Town of Winthrop : Record of Deaths 1951, Part 86

Author: Winthrop (Mass.)
Publication date: 1951
Publisher:
Number of Pages: 614

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 86

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DATE OF BURIAL November 2

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter . Baker (Signature of Agent of Board of Health ( other) Health Officer 11/1/5/ (Oficial Designation)

(Date of Issue of l'ermit)

...

(If nonresident, give city or town and State)

PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WARY Ruslan. Mais

St.

Registered No.

No.

2 FULL NAME

Boston 12/5/51

Means

That I attended deceased from

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death. stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.

A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.

No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person 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 deccased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner of cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).

Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or 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. 6.32. Sec. 4, Acts of 1945.

No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.

. . Chap. 114, Sec. 46, G. L., (Tercentenary Edition). .

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice :

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.

Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER

Conver 12/5/51

The Commonwealth uf Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH

To be filed for burial permit with Board of Health or its Agent.

Registered No.

...

......

No.

2 FULL NAM

Charles L. Moore

(If deceased is a married, widowed or divorced woman, give also maiden name.)

12 Vineyard St. Denvers Wars

St.

(If nonresident, give city or town and State)

Length of stay: In place of death.

... years ...

monthsdays. In place of residence 25 years.

months ..

- days.

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS

9 SEX

Malé

10 COLOR OR RACE

11 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

11a If married, widowed, or, divorced

HUSBAND of ..

(Give maiden name of wife in full)

(or) WIFE of.

(Husband's name in full)

12 IF STILLBORN, enter that fact here.

AGE: ? : "

.Years

Months.

Days

If under 24 hours

Hours .......

.Minutes

14 Usual

Occupation:

(Kind of work done during most of working life)

15 Industry

or Business:

033-16

5161

16 Social Security No.

17 BIRTHPLACE (City).

(State or country)

18 NAME OF FATHER

19 BIRTHPLACE OF

FATHER (City).

(State or country)

20 MAIDEN NAME

OF MOTHER

Hornet Hiv

21 BIRTHPLACE OF

MOTHER (City)

(State or country)

22 Informant (Address) 1

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:

35138

(Signature of Agche ol Board of Health or other)

NOV 1 1951

(Official Designation)

(Date of Issue of Permit)

BOSTON HEALTH DEPT.

5 Accident, suicide, or homicide (specify) accidental

Date and hour of injury ......

2mm- 2 -

1951

Where did

2 atlantic crean off Willer fr

Injury occur?

(City or town and State)

Did injury occur in or about home, on farm, in industrial place, or in publicet (place) ocean

(Specify type of place)

estouund dead in the beach at

(How did injury occur?)

Nature of Prut Shirley Winthrop.

Injury

While at work?

Was autopsy performed? 200

6 Was disease or injury in any way related to occupation of deceased?

If so, specify

(Signed)

(Address)

43 Ster

2016-3-3

1951

1 ...

(

1:00

DATE OF BURIAL. 19

8 NAME OF

FUNERAL DIRECTOR

ADDRESS

4.1

Received and filed ..

NOV 6 1951

(Registrar)

3 DATE OF

un0-2-1951

DEATH

(Month)

(Day)

(Year)

4 I 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.)

If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.

25M (B).8.50.902 592

PLACE OF DEATH

R-303 A 1

(County) Atlantic Ocean (City or Town)

f(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)

(a) Residence.

No.

(Usual place of abode)

of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF

PARENTS

M. D.

7 Place of Burial, or Cremation.

(City or Town)

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.

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. as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.

No undertaker or other person 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., as amended.

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.

.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 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.

(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

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: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."

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; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous 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

R-302 1

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, Ser 12, G. L.)

25M (E )-6-50.902253

PLACE OF DEATH

Middle ez (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

(City of town making return)

245

Registered No ..

1(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)

2 FULL NAME .. (I'dche 4 married, Hoved diforced woman, give also maiden name.)

(Was deceased a

U. S. War Veteran,

if so specify WAR)

(a) Residence. No. La0 Winthrop St. (Usual place of abode)"

onresident, give city or town and State)

Length of stay: In place of death .. .years ... ... months. .days. In place of residence .... years .. .months. .. days.

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

9 COLOR OR RACE

10 SINGLE

MARRIED

(write the word)

WIDOWEDWarrica

or DIVORCED

4 I HEREBY CERTIFY,

That I

attended deceased from

Sept. 1-

1951 to NOT 2

...

19.g.

I last saw h.

... alive on ..... Nov 2

51.

have occurred on the date stated above, at.

INTERVAL BE-

11 :00 A"

TWEEN ONSET AND DEATH

11 IF STILLBORN, enter that fact here.

AGE

.. +Years.

Months.

.. Days

If under 24 hours

.Hours.

Minutes

13 Usual

Occupation:

E.(kindJi won Gone during most of working life)

14 Industry

or Business:

Own Home

15 Social Security No ..

16 BIRTHPLACE (City)

(State or country)

Boston,

17 NAME OF

FATHER

18 BIRTHPLACE OF

Antonio I. DaCosta

FATHER (City).

(State or country)

Azores

19 MAIDEN NAME

OF MOTHER

Maria A. Faunts

20 BIRTHPLACE OF

MOTHER (City)

(State or country)

Azores

21 Informant Torech Rebelle

(Address)

A TRUE COPY

439 Winthrop St. Winthrop

ATTEST:

James J. Carroll

(Registrar of City or Town where death occurred)

Received and filed

NOV 1 3 1951

(Registrar of City or Town where deceased resided)

unknown

Due To (c)

OTHER

SIGNIFICANT

CONDITIONS

none

Major findings:

Of operations.

none

Date of operation.

none.

Was autopsy performed? 00

5 Was disease or injury in any way related to occupation of deceased? If so, specify no

(Signed) (Address)

.19 ...

6 Place ofmitli Cation Winthtio or Town)

DATE OF BURIAL

19.

NOV 5 51

7 NAME OF

FUNERAL DIRECTORJohn F ........ Naley

ADDRESS

Winthrop, Mass.

DATE FILED

November 2, 1951

.19

3 DATE OF

DEATH

(Un) 2, (Day)

1951(Year)

Female

white

10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)

(or) WIFE of .... Joseph abban

RebelAme in full)

DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) .. Cerebral Hemorrhage

day

ANTE

Due To CEDENT (b) CAUSES Arteriosclerosis"

What test confirmed diagnosis?

phys.

M. D.

PARENTS

No. 23 Wilson Rd.

. St.

death is said to

PLACE OF DEATH

Suffolk (County)

Winthrop (City or Town)

The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

To be filed for burial permit with Board of Health or its Agent.

246

Registered No.

No. Winthrop Community Hospital

J(If death occurred in a hospital or institution,

.. St. Į give its NAME instead of street and number)

2 FULL NAME William Edward Roberts (If deceased is a married, widowed or divorced woman, give also maiden name.)

(a) Residence. No. 29 Thornton Park

St.

(If nonresident, give city or town and State)

Length of stay: In place of death .. years ... months. 10 days. In place of residence 79 years months .days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF

DEATH

11 (Month)

(Day)

(Year)

4 I HEREBY CERTIFY,

Oct. 19

51.

to Nov ..

That I attended deceased from

10a If married, widowed, or divorced

HUSBAND of

Mary

3/21.200)

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

AGE 79 Years

Months .

Days

Hours . . Minutes

13 Usual

Occupation Stained Glass Artist

(Kind of work done during most of working life)

14 Industry

or Business :.

Self employd

15 Social Security No.

none

16 BIRTHPLACE (City).

Liverpool

(State or country)

England

OTHER

SIGNIFICANT

CONDITIONS

Major findings:

Of operations.

None

Date of operation

None

Was autopsy performed ?.

None

FATIIER (City)

Liverpool

What test confirmed diagnosis?

Clinical & X-rays

5 Was disease or injury in any way related to occupation of deceased?

If so, specify

(Signed)

(Address)

M. D.

Winthrop, Mass. DateLI-2-5119

6 Winthrop Cemetery, Winthron. Mass. Place of Burial or Cremation (City or Town)

DATE OF BURIAL November 5.1951

7 NAME OF

FUNERAL DIRECTOR

alfred To. Marche

ADDRESS

174 Winthrop St . Winthrop., Mass

Received and filed

NOV 6 1951

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

malel

white

9 COLOR OR RACE

10 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

Widowed

I last saw h

alive on 11-2

1. 50PM

have occurred on the date stated above, at

INTERVAL BE-

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Town of Winthrop : Record of Deaths 1951, Part 86

Author: Winthrop (Mass.) Publication date: 1951 Publisher: Number of Pages: 614

Author: Winthrop (Mass.)
Publication date: 1951
Publisher:
Number of Pages: 614