USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 42
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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
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No.
Winthrop Community Hospital
J(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
(If deceased is a married, widowed or divorced woman, give also maiden name.) 16 James Ave. (a) Residence. No. (Usual place of abode)
St.
(If nonresident, 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
3 DATE OR
DEATH
N
(Month)
24
(Day)
1953 (Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCEDLarried
4 I HEREBY CERTIFY.
That I attended deceased from
July
58
19
to June 24
5.3
10a If married, widowed, or divorced
HUSBAND of ..
Bertha E Staples
(Give maiden name of wife in full)
I last saw him alive on
ajune 24, 1953, death is said to
have occurred on the date stated above, at.
+ 2Pm
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) Coronary thrombosis
INTERVAL BE- TWEEN ONSET AND DEATH 19 hours
11 IF STILLBORN, enter that fact here.
12
AGE
7.2
Years
8
Months
2 0Days
If under 24 hours
Hours .. ... Minutes
13 Usual
Occupation :
Clerk
(Kind of work done during most of working life)
14 Industry
or Business:
Store
15 Social Security No.
023-07-1611
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
Unable to obtain
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country)
Unable to obtain
Date of operation.
Was autopsy performed?
200
What test confirmed diagnosis ?.
Blood sugar 333
5 Was disease or injury in any way related to occupation of deceased ?.........
If so, specify.
(Signed).
(Address) +47 thirty Stu Dithup Date June 2× 1953
M. D.
6
Puritan Lawn
Peabody Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. June .26. 19 53
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed JUN 25 1963 19
(Registrar)
C
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME
Harold Austin Blackstone
-
( if so specify WAR)
TRUCTIONS FOR L CERTIFICATE
giving . OF DEATH not enter than one e for each (b) and (c)
s does not mean , of dying, such ailure, asthenia, eans the disease. lications which ath.
bid conditions. ving rise to the se (a) stating erlying cause
litions contrib- he death but not the disease or causing death.
50M (B)-1-51 903586
21 Informant. (Address) 16 James Ave. Winthrop
Bertha E Blackstone
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued: Salleet Wakerz. (Signature of Agent of Board of Health of other) Health Officer 6.25.53
(Official Designation)
(Date of Issue of Permit)
(or) WIFE of
(Husband's name in full)
ANTE
CEDENT (b)
CAUSES
diabetes mellitus
Due To
certini: sclerosis
Due To (c)
OTHER
peripheral vascular discor
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
19 MAIDEN NAME OF MOTHER Carrie Ostman
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to obtain
Unable to obtain
East Boston
7
10
(Was deceased a
U. S. War Veteran,
No
M R-301A 1
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!th preceding section or hy section forty-five of chapter one hundred and foura 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 boan 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. IR For the purposes of this section and of sections forty-five, forty-six and forty-scven 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 borde JUMS es of practice:
S service of nineteen hundred and sixteen and ninetcen 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 purposc, 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. GSC (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons I as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases Asudting from injury or infection relating to occupation, or suddenly when not disabled hy, recognizable disease, or when any person is found dead. .. - General Lai's, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
Mundertaker 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 o to do from the board of health or its agent appointed to issue such permits, or there is nosichboard, from the clerk of the town where the body is to be buried WatisAn be held, or from a person appointed to have the care of the A burial ground in which the interment is made.
14. Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow-
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 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
C C
t 1 C
t
€ S
L
V
T
( 1
1
S
T (
T ( S
T
1 1 1 €
1
1
.
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) No. 270 Winthrop Street GEORGja Gerogia (Albin) Hicks
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. 137
2 FULL NAME
(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. Hampton
New Brunswick
St.
(If nonresident, give city or town and State)
Length of stay: In place of death . years .. months .. 21 .- days. In place of residence
7 9years ..
. . months .
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day)
(Year)
That I attended deceased from
1000
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Allan W Hicks
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
AGE
Years
Months
19
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
Due To Cantena sallisono (c)
generalized
Years
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
E.K.G.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ......
(Signed).
(Address) 194 Washington Date 6-25 1983
.. , M. D.
6
Hampton
Hampton New Brunswick (City or Town)
53
21 Informant (Address) 270 Winthrop St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter IK takker (Signature of Agent of Board of Health of other)
6,25,53
(Official Designation)
(Date of Issue of Permit)
S
1953
8 SEX
Female
White
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widow
I last saw halive on
Same 24, 1900
death is said to have occurred on the date stated above, at 10: 20 P. .. m.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)
Difonction
Due To
ANTE CEDENT (6) CAUSES sende
yo
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Conn.
17 NAME OF
FATHER
James Albin
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country)
Unable to obtain
19 MAIDEN NAME
OF MOTHER
Elizabeth Patterson
20 BIRTHPLACE OF MOTHER (City) (State or country)
Unable to obtain.
Curtis L Hicks
DATE OF BURIAL
Place of Burial or Cremation June 27 19.
7 NAME OF
FUNERAL DIRECTOR
Howard SPPainted
ADDRESS
Received and filed
JUN 2.5 1953
19
(Registrar)
50M (B)-1-51 903586
RUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease, ications which ath.
id conditions. ving rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
M R-301A 1
Registered No.
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
(Usual place of abode)
HIHEREBY CERTIFY,
June 24
5-3
19
24hrs.
79
7
Hartford
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, shal1, if the ‹leceased, 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 ande taker 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 se todd for the board of health or its agent appointed to issue such permits, or if theni up such heard, from the clerk of the town where the body is to be buried dr the funetes is to be held, or from a person appointed to have the care of the cemetery or buHalground in which the interment is made.
et: 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
Ilboot of the purpose of these laws calls for the observance of the follow- (Lice : ding physicians will certify to such deaths only as those of persons they have given bedside care during a last illness from disease unrelated to any form of injury.
Board of Health physicians will certify to such deathsonly as those of (2) Tho, though disabled by recognized disease unrelated to any form of JUNE Five died without recent medical attendance or whose physician is absent . from nome 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
RM 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·3-53-909098
PLACE OF DEATH
"Suffokčbunty)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City (@ @thalgpg return)
Registered No.
138
5792
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a mark Pauloco forced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abody Brewster Ave. ...
Wifithripresident give city or town and State)
Length of stay: In place of death ........... years. monthsdays. In place of residence ............ years
months.
.....
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Male
hite
single
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
Years.
Months ... ]
Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Winthrop, Mass.
17 NAME OF
FATHER
Arthur MeGee
18 BIRTHPLACE 8F
FATHER (City) Dorchester, .... Mas.s.
(State or country)
......
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed). M. D.
(Address) B. Giedion 19
6
Plak of Burial @ogagon Maldemor Town)
DATE OF BURIAL
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