USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 22
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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.
SPACE FOR ADDITIONAL INFORMATION
· DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
R-303-A
PLACE OF DEATH
SullyCk .(County)
The Summantoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burlai permit with Board of Health or Its Agent.
Registered No.
55
St. { {If death occurred in a hospital or institution, I give its NAME instead of street and number)
PHYSICIAN-IMPORTANT
(Was deceased a
NO.
(a) Residenoe. No.
77 Bourdein St Winthrop St
(Usual place of abodey
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
Hospital
years
5
months
days.
in this community 65 yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED widowed
5a If married, widowed, or divorced HUSBAND of
(Giye maiden name of wife in full)
(or) WIFE of Frederick .... Holmes ..... Homer
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that faot here.
AGE 90 Years 2
Months 13 Days
If less than 1 day
Hours.
.Minutes
9 Occupation :
housewife
Industry
10 or Business :
o.wn .... home
11 Soolal Security No.
none
Falmouth
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
FATHER
Richard Weston
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Mary Ann Burton
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17 Informant.Mrs.IrvingE .Clement Matog& any ( \deireix) 1 Lawrence rd, Wellesley
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Burlet or transit permit was Issued: Walter A Natale
( Signature of Agent of Board of Health or other) Health Alfiere 3/9/51
(Official Designationy (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
DEATH
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated
the death
of the person above-named and that the CAUSE AND MANNER thereof
to as follows: (H Th injury was involved, state fully.)
Seneliti
Fractured Left. temuri!
,
Sencial arterio Sclerose
20 Accident. sulolde, or homicide (specify)
Premios accidental
Date of ooourrenoe.
hov-30-
محكود
Where did
injury ooour?
(City or town and State)
Did Injury occur in or about homo, on farm, in industrial piace, or in publio
place ?
(Specify type of place)
Manner
injury
tell accidentally at her home in
Nature of Lov-30-1950
Injury
While at work ?.
Was there an autopsy?
40
21 Was disease or injury in any way related to occupation of deceased ?.
If so, speolfy
(Signed)
M. D.
(Address)
Men-7-
1957
22
Winthrop Cemetery Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL ..... March ..... 9. 1951
19
23 NAME OF
FUNERAL DIRECTOR
alfred B. Marche
ADDRESS
174.Winthrop.St.Winthrop
Reoelved and filed
MAR 1 6 1951
19
(Registrar)
If deceased was a U. S. War Veteran. G. L. Chap. 46, Section 10, requires physicians to Insert a reoltal to that effect
50m-(i)-1.45-15510
1
(City or Town)
No.
2 FULL NAME
Mary Jane Homer
(If deceased is a married, widowed or divorced woman, give also
maiden name.)
U. S. War Veteran,
If so specify WAR)
(Before death)
(Specify whether)
18 DATE OF
Juande-7-1951
female white
Usual
extracts from the laws relative to the return of certificates of death.
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
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 fre has attended during his last illness, at the request of an undertaker or other authorized person or of any nrember 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. Lawa, Chap. 16, Sec. 9.
A physielan 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, invert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate canse 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 aec- tlou and of actions forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the l'hilippine insurrection, which shall, for said purposes, be deemed to have taken jdace between February fourteentls, eighteen hundred and ninety-eight and July fourth, nineteen liundred and two, and the Mexi- can bonler service of nineteen hundred and aixteen 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 haa not been buried, until he has received a permit from the board of health, or ita agent appolurted 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 exilume a fruman 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 haa received a permit from the board of health or Its agent aforesald or from the clerk of the town where the body is burled. No such permit shall be issued until there ahall 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 interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. Il there is no attending physician, or if, for sufficient reasons, his 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 the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If desth Is causeil by violence, the medical examiner shall make such certificate. If auch a permit for the removal of a human body, not previously Interred, from one town to an- other within the commonwealth caunot 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 inake such renroval shall constitute a permit for such removal; provided, that such body shall be returned to the town froin which it was removed within thirty-six hours after such re- moval, unless a permit in the usual form for the remuval of such body has been soouer obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-xix, that the deceased served in the army, navy or marine corps of the I'nited States in any war in which
it has been engaged, such recital shall appcar upon the permit. The board of health, or. its agent, upon receipt of sueli statement and certificate, shali forthwith countersign it aml transmit It to the clerk of the town fur regis- trarion. 'I'le person to whom the permit is so given and the physician cet- 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 undertaker or other person shall bury a human body or the ashes thicreof which have bren 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 lield, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (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 umedical examiner has norice that there is within hia county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the sanic; ... - General Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.
... The medical examiner certifles the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfilment of the purpose of these laws calla for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persona who, though disabled by recognized disease unrelated to any forni of injury, have died without recent medical attendance or whose phyel- cian is absent frnin home when the certificate of death is needed.
(3) Medical Examiners will investigate aud certify to all desths sup- posably due to Injury. These include not only deatha caused directly or In- directly by traumatisin (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 Infeotlon related to occupation, the sodden 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 wili 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 the femur with ensuing septicemia (gas bacillua) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, sulcldal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstancea unkonwn."
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; all (2) under manner, indicate the circum- stances leading to medico-legal Inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosia. (Suchen death. )"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
PLACE OF DEATH
Suffolk (County)
R-301 1 Winthrop (City or Town) 387 Shirley St. No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
56.
f(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.)
387 Shirley St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. 27 years .. months. .days. In place of residence. .2.7.years. .months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
08th
1951
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
I HEREBY CERTIFY,
That I attended deceased
from
Jan. 11
191
to.
mand 8
1951
I last saw him
. alive on.
mark 8
.
20 1051
death is said to
12 º P
INTERVAL BE-
TWEEN ONSET AND DEATH 3 weeks 77 ]
12
AGE
Years
Months.
25
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Furrier
(Kind of work done during most of working life)
14 Industry
or Business:
Fur Store .
Self owned
15 Social Security No.
None
Boston
16 BIRTHPLACE (City).
(State or country)
Mass
17 NAME OF
FATHER
Charles N Carter
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Fonda
(State or country)
New York
19 MAIDEN NAME
OF MOTHER
Fannie Wood
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Frank B Carter
21 Informant (Address) 820 Boston Post Rd, Weston
I HEREBY CERTIFY that a satisfactory standard certificate of death was Wled with me BEFORE the burial of transit permit was issued:
Walter & Bakes (Signature of Agent of Board of Health or other)
Jhealth of
Oficer
3/9 /5/
(Official Designation)
(Date of Issue of Permits
A TRUE COPY ATTEST
(Registrar)
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)
Obstructive jaundice
Due · Carcinoma of the head
ANTE
CEDENT
CAUSES
(b)
of the pancréas
. 6 mos
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Diabetes mellitus
Major findings:
Of operations.
none
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
clinice
no
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Paul P. Whensoft
(Signed)
238 Shore Dr. Winthrop
yDate 3/8
M. D. 1951
6 Forrest Hills
Place of Burial or Cremation
Boston
(City or Town)
March. 10 19.50
DATE OF BURIAL.
7 NAME OF
FUNERAL DIRECTORY
award'S Krynica
ADDRESS Winthro max.
Received and filed
MAR .1.6 1951
19
CTIONS R ERTIFICATE
ving F DEATH enter an one or each )and (c)
es not mean dying, such re, asthenia, the disease. ions which ,
conditions, g rise to the (a) stating ing cause
ns contrib- eath but not disease or sing death.
SOM (A). 12.49.900722
(Address)
Unable to obtain
Charles Howard Carter 2 FULL NAME
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
have occurred on the date stated above, at.
m.
11 IF STILLBORN, enter that fact here.
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 clisease 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 hy 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 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, 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 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 hy 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, See. 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 oceupation, 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, ete. 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
IR-301 1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town) 891 Shirley Street No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
57
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Elizabeth (Elliott) Sargent
(If deceased is a married, widowed or divorced woman, give also maiden name.) 891 Shirley Street (a) Residence. No. (Usual place of abode)
St.
(If nonresident, give city or town and State)
6
Length of stay: In place of death.
1
years.
6
months.
.days. In place of residence
1
years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
(write the word)
Female
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Widow
4 I HEREBY CERTIFY.
november1
19.
49
to
March 16
5
I last saw
alive on
March 7, 1951 death is said to
have occurred on the date stated above, at.
4:10A.
m.
INTERVAL BE- TWEEN ONSET ANO DEATH
11 IF STILLBORN, enter that fact here.
/2 hour 12
67
8
Months.
11
Days
If under 24 hours
Hours .....
. Minutes
13 Usual
Housewife
Occupation:
(Kind of work done during most of working life)
14 Industry
15 Social Security No.
012- 12-6384A
Wellefleet
16 BIRTHPLACE (City)
(State or country)
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