USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 85
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What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specif
M. D.
(Signed)
Winthrop, Mass Date Dec. 19 1953
No
remport Center Newport Center Vt ·
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
Dec. 22
.19 ..
Kauvad SOEunuldo
ADDRESS
Received and filed. DEC 2 1 1955 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Berkshire
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER
Melissa Sweet
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Vermont
Fairfield
21 Madeline Dic Ercon Dickinson (Address) 29 Somerset Ave. Wirth:00 Informant
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter . thather - (Signature of Agent of Board of Health or other)
Health Office
17.20,53
(Official Designation)
(Date of Issue of Permit)
L
UCTIONS FOR CERTIFICATE
giving OF DEATH t enter than one for each b) and (c)
does not mean f dying, such ure, asthenia, ns the disease. ations which h.
d conditions, ng rise to the (a) stating lying cause
ions contrib -- death but not e disease or ausing death.
50M-5-52-907046
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
EmbolisTii
Pulmonary
About months
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At home
15 Social Security No.
wione
Newport Center
16 BIRTHPLACE (City)
(State or country)
vermont
17 NAME OF FATHER Alvin Larabee
AGE
Years
9 COLOR OR RACE
(write the word)
8 SEX
Female White
10 SINGLE
MARRIED
WIDOWED
DIVORCED Wid OW
have occurred on the date stated above, at 10:15 P.
.. m.
INTERVAL BE-
MEDICAL CERTIFICATE OF DEATH
(If deceased is a married, widowed or divorced woman, give also maiden name.) Newport Center Vermont St. (Usual place of abode)
(If nonresident, give city or town and State)
R-301A 1 Winthrop (City or Town)
7 NAME OF
FUNERAL DIRECTOR
Winthrop Miss.
(Address)
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
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., (Tereentenary 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 he 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, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ·ing rules of practice:
+ (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form.of injury.
(2)- Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably dya to injury. These include not only deaths caused directly or indirectly by Utraumatism (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
R-301 1
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
(City or town making return)
Registered No. ...... 276
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
6 Jefferson St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
years
.. months.
11
30
.days.
In place of residence.
years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December 2/1953
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCEDSingle
HEREBY CERTIEY,
act. 16
50
19.
.to
et I attended deceased from
Dec. 21/53
I last saw her alive on
dec 21, 195 death is said to
have occurred on the date stated above, at.
52.1
.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
Viterionclectic
TO DEATH (a) ..
Heart Disease
Due To
·Branco-
ANTE
CEDENT (b)
CAUSES
Premmu
na
Due To
Uremia
(c)
OTHER
Congestive Heart
SIGNIFICANT
CONDITIONS
Failine
6 mois
Major findings:
Of operations
none
20
Date of operation
.. Was autopsy performed
What test confirmed diagnosis!
clinical x lah
5 Was disease or injury in any way related to occupation of deceased60
If so, specif
(Signed).
Chamo M. WM. D.
Date 12/22/83 netappverett
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. 1953
7 NAME OF
FUNERAL DIRECTOR:
Howard S Pugnolds
ADDRESS
Received and filed. 19
(Registrar)
A TRUE COPY ATTEST:
TWEEN ONSET AND DEATH 3 yrs. AGE Years
12
82
0
15
Months
Days
If under 24 hours
Hours
.. Minutes
13 Usual
Occupation:
Forelady
(Kind of work done during most of working life)
14 Industry
or Business:
Envelope Co.
15 Social Security No
0-1-05-8541
larchfield
16 BIRTHPLACE (City).
(State or country)
Lass.
17 NAME OF
FATHER
Henry Baker
18 BIRTHPLACE OF
FATHER (City)
Duxbury
(State or country)
ass.
19 MAIDEN NAME
OF MOTHER
Maria Drale
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Hass.
Pembrook
21 Verna D Cole
Informant
(Address)
10 Center F1. Saurus Lass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial os transit permit was issued: quite
(Signature of Agent of Board of Health or other)
alter Nace
12.33 .5 3
(Official Designation) (Date of Issue of Permit)
1
TIONS R ERTIFICATE
ving DEATH enter an one r each and (c)
es not mean dying, such e, asthenia, the disease, ions which
conditions, rise to the (a) stating ing
> ons contrib. ath but not disease or sing death.
50M-(A)-11-51-905807
15.
Winthrop Community Hospital No. Hattie Naria Baker
f(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
10 SINGLE
(write the word)
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.
2 w/s
48 ks
PARENTS
Dec. 23
(a) Residence. No.
(Usual place of abode)
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 tbe 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, ninetcen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seven- teen. 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 buman 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 wbere tbe 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 hy 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 hy 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 registration. 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 only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . .
. General Laws, Chap. 38, Sec. 6.
No undertaker or other persons shall bury a human body or the ashes thereof which have. been brought into the commonwealth until he bas 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.
. .. Cbap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following 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 deatbs only as those of ", persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3)- Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical - (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, 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 bad 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 .....
R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
BB051020 1.7/54
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.
Registered No.
J(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
East Boston St.
(a) Residence. No.
48 Orient Avenue (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death years ........ months.
3 . days. In place of residence
15.years
. . months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female White
9 COLOR OR RACE
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
That I attended deceased from
Lee 20.
19 53
to ..
Dec 29
I last saw her alive on.
Deg 22
195, death is said to
have occurred on the date stated above, at ...
4:20 am.
INTERVAL BE- TWEEN ONSET ANO DEATH 3days
11 IF STILLBORN, enter that fact here.
12
AGE.5.4 ... Years
8
Months
2.0 Days
If under 24 hours
Hours . . Minutes
13 Usual
Occupation :.
At home
(Kind of work done during most of working life)
14 Industry
or Business:
Housewife
15 Social Security No.
None
16 BIRTHPLACE (City).
East Boston
(State or country)
Mass.
17 NAME OF
FATHER
Victor Wennerstrom
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Sweden
19 MAIDEN NAME
OF MOTHER
Regina Peterson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
21 Mr ..... William H. Barker-hus.
Informant
(Address)
48 Orient Ave. E. Boston
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS917 Bennington St., E. Boston
Received and filed.
DEC. 28.1953
19
(Registrar)
5B
10a If married, widowed, or divorced
HUSBAND of .
(Give maiden name of wife in full)
(or) WIFE of
William H. Barker
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING SEVEREMarque
TO DEATH (a) Scare
ANTE
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
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?
(Signed)
(Address) 193.
1 / 5 Date Due 23 19 21
M. D
6 Winthrop Cemetery, Winthrop Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
December 26th
19
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Waller It takes
(Signature of Agent of Board of Health of other) Thealthe Office 17.44.5 3
(Official Designation)
(Date of Issue of Permit)
X
ICTIONS OR ERTIFICATE
iving F DEATH t enter han one or each ) and (c)
Does not mean dying, such ure, asthenia, s the disease. tions which
conditions, g rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
50M (B)-1-51 903586
No. Winthrop Community Hospital
2 FULL NAME
Regina V. Barker
(Wennerstrom)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
3 DATE OF
DEATH
Doe
23
(Month)
(Day)
1959
(Year)
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 deccased. furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, nis 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 ( fficer 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, sha 1. 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-cight 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.
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