE (City).
(State or country)
TEXAS
18 NAME OF
FATHER
C.B. L Ley Den
19 BIRTHPLACE OF
C.B.L.
FATHER (City).
(State or country)
20 MAIDEN NAME
OF MOTHER
VIVIAN VANE
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
U. S. Naval Records
DATE OF BURIAL
February &
19 51
4.
8 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS
17 Bonnington St.T. Feather
19
Received and filed.
FEB 9 1950
(Registrar)
PARENTS
6 Was disease or injury in any way related to occupation of deceased?
If so, specify Suckle
(Signed)
M. D.
(A dress)
Folter-
1950
C.B.L.
Dallas Texas
7
Place of Burial, or Cremation.
(City or Town)
22
Informant
(Address)
Chelsea Naval Hospital
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
13355
1060
F (Signature of Agent of Board of Health or other)
VISION WEALTH DEFF
(Official Designation)
(Date of Issue of Permit)
1
(write the word)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Serchal Hemorrhage ....
Scalb
manter not determined
14 Usual
Occupation :
ELECTRICIAN
(Kind of work done during most of working life)
15 Industry
or Business:
U.S. NAVY
16 Social Security No ..
NO
DALLAS
.....
-0305
RM R-303 A 1
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 belicf 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.
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