USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 66
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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 he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, See. 46, G. L., (Tereentenary Edition).
RULES OF PRACTICE
The fulfilment 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 7fromethome 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 eaused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical
received a permit from the board of health or its agent aforesaid or from the que drugs or poisAfs) 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 ean 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)
Revere
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
REVERE (City or town making return)
Registered No.
212
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Burliegh Scammon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 64 Prospect Ave.
Winthrop ...... Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
.. months
.days. In place of residence.
5
.. years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September 1,
1953
(Month) (Day)
(Year)
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
(write the word)
or DIVORCED Divorced
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.)
11a If married, widowed, or divorced
HUSBAND of
Ada (Smalley) Scammon
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
Coronary occlusion
12 IF STILLBORN, enter that fact here.
Years.
13
AGE 58
6
.Months.
2.7 Days
If under 24 hours
Hours ........ Minutes
14 Usual
Occupation :
FordDealer
~
Date and hour of injury 19
Where did .
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Specify type of place)
Manner of
(How did injury occur?)
Nature of
While at work?
.Was autopsy performed?
No
6 Was disease or injury in any way related to occupation of deceased ?. If so, specify.
(Signed)
Michael A, Luongo
M. D.
(Address)
25 Shattuck St. Date 9/2/
19 .... 5.B
7 Norfolk Cem. Norfolk ... Ma.s.s.
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL October 11 19
53
22 Informant ..... Sgt ..... Burleigh .... E. .... Scammon (Address) Ha, Air Rescue Service 3800
8 NAME OF
FUNERAL DIRECTOR Eastman .... Funeral .... Service TRUE COPY.
ADDRESS
896 Beacon Street, Boston, Mas STTEST:
Received and filed. OCT. 16,1953 19
(Registrar of City or Town where deceased resided)
DATE FILED
........
October 14,
53
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-305 to the clerk of the city or town in which the deceased resided as soon as possible Injury 25m-(h)-10-48-24658
M R-305 1
WRITETLAINGI, WETTTONFAVING DLALE INA - THIS IS APERMANENT RECORD Injury
PARENTS
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
20 MAIDEN NAME
OF MOTHER
Mary Belle Stinson -
21 BIRTHPLACE OF
MOTHER (City)
Franklin
Norfolk
17 BIRTHPLACE (City) ..
(State or country)
Mass.
(Kind of work done during most of working life)
15 Industry
or Business:
Cannot ..... Be .... Learned
L
16 Social Security No .... Cannot Be Learned -
18 NAME OF
FATHER
Eugene P. Scammon -
(State or country)
Maine
(Registrar of City or Town where death occurred)
...
5 Accident, suicide, or homicide (specify)
(Was deceased a
U. S. War Veteran.
if so specify WAR).
WW I
No. 438 Boulevard
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
Nov. 7, 1917
March 3, 1919
Pvt. Q.M.C. Camp Devens 1 669 821
OCT16
IROP MAS ...
.....
..
RECEIVED
AM
P
PLACE OF DEATH Suffolk (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial pormit with Board of Health or its Agent.
Registered No. ...... .....
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
J (Was deceased a U. S. War Veteran,
( if so specify WAR) 213
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death ........ .. years. months. days. In place of residence ............ years .. .. months. 1 days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
September 28 1953
(Month) (Day)
(Year)
9 SEX
Male
10 COLOR OR RACE Urfete
11 SINGLE
MARRIED
WIDOWED
or DIVORCED ~
-
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.
13 AGE Years Months ...
Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation:
none
(Kind of work done during most of working life)
15 Industry or Business: none
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Y
18 NAME OF FATHER Unknown
19 BIRTHPLACE OF
Unknown
FATHER (City). (State or country)
20 MAIDEN NAME OF MOTHER Dowo tru Som
21 BIRTHPLACE OF MOTHER (City) (State or country) Minnesota
Informant. (Address)
Doug Beatrice Sagar 428 Revere St. Winters
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or Transit permit was issued:
Walter A Hoakerry
(Signature of Agent of Board of Health or other)
Health Of Recer 11753
(Official Designation) (Date of Issue of Permit)
25M (A).8.50-902 592
Tlasp. L Injury 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 If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. information should be carefully supplied. MEDICAL EXAMINERS should stato CAUSE AND MANNER OF Nature of Injury
5 Accident, suicide, or homicide (specify) Date and hour of injury .19
Where did Injury occur ?. (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
Manner of
(Specify type of place)
(How did injury occur?)
While at work?
.Was autopsy performed?
Yes
6 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed) 1 ... lichavil tard M. D.
.Date ... 9-28 1053
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL. November 2
1953
8 NAME OF FUNERAL DIRECTOR Howard & Reynolds 180 Winthrop St. Dintly ADDRESS.
Received and filed. NOV 2 1953 ......
..... 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
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.) Asphyxiation due to
c) spiration of blood Amniotic fluid- Unattended birth-
and
R-303 A 1 Winthrop (City or Town) 428 Revere St No. Baby Boy Sacar 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
428 Revere St. (If nonresident, give city or town and State)
hop
PARENTS
Minneapolis0
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 onc, 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. 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 giveri 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 discase resulting from injury or infection related to occupation, the sudden deaths of persons not 'disabled by recognized disease, and those of persons found dead. NAV
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 steamn 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 Led)." "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.
X 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.
214
2 FULL NAME
Frances M. Caverly
MacNeil1 )
(If deceased is a married, widowed or divorced woman, give also maiden name.)
106 Sunnyside Ave
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ... years. months days. In place of residence. 10
.. years
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Get
4
1953
(Month)
(Day)
(Year)
Female
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEarried
4 Į HEREBY CERTIFY,
That I attended deceased from
10
19 5.2
I last saw h.
alive on
10
.- 4
19 5%, death is said to
3 32
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary Pranchasis
TWEEN ONSET AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE67
Years
Months
Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Nova Scotia
17 NAME OF
FATHER
Hector G. MacNeill
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Catherine MacNeill
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21 Informant (Address) 106 Sunnyside Ave. Winthro
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Makers-
(Signature of Agent of Board of Health or other)
Heal thier 10-6-53
(Official Designation)
(Date of Issue of Permit)
50M-5-52-907046
Place of Burial or Cremation
Winthrop (City or Town)
DATE OF BURIAL
October
53
7 NAME OF
FUNERAL DIRECTOR.
Winthrop Mass.
ADDRESS
PAT 6 - 1953
Received and filed
19
(Registrar)
8 SEX
9 COLOR OR RACE
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Charles G. Caverly
(Husband's name in full)
ANTE
Due To
arterial hypertension
CEDENT (b)
CAUSES
Due To
Branchopneumonia
(c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Was autopsy performed? Lo
Date of operation
What test confirmed diagnosis? (Weg (3) x-Rays felt
5 Was disease or injury in any way related to occupation of deceased?
If so, specify~
M. D.
(Signed).
(Address) 447 Swidy Sr Distur Date Get
1923
6 Winthron
M R-301A 1
RUCTIONS FOR 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.
No.
Winthrop Community Hospital
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) -
(a) Residence. No. (Usual place of abode)
9-30
52
19
to
have occurred on the date stated above, at
Pm.
4
Registered No.
Charles G Caverly
John . O'malley
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 he 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
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