USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 103
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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.
PACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
ANK, RATING ORGANIZATION AND OUTFIT
ERVICE NUMBER
R-303-A
PLACE OF DEATH -
Suffolk (mounty ) Whathop (City or Towy)
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.
Registered No.
292
St. [ { If death occurred in a hospital or institution, give its NAME instead of street and number)
PHYSICIAN-IMPORTANT
2 FULL NAME.
Elva Elhampoo
2 .
give also maiden name.)
specify WAR)
(a) Residenoo. No. (Usual place of abode)
Length of stay: In hospital or Institution.
( Before death)
( Specify whether)
years
months
days.
In this community
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
i hate
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF DEATH .. Les 22,1951 (Day) (Year)
(Month)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Atthe Husband name
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE.
...
Years
Months.
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
toplumuist
Industry
10 or Business :
11 Soolai Security No ....
12 BIRTHPLACE (City)
(State or country)
13 NAME OF FATHER
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) .......
(State or country)
Relation, if any DATE OF BURIAL
19,2%
23 NAME OF FUNERAL DIRECTOR .....
ADDRESS
Received and flied DEC 20 1951 . 19
(Registrar)
should be carefully supplied. MEVIGAL banmittente altele atete 990 ft Ms
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect extracts from the laws relative to the return of certificates of death.
PARENTS
50m . (f) -6-43-12056
I HEREBY CERTIFY that a satisfactory standard certificate of death was Also With my BEFORE the burial or transit permit was Issued : Walter A. Baker
(Signature of) agent of Board of Health or other)
Healthe (Official Designation) (Date of Issue of Permity
12/25/57
19 | 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.) Pulmona sexand
phlebothrombow phlebothrombosis
both lago.
20 Accident, suloide, or homloide (specify) Date of ocourrenoe. 19
Where did Injury oocur?
(City or town and State)
Did Injury ooour In or about home, on farm, in Industrial place, or in publio
piaoo?
(Specify type of place)
Manner of Injury
Nature of
Injury
While work ? Was there an sotopsy?
21 Was disease or injury in any buy related to occupation of deceased ? hand Though M. D.
(Address) 25 Shattuck ST Date 12/23 1951
22 Place of Burial, Cremation or Removal. (City or Town)
17 Informant .... ( \dilrosx)
1
No.
(If deceased is a married, widowed or divorced woman,
817 Shirley St. Winthrop
Mª Callu
(Was deceased a U War Veteran,
(If no resident, give city or town and State)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloal offioer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an umlertaker or other authorized person or of any meniber of the family of the deceased, furnish for registration a standard certificate of deatlı, stating to the best of bis 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. 16, 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 wbich it has been engaged, insert in the certificate a recital to that effect, speck- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as be can atate the aame. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-reven of said chapter one hundred and fourteen, the word "war" shall inchide the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen bundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can bonler service of nineteen bundred aud aixteen and nlueteen hundred and seventeen. G. L. Cbap. 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 perinit froin the board of bealth, or ita 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 recelving tomb to another in the same cemetery, until be has received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the hody 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 ahall be accompanied, in case of an original interinent, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu tbereof a certificate aa hereinafter provided. If there is no attending physician, or If, for sufficient reasons, bis certificate cannot be obtained early enough for the purpose, or is Insufficient, a physi- cian who is a member of the board of health, or employed by it or by tbe selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death ia caused by vlolence. 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 perniit 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 baa 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 l'nited States in any war in which
it has been engaged, such recital shall appear upon tbe permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it ail transmit it to the clerk of the town for regis- tration. The person to whom the permit ia so given and the physician cer- tifying 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 regiatrar may re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No umlertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a per- aon appointed to have the care of the cemetery or burial ground in which the interment is made. ... Cbup. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Medical examincra 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 withiu bia 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. 3S, 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 aa full as may be, with the cause and manner of death .- General Lawa, Chap. 33, Sec. 7.
... The medical examiner certifes 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 rules of practice :
(1) Attending physioiana will certify to such deaths only as those of persona to whom they have given bedside care during a last illness from disease unrelated to any forin of injury.
(2) Board of Health physlolans will certify to such deaths only aa those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or wbose pbysi- ciau ia absent fromn hoine when the certificate of death ia needed.
(3) Medical Examinera will investigate and certify to all deaths sup- posably due to Injury. These include not ouly deaths caused directly or la- directly by traumatism (including resulting septicemia), and by the action of chemical (druga or poisons), thermal, or electrical agents, and deaths following abortion, but also desths front 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
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 tbe femur withi ensuing septicemia (gaa bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether adininistered aa a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circunstances unknown."
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; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (hasal ganglia ) ( found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death. )"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-301A 1
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.
293
No. Winthrop Community Hospital J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME .. Rose ... E. Dolan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Me
(a) Residence. No.
52 Center St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.. months.
days. In place of residence
years months days.
2 das. 14 hrs. 2 min.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Dec
(Month)
25- (Day)
195' (Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIMORNEDL ℮
(write the word)
4 I HEREBY CERTIFY,
That I attended deceased from
Quy 13 19 57 to Dec 25 195/
I last law h 22 alive on
have occurred on the date stated above, at 10.05 /Pm.
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) General carcinomaTores
INTERVAL BE- TWEEN ONSET AND DEATH 6 wles
11 IF STILLBORN, enter that fact here.
12
AGE
79 ears
Months
Days
If under 24 hours Hours .. Minutes
13 Usual
Occupation t
Home (Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City) (State or country) England
17 NAME OF FATHER John
PARENTS
20 BIRTHPLACE OF MOTHER (City) (State or country)
England
21 Info Margaret Dolan
(Address) 52 Center St
I HEREBY CERTIFY that a satisfactory standard certificate of death wa filed with me BEFORE the burial or transit permit was issued:
Walter J. Dalergi
(Signature of Ment of Board of Health or other)
Health Ofrece (Official Designation)
(Date of Issue of Pernyt)
22651 2
50m-(b)-11-49.90,569
6
Mt. Benedict
Place of Burial or Cremation
Dec 27 195
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Saluti O maley Winthrop
Received and filed
DEC 2 6 1951
.19
(Registrar)
4 days
Due To (c)
To Papillary Ca I left
OTHER SIGNIFICANT CONDITIONS
General arteriosclerosis
2 yrs
Major findings:
Of operations
in 7 Kidney f weten ureter
Date of operation.
Was autopsy performed?
Partilógicol Studen
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? We
If so, specify .
misin 22 Kami
M. D.
(Signed)
(Address) 25 Sturges ST Wallin Date 12/25/5/19
Boston
(City of Town)
18 BIRTHPLACE OF FATHER (City) (State or country) England
19 MAIDEN NAME OF MOTHER Ann Casey
6 mo.
10a If married, widowed, or divorced
(or) WIFE of
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
ANTE CEDENT (b) .. CAUSES
Due To Bronchopneumonia-
TAJT
Registered No.
PHYSICIAN - IMPORTANT -
(Was deceased a U. S. War Veteran, if so specify WAR)
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) stating derlying cause
nditions contrib- the death but not to the disease or n causing death.
(Usual place of abode)
20
Dec-25, 1951
, 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 f an undertaker or other authorized person or of any member of the family of he 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 lisease of which he died, defined as required by section one, where same was ontracted, the duration of his last illness, when last seen alive by the physician r 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 receding section or by section forty-five of chapter one hundred and four- een, shall, if the deceased, to the best of his knowledge and belief, served in the rmy, navy or marine corps of the United States in any war in which it has been ngaged, insert in the certificate a recital to that effect, specifying the war, and hall also certify in such certificate both the primary and the secondary or imme- iate cause of death as nearly as he can state the same. For neglect to comply ith 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 f said chapter one hundred and fourteen, the word "war" shall include the China elief expedition and the Philippine insurrection, which shall, for said purposes, be eemed to have taken place between February fourteenth, eighteen hundred and inety-eight and July fourth, nineteen hundred and two, and the Mexican border ervice of nineteen hundred and sixteen and nineteen hundred and seventeen. . L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body a town, or remove therefrom a human body which has not been buried, until he as received a permit from the board of health, or its agent appointed to issue uch permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shallexhume a human body and emove it from a town, from one cemetery to another, or from one grave or tomb ther than the receiving tomb to another in the same cemetery, until he has eceived a permit from the board of health or its agent aforesaid or from the clerk f the town where the body is buried. No such permit shall be issued until there hall have been delivered to such board, agent or clerk, as the case may be, satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original inter- nent, by a satisfactory certificate of the attending physician, if any, as required by aw, or in lieu thereof a certificate as hereinafter provided. If there is no attending hysician, or if, for sufficient reasons, his certificate cannot be obtained early nough for the purpose, or is insufficient, a physician who is a member of the board f health, or employed by it or by the selectmen for the purpose, shall upon pplication make the certificate required of the attending physician. If death is aused by violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from one town o 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 he undertaker desiring to make such removal shall constitute a permit for such emoval; provided, that such body shall be returned to the town from which it was emoved within thirty-six hours after such removal, unless a permit in the usual orm 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 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 issuc 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 carc of the cemetery or burial ground in which the interment is made.
. Chap. 114, Scc. 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
M R-303 A 1
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should stato CAUSE AND MANNER OF 25M (A).8-50-902 592 N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Nature of Injury
PLACE OF DEATH
Suffolk
17/52 1%
Che Sammanwealth uf shassarquspits EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial pormit with Board of Health or its Agent.
294
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
J (Was deceased a U. S. War Veteran, ( if so specify WAR)
R
(IMnonresident, give city or town and State)
months.
days. In place of residence .... 2.O.years.
.months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
White
10 COLOR OR RACE
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
11a If married, widowed, or Heten A. Power
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
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