USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 50
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Wellfleet Mass.
Date of operation.
June ... 22Was autopsy performed?
Yes
What test confirmed diagnosis ?.
electrocardiogram
5 Was disease or injury in any way related to occupation of deceased .o If so, specify.
(Signed)
(Address)
Boston Mass
Date 7-2
19
Winthrop Cem-Winthrop Mass.
6 Place of Burial or Cremation July 6/54 19
DATE OF BURIAL.
7 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS Winthrop Mass.
Received and filed.
JUL ---- 19 .... 1954.
19
...
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
--- Coffey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Bos ton Mass.
E A Murray
A TRUE COPY Les A. Mackie
ATTEST:
(Registrar of City or Town where death occurred)
July 7/54
19
DATE FILED
25M-3-53-909098
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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,
No.
New England Center Hospt.
John B Murray
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop Mass.
(a) Residence. No. (Usual place of abode)
have occurred on the date stated above, at
8:05PM
.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
Myocardial infarction
TO DEATH (a)
4 Days
ANTE
CEDENT (b)
CAUSES
Due To
Arteriosclerosis.
Yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Dysphasia due to cerebral thrombosis
9 Mos.
Major findings:
Of operations.
Feeding ..... je junos to my
JH Fisher
(City or Town)
21
Informant.
(Address)
RM R-302 1
(Month)
(Day)
(Year)
10a If married, widowed, or divo nelizabeth A Rinn
HUSBAND of
(Give maiden name of wife in full)
'THROP.
JUL 19
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) MayFLOWER
NURSING
No. 39 Grovers Ave
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
150
2 FULL NAME ..
Paralee.G. Sanders
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran.
if so specify WAR)
(a) Residence. No.
20 Crescent St.,
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ..... years.
months. 2 .days. In place of residence 40 years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July 2 1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Sept.
50
19
to
July 1
13/54
I last saw her ..... alive on
July1.
19 ... 5.4death is said to
have occurred on the date stated above, at L.O ... 40A .... m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Senility
ANTE
Due To
Cerebralvascular.
CEDENT (b)
CAUSES
accident (old)
Due To
(c)
Arteriosclerosis
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 ...........
(Signed) ..
(Address) :47 Shirley st Wuistros Date July 2
M. D.
6
Mt ...... Hope Cemetery,Boston
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July 6
195.4
7 NAME OF
FUNERAL DIRECTOR
Mario Splans
ADDRESS
89 Walnut Ave Roxbury
Received and filed.
....... 1954.
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Columbia
(State or country)
South Carolina
19 MAIDEN NAME
OF MOTHER
?
20 BIRTHPLACE OF
MOTHER (City)
Columbia
(State or country)
South Carolina
John Sanders
Son
21
Informant ...
(Address)
20 Crescent St. , Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Matter
A. Haberg
(Signature of Agent of Board of Health or other)
Frealthe Office
7/4/54
(Official Designation)
(Date of Issue of Perr. . ),
>
9 COLOR OR RACE
10 SINGLE
(write the word)
8 SEX
Female
Colored
MARRIED
WIDOWED
or DIVORCED
Widow
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John A. Sanders
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 79 Years
Months.
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:
15 Social Security No. none
Charleston Columbia
16 BIRTHPLACE (City)
(State or country)
South Carolina
17 NAME OF
FATHER
?
Logan
IOOM-10-53-910621
R-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH t enter han one for each b) and (c)
oes not mean f dying, such ure, asthenia, is the disease. ations which
conditions, g rise to the (a) stating ying cause
ons contrib- Heath but not e disease or using death.
To be filed for burial pormit with Board of Health or its Agent.
HOME
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
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 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 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 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
X
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
151
Winthrop Community Hospital No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Albert E Cole.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, 1 if so specify WAR)
(a) Residence. No. 61 Washington Ave. Winthrop St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death. years. months ... .]. days. In place of residence 12 years
.. months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Jolly
(Month)
(Dag)
3
1954
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWEDMarried
or DIVORCED
4 I HEREBY CERTIFY,
19
...
I Just saw him alive on
to.
July 3
19 54 death is said to
INTERVAL BE-
have occurred on the date stated above, at 11:50 A.m.
10a If married, widowed, or divorced
HUSBAND of
Etta ... Merriam
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
66
Years
0 Months 4
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Electrical Contractor
(Kind of work done during most of working life)
14 Industry
or Business:
Cole Electric Co.
15 Social Security NQ13-07- 1679
16 BIRTHPLACE (City) Philadelphia (State or country) Penna.
17 NAME OF FATHER ClarenceCole
18 BIRTHPLACE OF
FATHER (City) (State or country)
Portland , Maine
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
Clinical
No.
(Signed)
(Address) WinthropMe Date July 3 1954
6
Winthrop Cemetery Winthrop Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL July 6, 1954 19
7 NAME OF
FUNERAL DIRECTOR
Leslie W, Pike
ADDRESS 305 Besch St. Revere
Received and filed
8 .1954 19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Carrie Edwards
(State or country)
Mass
21 Informant. Etta Cole
(Address) 61 Washington Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter f. Walker (Signature of Agent of Board of Health or other)
I Dealte Oficer 76/54
(Official Designation)
(Date of Issue of Permity
5.
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
giving : OF DEATH
not enter e than one e for each . (b) and (c)
s does not mean : of dying, such ailure, asthenia, eans the disease. lications which ·ath.
bid conditions. iving rise to the «se (a) stating erlying cause
itions contrib- he death but not the disease or causing death.
50M-5-52-907046
ANTE CEDENT (b) CAUSES
Due To Hypertension
2 yrs.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
None
Major findings: Of operations
TO DEATH
(a).
Coronary Thrombosis
TWEEN ONSET AND DEATH 2days
DISEASE OR CONDITION
DIRECTLY LEADING
That I attended deceased from July 3. 1954
(write the word)
Registered No.
5 Was disease or injury in any way related to occupation of deceased? If so, specify ........ " harles Liberman M. D. 20 BIRTHPLACE OF MOTHER (City) Cambridge
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 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 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 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 supposahly 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
July ..... 25, .191.7.
DATE OF DISCHARGE
May 24, 1919
RANK, RATING
Sgt.
ORGANIZATION AND OUTFIT
Army
SERVICE NUMBER
583575
×
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
5883 152
[(If death occurred in a hospital or institution,
..... X.x.SE give its NAME instead of street and number) No. Baker Memorial Hospital
2 FULL NAME. JOHN F MC MAHON (If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so, specify WAR)
6 Adams
'inthrop,
Mass
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.....
.years.
months.
1.3lays. In place of residence
.......... years.
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
5
195.4
(Year)
8 SEX
M
9 COLOR OR RACE
10 SINGLE
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