USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 5
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12
AGE
Years
Months
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Vermont
17 NAME OF FATHER Addison Pond
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER
Fanny Janes
20 BIRTHPLACE OF MOTHER (City) (State or country) Vermont
Charles H Rogers
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with mg BEFORE the burial or transit permit was issued:
Walter & Baker Signature of Axohy of Board of Health of other)
Health Office /(Official Designation)
(Date of Issue of Permit)
·50M (B ). 12.49.900722
6
Place of Burial or Cremation
DATE OF BURIAL Jan, 13
7 NAME OF
FUNERAL DIRECTOR.
Toward S Reynolds
ADDRESS Winthrop Mais
Received and filed 19
JAN 1.5.1951
(Registrar)
10 years.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
none
Major findings:
Of operations.
none
Date of operation none
Was autopsy performed?
What test confirmed diagnosis?
Clinical.
5 Was disease or injury in any way related to occupation of deceased?
If so, specie
Surdie w. senckmasary.
M. D.
(Signed)
(Address) Whichof mass.
, Date /19, 1951
Erst Bulletin
Dumont
(City or Town) 21 Informant 105% (Address) 63 Rear Freemont St. Winthrop
1/11/st
3 DATE OF
DEATH
clan (Month)
10 (Day}
1951 (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Jan: 2
1951
to
10
...
195/
I last saw her
.. alive on
9
195 7, death is said to
have occurred on the date stated above, at
8 a. m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Chronic Myocarditis
TWEEN ONSET AND DEATH three 12 years
Due ToQ generalized
ANTE CEDENT (b) CAUSES arteriosclerosis
TRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH not enter 'e than one se for each , (b) and (c)
is does not mean le of dying, such failure, asthenia, means the disease. plications which eath.
rbid conditions, iring rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or causing death.
To be filed for burial permit with Board of Health or ite Agent.
PHYSICIAN - IMPORTANT -
(Was deceased a U. S. War Veteran, ( if so specify WAR)
(a) Residence. No. (Usual place of abode)
MARRIED
WIDOWED
or DIVORCED
Married
81
East Berkshire
No.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest 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 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 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 he, 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
cleath 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, See. 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 hody 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 he 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 eertify to such deathsonly 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 dore 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 domestie 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
Dr Dickinson
1
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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.) 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
25m-(b)-11-49-900,475
PLACE OF DEATH
SUFFOLK BASTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
36313
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
WILLIAM J KENNEY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
75 CREST AVE
St.
WINTHROP MAS3
(If nonresident, give city or town and State)
Length of stay: In place of death.
......
... years.
months. 8
days. In place of residence.
10
.years ..
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
JAN 12/51
(Month)
(Day)
(Year)
8 SEX
MALE
9 COLOR OR RACE
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
WIDOWED
4 4 HEREBY CERTIFY,
That WE attended deceased from
JAN 4
51
JAN 12
19
51
WE
I last saw h .... I.M .... alive on.
JAN 1.2 19.5 / death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEAD CARCINOMA OF
TO DEATH (a)
TWEEN ONSET
AND DEATH
I YR
11 IF STILLBORN, enter that fact here.
88
12
AGE
Years
7
Months.
16
Days
If under 24 hours
.. Hours ..
.Minutes
13 Usual
Occupation:
ACTOR
(Kind of work done during most of working life)
14 Industry
or Business:
PROFESSIONAL STAGE
15 Social Security No.
-
16 BIRTHPLACE (City).
(State or country)
NEW YORK"NY
17 NAME OF
FATHER
PATRICK KENNEY
18 BIRTHPLACE OF
FATHER (City)
(State or country)
IRELAND
19 MAIDEN NAME
OF MOTHER
SARAH MCGURK
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
F W KENNEY,
SON
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
A B MARSH
ADDRESS WINTHROP MASS
Received and filed JAN 25 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, specify
(Signed)
N A WILHELM
M. D.
(Address)
BOSTON MASS
Date JAN 12
19.51
6
WINTHROP .... CEM
Place of Burial or Cremation
WINTHROP ..
(City or Town)
JAN 15
15 1
21
Informant
(Address)
A TRUE COPY
Charles H. Macke
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
JAN 16
10 51
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?..
NO
What test confirmed diagnosis?
CLI.N.I.C.AL
10a If married, widowed, or divorced
HUSBAND of.
LOUISE NOLAN
(Give maiden name of wife in full)
have occurred on the date stated above, at
7:35
Am.
INTERVAL BE-
ANTE
Due To CORONARY OCCLUSION
TERM
No.
PETER BENT BRIGHAM HOSPITAL
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
19
to
(write the word)
1
M R-303-A
1
PLACE OF DEATH Sullek (County) Winthrop. (City or Town)
Boston 2/10/5/
The Commonturalth 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 Ita Agent.
14
Registered No.
104 Highland are Mounts Nursing Home St.{ ( If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
10g Woon Of East Boston
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ..
(Before death)
( Specify whether)
years
months
(3 days.
In this community 60 yrs.
mos.
days.
13
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE| 5 SINGLE
white
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Patrivelen na Lecit in Dauley
(Husband's name in full)
6 Age of husband or wife If allve deceased years
7 IF STILLBORN, enter that faot here.
8 AGE Years Months. Deys
If less then 1 day Hours Minutes
Usual
9 Occupation :
House wife
Industry
our home
11 Soolal Security No ... une
12 BIRTHPLACE (City)
60. Terry
(State or country)
Helana!
13 NAME OF
FATHER
Cornelius Dimmeen
PARENTS
14 BIRTHPLACE OF
To. Kerry
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Johannah Donahue
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Dieland
17 Mary 24: Gauley (Stationliter)
Informant.
( \delrenx)
109 thoore St. E.B.Q
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the Burial or transly permit was Issued: Watter ex Malalgo
(Signature of Agent of Board of Health or other)
1/15/07
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
Jan
13-1951
(Month )
(Day)
(Year)
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.) Bruncho Queci morcea: Fractured Left temur : Senility
20 Aooldent, sulolde, or homlolde (specify) ...
Date of occurrence You-17-
1950
Where did
Bartin
(City or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In public
place ?
(Specify type of place)
Mann
Bell accidentally at her home
Injury
Nature of
Jur-17-1950
Injury
While et work ?
Was there an autopsy ?.
40
21 Was disease of Injury In any way related to occupation of deceased ?
If so, speolfy
(Signed)
M. D.
(Address)
Jan -13- 15/
22 Holy Cross Malden
Place of Burlan Cremation or Removal.
(City or Town)
DATE OF BURIAL ..
January 16
19.57
23 NAME OF
FUNERAL DIRECTOR
John & Kelly
ADDRESS
286 Meridian St. E. Boa
Reoelved and filed. 19
15 4851
(Registrar)
+
If deceased was a U. S. War Veteran. G. L. Chap. 46, Section 10. requires physicians to Insert a reoltal to that effeot 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 should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,
× 50m. (i) -1-45-15510
/ Healthare %
No.
Mary
Mccauley
PHYSICIAN.IMPORTANT
U. S. War Veteran,
If so specify WAR)
40
(a) Residence. No.
(Usual plece of abode)
MEDICAL CERTIFICATE OF DEATH
accidental
Injury ooour ?
10 or Business :
Co. Ferry
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registarad hospital medloal offoar shall forthwitlı, after the death of a person whom he has attended during his last illneas, at the request of an undertaker or other authorized person or of any meniber 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 auction one, where sate 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, aerved In the arnty, 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, specl- fying the war, und shall also certify In such certificate both the primary and the secondary or iunnodiate cause of death as nearly as he can atate the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposea of thia aec- tion and of aections 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 Philippine insurrection, which shall, for aaid purposes, be deemeil to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nlueteen hundred aud alxteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec, 10.
No undertakar or other parsen shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, nutil he haa received & perinit from the board of health, or Its agent appointed to Issue such permits, or if there is no such hoard, from the clerk of the town where the person died; and no undertaker or other person shall exaume 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 aforesald or from the clerk of the town where the body is buried. No auch perinit shall be lasued until there ahall have been delivered to such hoard, agent or clerk, as the case may be, a aatisfactory written statement containing the facts required by law to be returned aud 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. If there is no attending physician, or If, for sufficlent reasons, his certificate cannot be obtained early enough for the purpose, or Is insufficleut, a physl- cian who is a mueinher of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certlicate re- quired of the attending physician. If death ia caused by vlolence, 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 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 auch 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-slx houra after such re- moval, unless a perinit in the usual form for the removal of such body has been sooucr obtained hereunder. If the death certificate contalus a recital, as required by section ten of chapter forty-xix, 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 appesr upon the permit. The board of health, or- its agent, ufrom receipt of such statement and certificate, shall forthwith countersign it and transmit It to the clerk of the town for regis- tration. The person to whom the permit fa 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. 15, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof 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 held, 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 sliall 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 hia county the body of such a person, he shall forthwith go to the place where the body lles and take charge of the same ;... - General Laws, Chap. 38, Sec. 6.
. ile shall in all casea 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 he, with the cause and manner of death .- General Lawa, Chap. 38, Sec. 7.
... The medical examiner certifies 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 calls for the obaervance of the following rulea of practice :
(1) Attending physloians will certify to such deaths only as those of persons to whom they have given bedside care during a last lilnesa from disease unrelated to any forin of injury.
(2) Board of Health physicians will certify to such deaths only as those of persona who, though disabled by recognized disease uurelated to any form of injury, have died without recent incdical attendance or whose phyal- cian is absent from home when the certificate of death ia needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posahly due to Injury. These include not only deatha caused directly or in- directly by traumatism (inchiding resulting septicemia), and by the actlon of chemical (druga or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from Injury or Infection related to occupation, tha sudden deaths of persons not disabled by recognized disease, and those of persous found dead.
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 ita 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 hacillua) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, sulcidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "fracture of the skull with associated internal injury sur tained under circumstances unkuown."
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 preaumable nature; aml (2) under manner, Indicate the circum- stances leading to medico-legal Inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglla) (found dead in bed)." "Heart dlaease, presumably coronary sclerosis. (Sudden death. )"
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