USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 2
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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, See. 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 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.
1> (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
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 steain 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
M R-301A 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
To be filed for burial permit with Board of Health or its Agent.
5
No. DAY VIEW MARY ELIZABETH ROBBINS 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
No. 41 WASHINGTONSE WINTHROPSt.
(If nonresident, give city or town and State)
Length of stay: In place of death ... years. 6 .months
.. days. In place of residence
1 years 6 .. months. .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Jan
(Month)
7.
1954
(Day)
(Year)
8 SEX
FEMALE WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDS / NCLE
4 I HEREBY CERTIFY,
That I attended deceased from
1954
to
Jan 7.
1934
last
12 alive
Jan UA 195 26
death is said to
have occurred on the date stated above, at 11.10 P m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE + Years
.Months
.Days
If under 24 hours
Hours .. ... . Minutes
13 Usual
20 years
Occupation :.
RETIRED TEACHER
(Kind of work done during most of working life)
14 Industry
or Business:
PERKINSINSTITUTE
15 Social Security No /GR
16 BIRTHPLACE (City)
(State or country)
MAASS
17 NAME OF
FATHER
FOREMANL, ROBBINS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
SVEIN
19 MAIDEN NAME
OF MOTHER
SARAH WHEELER
20 BIRTHPLACE OF
MOTHER (City)
UNKNOWN
(State or country)
21 Informant. REV. POJELAS ROBBINS (Address): 5- ELM ST. AUGUSTA ME
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter Liftakers
X
(Signature of Agent of Board of Health-of other)
Theatthe Office
1.5.04
(Official Designation)
(Date of Issue of Permit)
50M (B)-1-51 903586
7 NAME OF Wendell W. 64, Simon FUNERAL DIRECTOR.
ADDRESS
23 Gary cere C. telia
Received and filed.
January 8, 1954
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? HLV
If so, specify
(Signed)
(Address) Chelosa Tunes
-
73 h. Chutoch
M. D.
Date Jan E
NASHUA N.H. -
6 1: 10 ALAWN Place of Burial or Cremation (City or Town)
DATE OF BURIAL
JAN. 11,
1954
Major findings:
Of operations.
Date of operation
.Was autopsy performed?
What test confirmed diagnosis?
15 year
ANTE CEDENT (b) CAUSES
Due To arteriosclerosis
Due To (c)
10a If married, widowed, or divorced
HUSBAND of ..
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
degeneration
Myocardial.
9 COLOR OR RACE
Registered No.
NE HOME 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)
Residence. (Usual place of abode)
RUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not mean of dying, such silure, asthenia, ans the disease. ications which ath.
bid conditions. ving rise to the se (a) stating erlying cause
ditions contrib- he death but not the disease or causing death.
DUNSTABLE
OTHER
SIGNIFICANT
CONDITIONS
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 pernuits, or if there is no such board, from the clerk of the town where ther person died; and no undertaker or other person shall exhume a human body abdil 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 elerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) , Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease recalting 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
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, Ser 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
PLACE OF DEATH
Middlesex (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Medford
(City or town making return)
6
Registered No.
f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 176 Bowdoin
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
......
.. years ..
.months.
2 .... days. In place of residence
31
.. years
.months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
8
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
Jan
6
19 54
to.
Jan
8
19
54
HUSBAND of.
Marjorie Loraine Brayne
(Give maiden name of wife in full)
have occurred on the date stated above, at
1.30 Am.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Hypostatic Pneumonia
1dy
ANTE
Due Carcinoma of stomach
CEDENT (b) CAUSES
Due ToCarcinoma of Rectum
(c)
3yrs
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Ca. Stomach & Rectum
Date of operation.
Was autopsy performed ?.
no
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? no
If so, specify ..... . ] Wallis L. Bursey
(Signed) 3.51 -Bieg
St.
Date 1/8 54
19
6 Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Jan 11, 1954
19
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS
174 Winthrop St. Winthrop
Received and filed
FEB 2 1604
19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE ..
83 Years
3
Months
9
.Days
If under 24 hours
.Hours.
Minutes
13 Usual
Retired Coke Mfgr.
Occupation :.
(Kind of work done during most of working life)
14 Industry
or Business:
Cambridge Gas & Electric
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Nova scotia
17 NAME OF
FATHER
Leonard Andrews
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Mary Gavel
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21
Lester J. Andrews
Informant
(Address)
176 Bowdoin St. Winthrop
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
City Clerk
DATE FILED
Jan 11, 1954
19
X
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M (E)-6-50-902253
W SI
M R-302 1 Medford (City or Town)
No. Resthaven, Nursing Home 96 Mystic St. Leonard B. Andrews
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(Usual place of abode)
8 SEX
male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
wi dowed
54
im
I last saw h.
alive on
Jan 8
19
death is said to
10a If married, widowed, or divorced
(or) WIFE of
(Husband's name in full)
2yrs
(Address) ModTord
Winthrop
....
6
FEB-3
c
F
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 4 Atkinson Circle
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. \ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
4 Atkinson Circle
St. . .
(If nonresident, give city or town and State)
Length of stay: In place of death years. months. days. In place of residence
25
years
.months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January
8
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
1958
to ..
Jan 8
Jan. 8, 1955, death is said to
have occurred on the date stated above, at 6:100 m.
DISEASE OR CONDITION DIRECTLY LEADING Caro TO DEATH (a). OSalus ou
ANTE
CEDENT (b)
CAUSES
bent disease
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation.
Was autopsy performed?
What test confirmed diagnosis?
clinical finden
5 Was disease or injury in any way related to occupation of deceased?
Stregone
M. D.
If so, specify
(Signed)
(Address) 194. Wasteembar az Date 1-8
1954
Holyhood
Brookline
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
January 11. 1954
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Winthrop Mass
4
Received and filed. 1
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
White
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIWarmDied
10a If married, widowed, or divorced
HUSBAND of .
(Give maiden name of wife in full)
(or) WIFE of
Harry M. Atkinson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE52
.. 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)
East Boston
Mass
17 NAME OF
FATHER
Robert Black
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Bessie Hellyer
20 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Magg
21 Informant (Address) 4 Atkinson Circle
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter S- Bakker (Signature of Agent of Board of Health or other)
Thealth Ile der (Official Designation) (Date of Issue of Permit)
L
M R-301A 1
RUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one e for each (b) and (c)
does not mean of dying, such Bilure, asthenia, eans the disease. lications which ath.
bid conditions, ving rise to the ase (a) stating erlying cause
ditions contrib- he death but not the disease or causing death.
janadetine en) 2
50m-(b)-11-49-900,560
No.
2 FULL NAME .. Gladys G. Atkinson. (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. . (Usual place of abode)
That I attended deceased from
I last saw h
alive on
INTERVAL BE- TWEEN ONSET ANO DEATH
20 min
yo.
PARENTS
M Atkinson
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased. to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been. engaged. insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme; diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and. ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the." person died; and no undertaker or other person shallexhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose. the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
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