USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 21
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STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (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 with ensuing septicemla (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, hoinicidai." "Asphyxiation by suspension, sulcldal." "Syncope while under the influence of ether adininlstered as a surgical anaesthetic." "Fracture of the skull with associated internal injury mus- tained under circumstances unkuown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, apecity : (1) Under cause it known or presumable nature; amıl (2) umler manner, indicate tbe circum- stancea 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
IR-302 1
PLACE OF DEATH
Middlesex (County)
Somerville (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Somerville (City or town making return)
Registered No.
161
52
J (If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME
Frederick C. Danforth
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
134 River Rd. , Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months. days. In place of residence 8
ears ..
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Mar. 3, 1951.
(Month)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
That I attended deceased
from
Jan. 10,,
51
Mar. 3,
51
to
19
10a If married, widowed, or divorced
Clara De
HUSBAND of
(Give maiden name of wife in full)
Bott
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Retroperitoneal
Sarcoma
6
12
46
MonthsAGE
Years
-
Months.
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :.
Machinist
14 Industry
or Business:
General
15 Social Security No.
Danvers
16 BIRTHPLACE (City).
(State or country)
Mass.
17 NAME OF
FATHER
Joseph Danforth
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Danvers
Mass.
19 MAIDEN NAME
OF MOTHER
Harriet Crean
20 BIRTHPLACE OF MOTHER (City) (State or country) Conn.
Hartford
21 Mrs. Clara Danforth
Informant
(Address)
134 River Rd. Winthrop, Mass
A TRUE COPY.
(Registrar of City or Town where death occurred)
Received and filed.
APR 1 0 1951
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, spe Richard J. Moran
No
(Address)
(Signed)
Arlington, Mass.
Date
3/5/ 51
¿Annunciation Cem. , Danvers, Mass.
Place of Burial or Cremation
(City or Town)
Feb.
6,
DATE OF BURIAL ..
7 NAME OF
E DIRECTO
Maurice W.Kirby
ADDRESS~10 Winthrop St. , Winthrop, Mas STTEST:
19.
50m-(e)-10-48-24658
Major findings: Of operations.
Date of operation.
Dec. 13, 1950
autopsy performed?
No
What test confirmed diagnosis ?.
Biopsey
alive on
11.20 A
m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
Mar. 2,
151
death is said to
I last saw
im
have occurred on the date stated above. at
11 IF STILLBORN, enter that fact here.
ANTE
Due To
CEDENT (b)
CAUSES
(Kind of work done during most of working life)
Due To
(c)
OTHER SIGNIFICANT CONDITIONS
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.
Hillcrest Nursing Home 1323 Broadway
DATE FILED
Mar. ... . 6, 19 51
(Was deceased a
U. S. War Veteran,
[ if so specify WAR)
(write the word)
(Day)
(Year)
RECEN. 7*
APR101951 ["!
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 84 Cliff Ave
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.
Registered No. 53.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
William L. O'Connor
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 84 Cliff Ave (Usual place of abode)
St.
(If nonresident, give city or town and State)
years. months days. In place of residence 25 years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
5
1951
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Houby 22.
19
to ..
mark 5
...
19
10a If married, widowed, or divorced Mary A. Black
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
INTERVAL BE- TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
12
AGE7.9.
Years
Months
Days
13 Usual
Occupation :.
Retired Collector
14 Industry
or Business:
Boston Con. Gas Co.
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Roxbury Mass
17 NAME OF FATHER Patrick O'Connor
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Ireland
19 MAIDEN NAME OF MOTHER Hannah E. Green
Roxbury 20 BIRTHPLACE OF MOTHER (City) (State or country) Mass
21 Informant Saigeon Cliff Ave Winthrop (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filodi with me BEFORE the burial or transit permit was issued: Walter A. Baker (Senature of event of Board of wealth or other) Malin offices 3/5/5/ (Official Designation) (Date of Issue of Permit)
CTIONS R ERTIFICATE
ving F DEATH enter an one or each ) and (c)
es not mean dying, such re. asthenia, s the disease, tions which
conditions, g rise to the (a) stating ung cause
ons contrib- eath but not disease or using death.
.50M (B)- 12-49.900722
Winthrop
6 Place of Burial or Cremation DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Winthrop Mags MAR 7 1951
(Registrar) ·
8 SEX Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
I last saw h w alive on
maril 5
~ 19
death is said to
have occurred on the date stated above, at
2" A
.. m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
gangrene, both
5 days
ANTE
Due To
arterial sclerosis
CEDENT (b)
CAUSES
generalized
2 yrs
Due To (c)
OTHER SIGNIFICANT Cerebral arterio sclerose 2 yrs CONDITIONS arterio selerotis heart disease
Major findings :
Of operations.
Date of operation ..
Was autopsy performed?
no
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
(Signed)
238 Shore
M. D.
(Address)
author Dåte 191
John haig Tinthrop (City or Town) 19
Received and filed
R-301A 1
No.
PHYSICIAN - IMPORTANT -
(Was deceased a U. S. War Veteran, if so specify WAR)
Length of stay: In place of death 14
15
If under 24 hours
Hours .. . Minutes
(Kind of work done during most of working life)
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- tecn, 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 cffect, 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, ninctcen hundred and two, and the Mexican border service of nineteen hundred and sixtecn and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. caused by violence, the medical examiner shall make such certificate. If such a
If death is permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap, 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observanee 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 discase unrelated to any forin 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 no.1e.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE. RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
March 24195
PLACE OF DEATH
Suffolk (County)
Winthrop
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
54
104 Highland Ave.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Benjaming James Graham
(If deceased is a married, widowed or divorced woman, give also maiden name.)
32 Palmyra Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
1
months ..
.2.2 ... days. In place of residence
10
.years
.. months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OK
DEATH
March
7
1951
(Month)
(Day) )
(Year)
4 I HEREBY CERTIFY.
That I attended deceased
from
Sept. 14,
19:50
to ..
march 7
19
51
I last saw him alive on
march 7
19 ... /, death is said to
have occurred on the date stated above, at 10:10 A. m.
INTERVAL BE-
TWEEN ONSET ANO DEATH
1 year
12
86
4
Months.
8
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation: Stair Builter ( retired) (Kind of work done during most of working life)
14 Industry
or Business:
Own factory
15 Social Security No.
None
BIRTHPLACE (City) .... Prince Edward Island (State or country)
17 NAME OF
FATHER
George Graham
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Prince Edward Island
19 MAIDEN NAME
OF MOTHER
Charlotte Clow
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Prince Edward Island
21 Elizabeth Graham
Informant. (Address) 32 Palmyra St. Winthrop, Mas
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter & Maker (Signature of Agent of Board on Health or other)
(Official Designationy
(Date of Issue of Permit) 3/9/5/
A TRUE COPY ATTEST
2 years
5 days.
Major findings:
Of operations.
Zone
Date of operation
What test confirmed diagnosis
Was autopsy performed ?. Clinical Laboratory
5 Was disease or injury in any way related to occupation of deceasedto If so, specify (Signed) Maurice Tranche M. D.
(Address) 562 Shipley St Wiathigh Date Milch 7 1957
6 Winthrop Place of Burial or Cremation
Winthrop
(City or Town)
DATE OF BURIAL.
March 9
.19 51
7 NAME OF
FUNERAL DIRECTOR Va
Howard S hunolds
ADDRESS Minthof maks.
Received and filed
MAR 1.6 1951 19
(Registrar)
8 SEX
Male
White
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, ogdiverszdbeth Bloomfield HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
arterioscleratic Heart
Disease.
Due To
Generalized
ANTE
CEDENT (b)
CAUSES
arteriosclerria
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Branchopreumonia
Eduar
ICTIONS OR ERTIFICATE
iving F DEATH tenter han one or each ) and (c)
xes not mean dying, such Te, asthenia, s the disease, tions which
conditions, g rise to the (a) stating ying cause
ons contrib- leath but not e disease or using death.
KOV (A ). 12.49.900722
I R-301 1
Registered No.
(City or Town)
No.
2 FULL NAME.
(a) Residence. No.
(Usual place of abode)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
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 onc, 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- tecn, 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 imine- 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, br 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 seventecn. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement contaming 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.
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