USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 86
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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 inake examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of cheinical, 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
DEC10
OFFI
WINI
LO
OF
NIN
TOWN
ASE
AM
RECEIVED
X
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) CRESTHA
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
256
[(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number) No.
2 FULL NAME ...
Kemble C Douglas
widowed or divorced woman, give also maiden name.) (If deceased ig a matiedesnoton Avenue 86 Winthrop Shore" Drive
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. 2
years .months .. days. In place of residence.
6.Oyears.
.months
.days.
MEDICALCERTMLABELOF DEATH. 1954
3 DATE OF
DEATH
December 8 1954
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDidowed
4 I HEREBY CERTIFY,
That I attended deceased from
Oct. 18
1951
to.
DECEMBER 81.54
I last saw h.t.
alive
December fo 54/
death is said to
have occurred on the date stated above, at IA
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a).
CEREBRAL
HEMORRHAGE
TWEEN ONSET AND DEATH 4 hrs
11 IF STILLBORN, enter that fact here.
12
AGE
92
Years
2
Months
.7.
Days
If under 24 hours
Hours .
Minutes
13 Usual
Occupation :
Builder
(Kind of work done during most of working life)
Due TAPTETTIOSCLEROTIC (c)
HEART DISEASE
OTHER
SIGNIFICANT
CONDITIONS
SENILITY
3 yra
Major findings:
Of operations.
none
Date of operation name
200
What test confirmed diagnosis!
.. Was autopsy performed ?..
clinical la b.
No
(Sign
6562 Sauley St Wuertup!
.. 19.
6 Evergreen
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Dec. 10
54
7 NAME OF
Edward S hunold
ADDRESS
Received and filed DEC 10 1954
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country) Prince Edward Island
19 MAIDEN NAME
OF MOTHER
Elizabeth Coffin
20 BIRTHPLACE OF MOTHER (City) State or country) Prince Edward Island
21 Informant Ellen Leighton (Address) 24 Windson Rd. Wellesley
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter L. Baker (Signature of Agent of Board of Health of other)
Tealthe Officer
(Official Designation)
(Date of Issue of Permit) 12/10/04
ICTIONS OR ERTIFICATE
iving F DEATH enter han one or each ) and (c)
Des not mean dying, such re, asthenia, s the disease, tions which 1.
conditions. g rise to the (a) staling ying cause
ons contrib- leath but not e disease or using death.
Chapter 137. 954, requires s to print or use or causes on death 8.
50M-3-54-911887
R-301A 1
66 Winthrop Shore Drive
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, ( if so specify WAR)
(write the word)
10a If married, widowed, or divorced Lorena A Confir Clark
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
ANTE
CEDENT
(b)
Cerebral
ARTERIOSCLEROSIS
2 years
14 Industry
or Business:
Contractor
3 years
Social Security No.
None
16 BIRTHPLACE (CityPrince Edward Island (State or country)
17 NAME OF.
FATHER Henry Douglas
5 Was disease or injury in any way related to occupation of deceased?
If so, specify .......
Jacob 1. ahamo Z.
Stoughton
PERSONAL AND STATISTICAL PARTICULARS
To be filed for burial -permit with Board of Health or its Agent.
(a) Residence. No. (Usual place of abode)
1.5.
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, eightcen 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 n 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 emove 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 aw, 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, theripal or electrical agents or following abortion, or from diseases resulting from mjury 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 orother persons shall bury a human body or the ashes thereof which,haye bref Brought into the commonwealth until he has received a permit so to do from thumpatd of health or its agent appointed to issue such permits, or if the} isnosuch board, from the derk of the town where the body is to be buried of, the funeral is to be beidzor from a person appointed to have the care of the cemetery or burra Mfround in which the interment is made.
Chap. Il Fecho 0, E. (Tercentenary Edition).
RULES OF PRACTICE
6:3 ufrpose of these laws calls for the observance of the follow-
ing rules/ (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 person hecho h disabledby recognized disease unrelated to any form of injury, rthout 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
M R-302 1
2 FULL NAME.
(a) Residence.
No.
DEATH
(Month)
Aug.19
DISEASE OR CONDITION
Due To
(c)
Major findings:
Of operations
Date of operation
25M-3-53-909098
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,
CONDITIONSILSCASE .
PLACE OF DEATH
Suffolk
(County)
(City or town making return)
604 257
J(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
783 Shirley
Winthrop
St.
(If nonresident, give city or town and State)
h&syalplace of abode)
Length of stay: In place of death.
months.
days. In place of residence ..
.. years ..
.. months.
........ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
Doc .12,1954
(Day)
(Year)
8 SEX
Malo
9 COLOR OR RACE
Thito
10 SINGLE
MARRIED
WIDOWED
of DIVORCEDarricd
4 I HEREBY CERTIFY,
That I attended deceased from
to ..
Doc.12
154
i.m
Dec.12
54
death is said to
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET AND DEATH
DIRECTLY LEADING
Obstructing
TO DEATH (a)
adenocarcinoma involving
ANTE
Due Toappendix and je junum
CEDENT (b)
CAUSES
MOE
OTHER
Arteriosclerotic heart
SIGNIFICANT
.... ?yrs.
5 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed). Voldomars Jansons M. D.
(Address) Soldiers home Date1 2/13
1954
6 Furitan Ium, Peabody IRas Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Dec.15,1054
19
7 NAME OF FUNERAL DIRECTOR .. Maurice W.Kirby
ADDRESS
210 WinthropStanthron
Received and filed
MAN ( 1) 19
(Registrar of City or Town where deceased resided)
10a If married. widowed, or divorced
Lethlon
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
1232
AGE
Years
5
Months
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation:
Marine Ingineer
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
not TOM
16 BIRTHPLACE (City) Scotland (State or country)
17 NAME OF Androw FATHER
18 BIRTHPLACE OF
.
FATHER (City) (State or country)
Scotland
19 MAIDEN NAME
OF MOTHER Christina walker
20 BIRTHPLACE OF
MOTHER (City) .Scotland
(State or country)
21 Hos ital Records
Informant
Joseph a Tyrrell
ATTEST:
Registrar of City or Town where death occurred)
DATE FILED
Dec. 13, 19 54
................... 19 .:
.
PARENTS
(Address)
Chelsea
Chelsea
(City or Town)
Soldiers' Home Mospital No. John W. Ritchie
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Registered No.
MAI
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(write the word)
I last saw }
alive on
9:55P.
m.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
215.
A TRUE COPY
Was autopsy performed?
yes
What test confirmed diagnosis ?.
autopsy
RECEIVED
TO:
OF
11 12
-
isL.L.
.5
6
JAN-'7 AM
Enlisted 8/31/18 Discharged 10/9/19 Lt. Commander U. S.Navy
PLACE OF DEATH X SUFFOLKI (County)
Boston X-7-55
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial ·permit with Board of Health or its Agent.
258
No. Winthrop Community Hosp.
Baby Boy GEATA 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
119 WALDMER AVE
St. EAST BOSTON
(a) Residence. No. (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. .years .. months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
4 I HEREBY CERTIFY,
That I attended deceased from
Dec 13. 1954
to.
Dec 13
19 34.
I last saw him alive on
De 13
19% death is said to
have occurred on the date stated above, at 6:00 Am.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here. STILL Born V
12
AGE.
Years
.Months
Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City) ..
(State or country)
winthrop
17 NAME OF
FATHER
Alphonse GEATA
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
Reine WILLIAMS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
BOSTON
6 Woodlawn Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Dea . 14
~ 1950
Pone Scannen
7 NAME OF FUNERAL DIRECTOR 39 Orleans St E. Barton ADDRESS.
Received and filed. DEC 1 - 1954 19
(Registrar)
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)
stillborn,
ANTE
Due To
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
PARENTS
21 Informant
Alphonse GEATA (Father) (Address) 119 WALDNER NVE EIBOSTON
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter A. Lakers. (Signature of Agent of Board of Health or other)
Thealth Office
12/14/54
(Official Designation) (Date of Issue of Permit)
·
SOM-3-54-911887
R-301A 1
winthrop (City or Town)
CERTIFICATE OF DEATH
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)
UCTIONS OR CERTIFICATE
iving F DEATH t enter han one For each ) and (c)
oes not mean f dying, such ure, asthenia, is the disease, tions which
conditions, ig rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
Chapter 137, 954, requires s to print or use or causes on death .8.
3 DATE OF
DEATH
12
(Month)
(Day)
13
3-4
(Year)
If so, specify ...
(Signed)
Hannes
Wiener
M. D.
(Address) 112 Starten Auf Revery Date 12/13 19/04
Everett MASS
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- een, 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 hall also certify in such certificate both the primary and the secondary or imme- liate 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 elief 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 ervice 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 n 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 uch permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shall exhume a human body and emove 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 eceived 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 hall have been delivered to such board. agent or clerk, as the case may be, satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original inter- nent, by a satisfactory certificate of the attending physician, if any, as required by aw, 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
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