USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 76
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days. In place of residence 20 .years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sept. 29
(Month)
1
(Day)
1901
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Domande 1946.
to Leph. 29
19NY
I last saw h Im alive on 4424.29 1987, death is said to have occurred on the date stated above, at 12:30 hogy INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING/
TO DEATH (a)
Coronary Thrombosis
4 ks
ANTE
CEDENT
CAUSES
Due ToY
(b)
Coronary artery
das
al artery
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation .
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease br injury in any way related to occupation of deceased?
If so, specify ..
(Signed)
(Address)2) Calmalung Cancer Date 9/29 1907
.
M. D.
6 Winthrop
Place of Burial or Camaron) 6 et 2-1951
(City or Town)
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
Cambise
ADDRESS
Received and filed
1951 .19
(Registrar)
11 IF STILLBORN, enter that fact here.
12
AGE
5.3.
Months
Days
If under 24 hours Hours Minutes
13 Usual Occupation@z Executive NE, Tel Co (Kind of work done during most of working life)
14 Industry
or Business :
Jelephone
15 Social Security No. Cambiaje
16 BIRTHPLACE (City) (State or country)
masa
17 NAME OF
FATHER
Daniel Mac Dougall
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME Mary Sme Lowag OF MOTHER
20 BIRTHPLACE OF MOTHER (City) (State or country) Tilite mac Dougall
21 Informat (Address) 297 Rive Rill
I IIFREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter games (Signature of Agent of Board of Health or other) / Seattle 10,1 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, the disease, ions which
conditions. g rise to the (a) stating ing cause
ns contrib- eath but not disease or sing death.
·50M (B)- 12.49.900722
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. 211
Registered No.
WinthruHospital - George Mathongall
j(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran.
if so specify WAR)
I
(If deceased is a married, widowed or divorced woman, give also maiden name.) 297 River Road
St.
(If nonresident. give city or town and State)
8 SEX
Male
9 COLOR OR RACE White
10 SINGLE (write the word) MARRIED WIDOWED or DIVORCED Married
10a If married, widowed or divorced HUSBAND of Leith
Sullivan
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
PARENTS
Nova Scotia
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 cleath 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 hy section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the hest 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 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 heen 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 hody, 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 oceupation, 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 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 fromn 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, eook-hotel, etc. For a person who had no occupation whatever write no.1e.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
may 11-1917 may 10-1921
DATE OF DISCHARGE
RANK, RATING German 3C
ORGANIZATION AND OUTFIT U.S Navy.
SERVICE NUMBER
141-03-47
R-302 1
PLACE OF DEATH
Middlesex
(County)
Lexington
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lexington (City or town making return)
£12
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Marie M. Roberts
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
45 .... Beal
.......
St.
Winthrop
a.S.G.
(If nonresident, give city of town and State)
Length of stay: In place of death .......... years .......... months ... 5.
.days.
In place of residence.
......
... years.
.months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September 24,
1951
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
August ..... l., 19 ..
50. September 24
19 ..
51
I last saw h ........... alive on ..
9.24
19 ... 5.1death is said to
have occurred on the date stated above, at
7:15 Pm.
INTERVAL BE-
11 IF STILLBORN. enter that fact here.
12
AGE. 90 Years 5
.Month2.5
.Days
If under 24 hours
.. Hours ..... .. Minutes
13 Usual
Occupation:
at home
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City) Champlain
(State or country)
17 NAME OF
FATHER
Charles Senecal
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
Cannot learn
19 MAIDEN NAME
OF MOTHER
Delphine Goodrow
20 BIRTHPLACE OF
MOTHER (City)
Champlain
(State or country)
New York
21
InformantRecords ..... Not .............. Host.
(AddressSINGLE
A TRUE COPY
ATTEST:
James J. Carroll
ADDRESS 210 Winthrop at2 Winthrop
Received and filed
OCT 15 1951
19
(Registrar of City or Town where deceased resided)
8 SEX
F
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Widored
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Augustus Roberts
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Arteriosclerotic
Heart Disease
TWEEN ONSET AND DEATH 420
Due To (c)
Generalized
Arteriosclerosis
450
What test confirmed diagnosis ?.
clinical
.no
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed)
Lung del Bosque
M. D.
1053
DateSent ... 2.419 .... 51
6 Winthron Cemotory Place of Burial or Cremation
Winthrop (City of Town)
DATE OF BURIAL Sent. 27 19 51
7 NAME OF
FUNERAL DIRECTORTuri.ce ............ Kirk
(Registrar of City of Town where death occurred)
DATE FILED September 27 51
2 FULL NAME CEDENT (b) CAUSES OTHER SIGNIFICANT CONDITIONS Major findings: Of operations. Date of operation. (Address) 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 ANTE Due To after the close of the month in which the death occurred. (See Chap. 46, Ser 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 (E )-6.50.902253
Was autopsy performed ?...
PARENTS
Registered No.
No. MetropolitanStateHospital
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop (City of Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or 1ts Agent. C13
No.
Winthrop Nursing Home
.
J(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
2 FULL NAME ... Ella Wright Abbott (If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
152. Pleasant Street St.
(If nonresident, give city or town and State)
Length of stay: In place of death .... .. years .. 1 .months. ... days. In place of residence56.
.years.
.months
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
1
1951
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
august 3/ 1951.
to
October 1, 1951
I last saw her alive on
September 30051, death is said to
p
have occurred on the date stated above, at. / .m. INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING,
TO DEATH
(a)
Generalized
arterio sclerosia
ANTE CEDENT (b) CAUSES
Due To
Chronic myocarditis
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed)
Jennie 3. Roitman
M. D.
(Address) 47 Washington ave Date 02.2.1951
6 Winthrop cemetery Place of Burial of Cremation (City ui lown
WinthropMas81
DATE OF BURIAL October 4. 1951 19
7 NAME OF
alfred 3. March
FUNERAL DIRECTOR
ADDRESS
174 Winthrop St, Winthrop, Mass.
Received and filed 19
OCT 9 1951
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
female white
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.
12
AGE 7.9 Years 1 O ... Months1 5
.Days
If under 24 hours
Hours .. .. Minutes
13 Usual
Occupation :
retired
(Kind of work done during most of working life)
14 Industry
or Business:
Realter
15 Social Security No ...
none
16 BIRTHPLACE (City).
(State or country)
Massachusetts
17 NAME OF FATHER James Gardner Abbott
18 BIRTHPLACE OF
FATHER (City)
Andover
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Mary Elizabeth Pearl
20 BIRTHPLACE OF
MOTHER (City)
Dover, He
(State or country)
New Hampshire
21
Informant
(Address)
James G. Abbott
152 Pleasant St
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter & Krakers
(Signature of Agent of Board of Health or others /
1 U3
calle Officer (Official Designation)
(Date of Issue of Permit) 4
CTIONS R ERTIFICATE ving DEATH enter an one r each and (c)
es not mean dying, such re, asthenia, the disease. ions which
conditions, grise to the (a) stating ing cause
ns contrib -- eath but not disease or sing death.
SOM (0)- 1-51 903586
PARENTS
Lawrence
no
Registered 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 cleceased, 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, shail. 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 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 hy 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 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
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