USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 23
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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 madc ...... .. Chap. 114, Sec. 46, G. L., as amended.
Medical examiners shall make cxamination 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 discase, 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 nis 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 carc 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 alfordeaths 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 spontancous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
(8-15-18)
DATE OF ENTERING MILITARY SERVICE
8-15-1918
DATE OF DISCHARGE
1-27-1919
RANK, RATING.
Chief Commissary Steward
ORGANIZATION AND OUTFIT navy Commissary School Boston Mass
SERVICE NUMBER 1214769
A R-301A 1
PLACE OF DEATH
Suffolk (County
(City or Tow Day)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME ..
( deceased is a married widowed or divorced woman, give also maiden name.) 41Nasfungton are
(THTRO)
(Was deceased a U. S. War Veteran, if so specify WAR)
St. (If nonresident, give city or town and State)
Length of stay: In place of death .years months
3
days. In place of residence 50 years
.months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
april
9
1953
(Year)
(Month) (Day)
4 I HEREBY CERTIFY,
That I attended deceased from
June 1950 to april 9. 1953
I last saw had alive on.
april 9, 1953 death is said to
have occurred on the date stated above, at 10:15 P.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
a) Cerebral Trombosis
ANTE CEDENT (b)
· arteriosclerosis
CAUSES
Due To (c)
1
OTHER
SIGNIFICANT
CONDITIONS
Hypertension
Vogro.
Major findings: Of operations. rione
Date of operation.
Was autopsy performed ?.
What test confirmed
Clinical exam
5 Was disease or injury in any way related to occupation of deceased ?..... d.
(Signed)
Charles Liberar
M. D.
(Address) 23& Slune Drive Wingate 4/ 9/ 1953
Place of Burial or Ckemation DATE OF BURIAL. cahil 13 19/
7 NAME OF
FUNERAL DIRECTØR.
Maurice W I fuby
ADDRESS
Received and filed APRICO 1958 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8-SEX
9 COLOR ØR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Nedowach
10a If married, widowed, or divorced HUSBAND of.
(or) WIFE of
Etienne I Dussault (Husband's hame in full)
If under 24 hours
Hours . . Minutes
13 Usual
Occupation :
home
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
Buttonmont
16 BIRTHPLACE (City).
(State or country)
Edward Patro
17 NAME OF
FATHER
18 BIRTHPLACE OF FATHER (City) (State or country)
Canada.
19 MAIDEN NAME
OF MOTHER
Lacal Bacon
20 BIRTHPLACE OF MOTHER (City) (State or country)
Canada
21
Informant (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Brakes (Signature of Agent of Board of Health or other)
4,10.57
(Official Designation)
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, cations which ith.
id conditions, ing rise to the se (a) stating rlying cause
tions contrib- e death but not the disease or causing death.
50M-2.19-25666
No.
Strachuglow Que
To be filed for burial permit with Board of Health or its Agent.
JEANETTE E DUSSAULT
(a) Residence. No. (Usual place of abode)
(write the word)
TWEEN ONSET AND DEATH 5 Days 11 IF STILLBORN, enter that fact here. AGE 45 Years Months ... ..... Days
10 yrs
PARENTS
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 shallexhume 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 cxamination 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 discases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable dliscase, 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 nosuch 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. ++ 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 ohpractge:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have giyen' 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, Kap Mich without recent medical attendance or whose physician is absent from hohe 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 occup :- 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
....
A R-301A 1
PLACE OF DEATH
Suffolk Winthrop (Calinty)
BESTEN 3/6/53
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
90
(City or Town) Winthrop Community Hospital No. James J. Collins 2 FULL NAME
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)
(If deceased is a marned, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 517 Orleans
(Usual place of abode)
Length of stay: In place of death .years .. .months. 11 days. In place of residence.
40
.years months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
april
10
1953
(Year)
(Month) (Day)
That I attended deceased from
10
19
1953 death is said to
have occurred on the date stated above, at. m.
INTERVAL BE-
TWEEN ONSET ANO DEATH hour
ANTE
CEDENT (b)
CAUSES
Due To
surgery hemay.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
. T.
Major findings: Of operations. huppertimplied Prostate
Date of oper
april 1,643
.Was autopsy performed ?. 100
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
(Address)
M. D.
Date 0/411 19
6 Holy Cross Place of Burial or Cremation
Melden City of Town)
DATE OF BURIAL april 14 1957
7 NAME OF
FUNERAL DIRECTOR:
Charles H. Treanor
ADDRESS Each Boston
Received and filed
APR 13 1953 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M.
9 COLOR OR RACE
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCEDlowed
10a If married, widowed, or divorced HUSBAND of Mary
a. Gaffney
(Giy, maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ...
89.
Months Days
If under 24 hours Hours Minutes
13 Usual
Occupation:
Real Estate Operator (Kind of work done during most of working life)
14 Industry or Business: Real Estate
15 Social Security No ..
16 BIRTHPLACE (City) (State or country) priland
17 NAME OF FATHER John Collins
18 BIRTHPLACE OF FATHER (City) (State or country)
treland
19 MAIDEN NAME
OF MOTHER
Ellen Mccarthy
20 BIRTHPLACE OF MOTHER (City) (State or country)
freland
21 Informant (Address) 517Orleans ft . Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjal or transit permit was issued: Walter A. lakers
(Signature of Agent of Board of Health or other) Health Office 4.13.53
(Official Designation )
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, cations which th.
id conditions, ing rise to the se (a) stating rlying cause
tions contrib- e death but not the disease or causing death.
50M-5-52-907046
4 I HEREBY CERTIFY,
Search 28 1953
to.
I last saw
h /m alive o
SLIP.
DISEASE OR CONDITIONPERIP HERE! Circula TRBy DIRECTLY LEADING Sempler Circulatory TO DEATH (a) collapse
East Basta
(If nonresident, give city or town and State)
To be filed for burial permit with Board of Health or its Agent.
PARENTS
Walter Collins
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 deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114. Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the 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 deathsonly as those of sans who, though disabled by recognized disease unrelated to any form of injury: have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation. the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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