USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 29
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(City or town making return)
Registered No.
86 3298 ...
f(If death occurred in a hospital or institution, ......... St. [ give its NAME instead of street and number)
2 FULL NAME
FLORAN. KELLEY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
235 Washington Ave
Stå
(Was deceased a
U. S. War Veteran,
if so specify WAR).
idas.s
(a) Residence. No.
(Usual place of abode)
XXX
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
.months.
.7 ..... days. In place of residence .......... years.
... months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
12
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
... 4/6
... 19
...
to ...
4/10
1954.
19.5.4
death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Willie I Kelley
(Husband's name in full)
have occurred on the date stated above, at 1.4.3.0 .. > .m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Agphyxia
TWEEN ONSET AND DEATH 30mins
11 IF STILLBORN, enter that fact here.
12
AGE ... £3.3. Years.
... Months .. 2.2 ... Days
If under 24 hours
.. Hours .....
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
-
40,00
15 Social Security No ..
16 BIRTHPLACE (City).
(State or country)
Boston, Mass
OTHER SIGNIFICANT CONDITIONS "Bleeding from broncho-
3his
Major findings:
Of operations.
umor in rt.main stem bron
Date of operation
4/12
Was autopsy performed ?.
......
What test confirmed diagnosis ?.
biopsy
19 MAIDEN NAME
OF MOTHER
-unable to obtain
5 Was disease or injury in any way related to occupation of deceased? .no ..
If so, specify
(Signed)
(Address).
M. D.
.Date
170 19 F
The Park
6 Place of Burial or Cremation (City or Town)
19
4
Informant
(Address)
Đ williamson
7 NAME OF
FUNERAL DIRECTOR
A Marsh
ADDRESS
Winthrop,
Received and filed. APR 2-6-1954
19
(Registrar of City or Town where deceased resided)
A TRUE COPY()
ATTEST:
(Registrar of City or Town where death occurred)
Apr 16
19
V.1B V/
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-10-53-910621
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible,
ANTE
Due To
Pulmonary congestion
CEDENT (b)
CAUSES
1yr
Due To
(c)
Heart .... failure
1yr
17 NAME OF
FATHER
Alfred T nelson
PARENTS, CO
chus BIRTHPLACE OF
FATHER (City).
(State or country)
Sweden
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
DATE OF BURIAL
Apr ..... 15
21
DATE FILED
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
I last saw h ..... e.L ... alive on
4/12
8 SEX
No.
Mass .... MemorialHospitals.
M.S.
scopic biopsy site
PPR86
PLACE OF DEATH
Suffolk
(County)
I R-301 - Winthrop
(City or Town) 44 Pleasant Street No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
83
f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Maggie Georgina (Coles) Loukes
(If deceased is a married, widowed or divorced woman, give also maiden name.)
44 Pleasant Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
.. months.
days. In place of residence.
.years
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
april
13
1954
(Month)
(Dax)
0 ( Year )
HEREBY CERTIFY.
That iattended deceased from
anil 10
1951
to
195
I Vast saw h . alive on.
april 12 1954 death is said to
INTERVAL BE-
have occurred on the date stated above, at 5:30 Am.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE offerton H Loukes
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
Months.
23
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 ...
.. one
16 BIRTHPLACE (City)
(State or country)
E. Island
17 NAME OF
FATHER
James Coles
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country) P.E. Island
19 MAIDEN NAME
OF MOTHER
Agnes Taylor
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
P.E.Island
21 Marguerite Loures
Informant ..
(Address)
44 Pleasant St. With
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter & Laker (Signature of Agent of Board of Health or other)
Theatthe Officer 4.14.5€
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
2 yrs
6 mois
6 hrs
OTHER SIGNIFICANT CONDITIONS
Major findings: Lechenocarcinoma Nt. overy Of operations.
Date of operation.
May 14 h& au opsy performed?
2011
What test confirmed diagnosis ?.
clinical + pathological
5 Was disease or injury in any way related to occupation of deceased? to
If so, specybe
ahamo
(Signed)
(Address) 562 Jaitley St Date 4/14/54
M. D.
Evergreen Un thuysit Land Vermont 6
Place of Burial or Cremation
DATE OF BURIAL
April 16
19.5.5
7 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Winthrop mais
Received and filed.
/ APR 1 1954 19
(Registrar)
8 SEX
Femalel
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widow
(write the word)
1
4
JCTIONS OR CERTIFICATE riving F DEATH t enter han one for each b) and (c)
oes not mean dying, such ure, asthenia, - s the disease, tions which 1.
id conditions, ig rise to the (a) stating ying cause
tions contrib-> death but not e disease or using death.
50M .(A)-11-51-905807
.S.
TWEEN OHSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Papillary cysto-
a deurcan amoma ht. ovary
Due To
To General
ANTE
CEDENT (b)
CAUSES
Carcinom
tosio
Due To
Terminal
Premia
28
28
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
(City or town making return)
(City or Town)
South walton
80 9
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 helief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive hy 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 hy the preceding section or hy section forty-five of chapter one bundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in tbe 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 Fehruary 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 seven- teen. G. L. Chap. 46, Sec. 10.
No undertaker or other person sball bury or otherwise dispose of a buman body in a town, or remove therefrom a human hody which has not been buried, until he has received a permit from the board of bealth, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town wbere the person died; and no undertaker or other person shall exhume a human hody 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 be bas received a permit from the board of health or its agent aforesaid or from the clerk of the town wbere the body is buried. No such permit shall he issued until tbere shall have heen delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to he 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 bereinafter 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 he 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 hody 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 hody has been sooner obtained hereunder. If the
death certificate contains a recital, as required hy 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 hoard 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 he 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 heen brought into the commonwealth until be bas received a permit so to do from the hoard of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be huried or the funeral is to he held, or from a person appointed to have the care of the cemetery or hurial 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 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 hy 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 ahortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disahled hy 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 he 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 he returned as at school or at home. For a woman whose only occupation was that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as bousekeeper-private family, cook-hotel, etc. For a person wbo 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)
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.
88
Winthrop Community Haykital No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Imis. Lattee Whitemore 2 FULL NA
(If deceased is a married, widowed or divorced woman, give also maiden name.)
98 Bellevue Que, Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years.
months .. 7 .days. In place of residence ... years months. .. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
4 I HEREBY CERTIFY,
19.
52
to ..
april 13
1954
I last saw her
alive on
april 12
195
.. , death is said to
3
4
m.
have occurred on the date stated above, at
INTERVAL BE-
DISEASE OR CONDITION
Mye olenous
DIRECTLY LEADING
TO DEATH (a) ...
Splenic Myelogenans
Leukemia
TWEEN ONSET AND DEATH
6 mes
ANTE
Due To
Chronic myocarditis
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? No
If so, specify La 7 Salerno
(Signed)
(Address) 175 Placesaux St.
Date april 13 1954
6
Winthrop
Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL April 15 19.5.4
7 NAME OF
FUNERAL DIRECTOR
Howard ( Uhrmed
ADDRESS Menthol Muco
Received and filed. APR 14 1954
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Winthrop
(State or country)
.a.ss .
19 MAIDEN NAME
OF MOTHER
Kary Pech
Penncann
20 BIRTHPLACE OF
MOTHER (City)
(State or country) New York
21 Charles H Whittemore
Informant (Address) Sc Bellevue Ave. inthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Halter A. lakers. (Signature of Agent of Board of Health or other)
4.14,56
(Official Designation) (Date of Issue of Permit)
V/
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Charles H Whittemore
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
83
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.
sone
Vineland
16 BIRTHPLACE (City).
(State or country)
New Jersey
17 NAME OF
FATHER
James P Turnbull
50M-5-52.907046
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
april
13 1954 (Year)
(Month)
(Day)
That I attended deceased from
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
25
Registered No.
M R-301A 1
RUCTIONS FOR L CERTIFICATE giving OF DEATH not enter than one · for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease, ications which ath.
bid conditions. ving rise to the se (a) stating erlying cause
itions contrib- te death but not the disease or causing death.
M. D.
2 yrs
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, ninetcen 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 hoard 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., (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 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 deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
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