USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 13
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19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
"W P Rivers
(Signed)
300 Longwood Ave . Date
2-7- MSP
(Address)
Winthrop em-winthrop
Mass.
Major findings:
Of operations.
Date of operation
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Prematurity
TO DEATH (a).
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
25m-(b)-11-49-900,475
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 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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
No.
The Infant's Hospt.
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
~
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
That I
attended deceased from
Feb. 7
51
19
.m.
INTERVAL BE-
MEDICAL CERTIFICATE OF DEATH
21
Informant
"Address)
Joseph Carinha
TRUMourles H. Mackie
DATE FILED
ATTEST: (Registrar of City or Town where death occurred) Feb/12/51 19
RECEIVE
6
FEB251951 A + 4
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 37 Pleasant Px. Road
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.
34
Registered No.
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
WW1
U. S. War Veteran, if so specify WAR)
(a) Residence. No. 37 Pleasant ..... Park Rd. St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death years months days. In place of residence 2.Gears
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
1951 (Year)
8 SEX
male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED,
or DIVORCED dowed
4 I HEREBY CERTIFY,
19
to
19
I last saw h
alive on
19 .. .. , death is said to
have occurred on the date stated above, at
5: 20Pm
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE .
70
Months
.Days
If under 24 hours
Hours
.. . Minutes
13 Usual
Occupation:
teacher
(Kind of work done during most of working life)
14 Industry
or Business:
Boston School Dept.
15 Social Security No.
none
16 BIRTHPLACE (City).
Boston, Mass.
(State or country)
17 NAME OF
FATHER
John J. Lane
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston, Mass
19 MAIDEN NAME
OF MOTHER
Ellen Brogan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston Mass.
6 Holyhood Place of Burial or Cremation
Brookline (City of Town)
DATE OF BURIAL .. Feb.lo,1951 19
7 NAME OF
FUNERAL DIRECTOR
J. Vincent Murray
Revere Mass.
ADDRESS
Received and filed.
FEB 12 1351
19
(Registrar)
PARENTS
21 Informant Mrs. J. veo Meehan (Address) Lancaster Ave. Nevere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filet with me BEFORE the burial ontransit permit was issued: Walter & Bakero , (Signature of Agent of Board of Health or other)
(Official Designation) (Date of Issue of Permity 2/9/51
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such lure, asthenia, ins the disease, cations which th.
id conditions. ing rise to the e (a) staling lying cause
tions contrib- death but not he disease or ausing death.
50m-(b)-11-49-990,560
Due To
ANTE
CEDENT (b)
CAUSES
Due To
(c)
pinadiction
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. M. D. (Signed) (Address Withid) Brand /6 held 2/0251
No.
2 FULL NAME .. John A. Lane
(If deceased is a married, widowed or divorced woman, give also maiden name.)
That I attended deceased from
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
10a If married, widowed, or divorced
HUSBAND of ..
Margaret ricSweeney
(Give maiden name of wife in fully
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Colony cullis
I R-301A 1
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 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 diseasc, 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 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
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 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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No. 1251 .35
No.
Peter Bent Brigham Hospt
1(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Waiter G Damon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
270 Bowdoin St
St
Winthrop Mass.
(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
Feb.9/51
8 SEX
M
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
Jan.28. 19
51
to
19
death is said to
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
Term 63
12
AGE.
Years
11
12
Months.
Days
If under 24 hours
Hours.
Minutes
Due To
Pulmonary edema and congestive and marked venous congestion
Due To (c)
Pneumonia, lower lobes .. Hypertensive cardio vascular disease
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
None
Yes
Date of operation
Was autopsy performed?
What test confirmed diagnosis? autopsy.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify (Signed) (Address)
N A Wilhelm Peter Bent Brigham Hospt. 249-
Winthrop Cem-Winthrop Mass.
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Feb/12/51
19
7 NAME OF
FUNERAL DIRECTOR.
Winthrop Mass.
ADDRESS
Received and filed. 19
FEB 24 1951
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Jennie A Monegle
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lillian Damon
21 Informant (Address) RUEcharles H. Mackie
ATTEST
(Registrar of City of Town where death occurred) Feb/12/51
DATE FILED
.19
25m-(b)-11-49-900,475
(Month)
(Day)
(Year)
deceased from 51
I. last saw h imalive on Feb.9
have occurred on the date stated above, at 5;20A m. INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADICongestive heart failure TO DEATH (a)
ANTE CEDENT (b) CAUSES
1 Week
14 Industry
or Business:
Mens Clothing Store
15 Social Security No. 011-01-7269
15 Yra6 BIRTHPLACE (City).Belchertown Mass. (State or country)
17 NAME OF FATHER Ira E Damon
18 BIRTHPLACE OF FATHER (City) (State or country)
Springfield Vermont
Canada
H S Reynolds
1 Week
13 Usual
Occupation:
(Kind of work done during most of working life)
Manager
Lillian Nelson
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(a) Residence. No. (Usual place of abode)
That
I
Attended
Feb. 9
I R-302 1
RECEIVER
6
FEB2 1951 A:
I 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. 36
Registered No.
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAM
(H deceased is a married, widowed or divorced woman, give also maiden name.) 1 38 Main St. (a) Residence. No. (Usual place of abode) Length of stay: In place of death months years
.. St.
(If nonresident, give city or town and State)
.. days. In place of residence years
months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February (Month)
9 (Day)
1951 (Year)
4 I HEREBY CERTIFY.
That I attended deceased1 from
February 7.
1951
to
February 9
I last saw her alive on February 9, 1951, death is said to
have occurred on the date stated above, at
8:05A.m.
INTERVAL BE- TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
18 hours 12
AGE
Years
Months
Days
If under 24 hours
Hours .
.Minutes
13 Usual Occupation :
33 hours (Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City) (State or country)
Winthrop
17 NAME OF FATHER alfonso Scandone
18 BIRTHPLACE OF FATHER (City) (State or country)
Winthrop
Mais
19 MAIDEN NAME OF MOTHER Lucille
20 BIRTHPLACE OF MOTHIER (City) (State or country)
Winterch Maga
21 alfonso brandone
(Address) 138 Mainly non
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or fransy permit was issued :
Walter - Wakes J
(Signature of Agent of Board of Health or other) Health Officee 2/9/01
(Date of Issue of Permit)
-
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such lure, asthenia, ns the disease. cations which th.
d conditions, ing rise to the e (a) staling lying cause
tions contrib- death but not he disease or ausing death.
OTHER SIGNIFICANT CONDITIONS
Major findings: Of operations. none
Date of operation
What test confirmed diagnosis?
Was autopsy performed? Clinical+ laboratory.
5 Was disease or injury in any way related to occupation of deceased?
If s Maurice Trance PEin (Signed) M. D. (Address) 562 Shirley SP Withings Date Fcb. 9. 19.51
6 Withinog
Winthrop (City of Town)
Place of Burial or Cremation DATE OF BURIAL Kreb 10 1951
7 NAME OF FUNERAL DIRECTOR
Ernest & Caggiano 147 Winthrop St Winthrop
ADDRESS
Received and filed
FEB 12 1951
19
(Registrar)
8 SEX Female White
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED male
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Bronchopneumonia
ANTE CEDENT (b) CAUSES
Due To massive atelectasia
Due To (c)
50M (B).12.49.900722
Winthrop Comm. Hochital so No. Laura L.
Scandone
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(write the word)
51
PARENTS
Fichtner
(Official Designation)
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 hy 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 ceinetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a
permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-Six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner of cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence. or hy 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 hy 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 he 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.
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