USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 8
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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
61
AGE
Years
- Months.
Days
If under 24 hours
Hours . . Minutes
13 Usual
Occupation :.
Labor ~~- (Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
17 NAME OF
FATHER
Unknown ) Uguccione
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria ( Pollato)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Informant (Address)
Wife
7 NAME OF
FUNERAL DIRECTOR
William E. Pepi
ADDRESS
971 Saratoga St. E.B.
Received and filed
FEB 1 6 1953
19
(Registrar)
19. 53
1957
death is said to
have occurred on the date stated above, at. INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
peritinitio
DIVERTICULITIS
ANTE
Due To
Questa divertualetes - a
CEDENT (b)
CAUSES
abscessed - raptured.
day
Due To (c) ANUCÍA
OTHER
anuria - lost 24 hrs.
SIGNIFICANT
CONDITIONS
divecticolain
SIGHOYD
Major findings:
perforated alsoned Aventuras sugar
Date of operat
FEB 1,1953
What test confirmed diagnosis ?.
Was autopsy performed? no labinotam test
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed).
21 Bread LA Date File 15.
1953
M. D.
(Address)
Holy Cross Cemetery
Malden
-
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Feb. 16, 1953
19
PARENTS
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Burial or transit permit was issued: Walter of Maker (Signature of Agent of Board of Health or other)
He although
fiche
2.16.53
(Official Designation) (Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such lure, asthenia. ns the disease. cations which th.
d conditions, ing rise to the e (a) stating lying cause
lions contrib- death but not he disease or ausing death.
50M (B).1.51 903586
R-301A 1
Registered No.
f(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
10 SINGLE
(write the word)
4 I HEREBY CERTIFY,
That I attended deceased
from
20 19
53
to
Fele 13
last saw h.
alive on
Fel 13
(a) Residence. No. (Usual place of abode)
Winthron Community Hos ital
2 FULL NAME
PERSONAL AND STATISTICAL PARTICULARS
days.
Italy
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 comphì 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, b& 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 seventeend10 G. L. Chap. 46, Sec. 10.
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 other than the receiving tomb to another in the same cemetery, until he } 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 r the funeral is to be hekl, or from a person appointed to have the care of the 1.7 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:
Attending physicians will certify to such deaths only as those of persons whom they have given bedside care during a last illness from disease unrelated
to any form of injury.
No undertaker or other person shall bury or otherwise dispose of a human body -(?), Board of Health physicians will certify to such deathsonly as those of in a town, or remove therefrom a human body which has not been buried, untilbe : " 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 remove it from a town, from one cemetery to another, or from one grave or B ( 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
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 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
25m-(c)-11-49-900.475
PLACE OF DEATH
Plymouth (County)
Plymouth
(City or Town)
No. Cliff
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Plymouth
(City or town making return)
Registered No. 29
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
David Noel Brewer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(a) Residence. No.
7 Faun Bar Ave.
St.
Winthrop, Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
......
.years
months.
1
days. In place of residence.
.....
.years.
7
months
22 days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
February
14,
1953
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.) Death by aspiration of
... vomi tus
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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
0
Years ..
7 Months.
23 Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :.
none
(Kind of work done during most of working life)
15 Industry
or Business:
16 Social Security No ....
none
17 BIRTHPLACE (City).
(State or country)
Mass.
18 NAME OF
FATHER
David L. Brewer
19 BIRTHPLACE OF
FATHER (City).
Plymouth
1
(State or country)
Mass.
20 MAIDEN NAME
OF MOTHER
Dorothy E. Nowell
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Brighton
7 Chiltonville Plymouth
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
February
17
19 5
8 NAME OF
FUNERAL DIRECTOR
Roy E. Beaman
ADDRESS
Plymouth Mass.
Received and filed
MAR 5 - 1953
.......... 19
(Registrar of City or Town where deceased resided)
PARENTS
Informant ...
22
Mr. David. L. Brewer
(Address) / Faun Bar Ave. Winthrop
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
February
17
,53
5 Accident, suicide, or homicide (specify).
Accidental
Date and hour of injury
Feb. 14
.. 19
53
8:00 p.m.
Injury occur?
Where did
Cliff St. , Plymouth , Mas s.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Home
Manner of
Injury
Aspiration of vomitus
Nature of
(How did injury occur?)
Injury
Suffocation
While at work?
no
.Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Walter E. Deacon
M. D.
(Address)
Date.
19
...
...
I R-305 1
(Specify type of place)
Winthrop,
RECEIVED
.. 1
0
1.9
TES
5
MAR-5
50M-5-52-907046
7 NAME OF
FUNERAL DIRECTOR,
Juderick Shagrant
ADDR
ss98 Havre St. & Boston
Received and filed.
REB 1 0 1905
19
(Registrar)
11 IF STILLBORN, enter that fact here.
12
57
.Years
Months
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :....
Housework
(Kind of work done during most of working life)
14 Industry
or Business :.
Pun home
15 Social Security No .... Provincetown
16 BIRTHPLACE (City). (State or country)]
mais.
17 NAME OF
FATHER
Joseph Johns
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Portugal
19 MAIDEN NAME
OF MOTHER Mary & Saton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Portugal
21 Informant
Ethel Laracy
5) 10 noble Ctl East Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transi) permit was issued: Walter 2, Bakery
(Signature of Agent of Board of Health or other) Health Officer 2 . 16 . 5}
(Official Designation)
(Date of Issue of Permit)
-
Nonterap Community Hospital
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
mary 9. Lalacy
(If deceased is a married, widowed or divorced woman, give also maiden name.) 10 Noble ' CV.
St.
E. Boston
(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 OF
DEATH
Feb
(Month)
14
(Day)
1953
(Year)
8 SEX
Female Site
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED"
WIDOWED
or DIVORCEDIGweed
4 L HEREBY CERTIFY,
19.480
to ...
Feb 14
190-3
I last saw her alive on K2B
13, 1955, death is said to
0
10a If married, widowed, or divorced
HUSBAND of ......
(Give maiden name of wife in full)
Patrick a Jaracy
(or) WIFE
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
4Remia
TWEEN ONSET ANO DEATH 4/8hs
ANTE
CEDENT
CAUSES
Kong disease
Due To arterio-selerstee
(b)
(c)
· Hypertension
essential
OTHER
Chronje capsular
SIGNIFICANT
CONDITIONS
heart disease-obesity
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? no
ft so, specify.
(Signed) socjalu 227
M. D.
(Address) 20 I malungle
Date 2-11 19:3
oHoly Cross
S VintoTrop. Matelem
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Feb 17
1953
Boston 3/6/5"
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.
30
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WARY
none
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.
R-301A 1
PLACE OF DEATH Suflack (County) enteros (City or town)
2 FULL NAME ..
(a) Residence. No. (Usual place of abode)
That I attended deceased
from
have occurred on the date stated above, at.
2:09 17.
.m.
INTERVAL BE-
PARENTS
Madre Islands
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.
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 ør: burial ground in which the interment is made.
Chap, 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
6
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 injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
No undertaker or other person shall bury or otherwise dispose of a human body thesons who, though disabled by recognized disease unrelated to any form of
(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
PLACE OF DEATH
Suffolk (County)
nathrop
(City or Town) 39 g No ... ....
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.
31.
J(If death occurred in a hospital or institution. St. { give its NAME instead of street and number)
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