USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 10
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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 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 derk 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, Sep 16. , L. (Tercentenary Edition).
RULES OF PRACTICE TOWE
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 giver bedside care during a last illness fron 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 recen't 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 Thelude not only deaths caused directly or indirectly by traumatism (including resp ting septicemia), and by the action of chemical (drugs or poisons) thermalpor 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 Erube 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
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 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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m-(b)-11-49-900,475
7 NAME OF
FUNERAL DIRECTOR Grunder , Dritteri
ADDRESS
Carré 1au
Received and filed
Fel
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
4
1955
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
Volete
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDDuacced
4 I HEREBY CERTIFY,
12/1
1954
to ..
2/4
19
55
I last saw
been alive on
1/21
1955 death is said to
have occurred on the date stated above, at
6,450
.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE8 3
Years
7 Months 22 Days
If under 24 hours
Hours ... ... Minutes
13 Usual
Occupation :.
Alovit
(Kind of work done during most of working life)
14 Industry
or Business A
15 Social Security No.
16 BIRTHPLACE (City) Nenthudf NBass (State or country)
17 NAME OF
FATHER
Rychenwesten Belcher
18 BIRTHPLACE OF
FATHER (City)
(State or country)
1 Mars
19 MAIDEN NAME
OF MOTHER
Helen Grace
Harwich
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mau.
6. Elqui Belcher
21
Informant
(Address)
Base Mau
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
6
..........
1955
V.B.V
10a If married, widowed, or divorced
HUSBAND of Lesauce
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADI
TO DEATH (a)
and arterios cler ptic heard
Hypertensie
Disease
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
... Was autopsy performed?
No
What test confirmed diagno
Olivercal
5 Was disease or injury in any way related to occupation of deceased? Na
Species Man 16 Harnes
M. D.
(Signed)
So Bare Mask
A Date 2/5
1955
Mentirase bem
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Hef 7
19 SS
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
arre (City or town making return)
Registered No.
27
J(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
339
Winthrop
St.
(Was deceased a
U. S. War Veteran,
{if so specify WAR).
Methode Mass
(a) Residence.
No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
0 years 2
months 12
83
.days. In place of residence
years.
-
months ....
.days.
PLACE OF DEATH
X Worcester (County) Parce (City or Town) Kendall
No.
Herbert Lee Belcher
MEDICAL CERTIFICATE OF DEATH
That I
attended deceased from
ed Moleste
10%
PARENTS
DATE FILED
RECEIVED
OF
TON
OFFICE !
11 12
1
CLERK
3
B
SP
5
6
THROP
FEB11
1
× 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.
28
No. Winthrop Convalescent ..... Home ..... St. [ give its NAME instead of street and number)
2 FULL NAME Margaret Thomson Stainforth
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 124 Cottage Park Road
St.
(If nonresident, give city or town and State)
Length of stay: In place of death . . years .. 4 months. .days. In place of residence 50 years ... .. months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH February
6
1955
(Month)
Way)
Female
White
4 I HEREBY CERTIFY.
That I attended deceased from
ius. 13, 19 54, to Feb. 5th,
19 55
I last saw h.el ...... alive on .. .
Jan. 28th, 19 55 death is said to
have occurred on the date stated above, at 9.10 A.
DISEASE OR CONDITION AcuteCoron ry
DIRECTLY LEADING
rteriosclerotic
TO DEATH (a)
Decubitus Ulcer Imo
1
ANTE
Due To
"cuts coron ry Fyre
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?
Myron b. King
M. D.
(Signed)
(Address) 212 PleasANT ST WINTER 2/7
1955
6 Woodlawn Cemetery, Everatt. .. Mass Place of Burial or Cremation DATE OF Cremation Deb 8 1955 19
7 NAME OF
FUNERAL DIRECTOR
Alfred 15. March
ADDRESS 174 WiAt FEBER pt. Winthrop,
Received and filed
(Registrar)
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
10a If married, widowed, or divorced HUSBAND of .. (Give maiden name of wife in full)
(or) WIFE of
Alfred Stainforth
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 87 Years
Months
2.7 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. 018-12-4764-D
16 BIRTHPLACE (City)
(State or country)
Scotland
Scone
17 NAME OF
FATHER
Unknown The, por
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Unknowm
20 BIRTHPLACE OF MOTHER (City) (State or country) Scotland
21 Informant Henry A.Stainforth
(Address)
36 Waldemar Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Mass
Walter . Marile
(Signature of Agent of Board of Health or other) laitte Krkicer 2,8,50
(Official Designation) (Date of Issue of Pepmit) X
RUCTIONS FOR . 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.
id conditions, ring rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
SOM (B)-1-51 903586
PLACE OF DEATH
M R-301A 1
Registered No. .
J(If death occurred in a hospital or institution.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
( if so specify WAR) ...
NO
(Usual place of abode)
INTERVAL BE- TWEEN ONSET ,AND DEATH ne rt
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 E D'E undertaker or other persons shall bury a human body or the ashes thereof preceding section or by section forty-five of chapter one hundred and four- 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 rede is no such board, from the clerk of the town where the body is to be buried Cor the funeral is to be hell, or from a person appointed to have the care of the etory br burial ground in which the interment is made. 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 imine- Cen diate cause of death as nearly as he can state the same. For neglect to comply $1. 1.2.CbaR: 114. Sec. 46, G. L., (Tercentenary Edition). 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 RULES OF PRACTICE 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. 1
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 - praumatism (including resulting septicemia), and by the action of chemical
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.
The fulfilfinest 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 hom they have given bedside care during a last illness from disease unrelated forn of injury.
ric Board of Health physicians will certify to such deathsonly as those of mersous who, though disabled by recognized disease unrelated to any form of monty, 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 (druge 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, eook-hotel, etc. For a person who had no oceupation 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
fuffle County)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
29
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)
(a) Residence. No. (Usual place of abode)
1
Length of stay: In place of death. years.
months
days. In place of residence 30 .. years
.months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
Valute
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Medal
10a If married, widowed, or divorced HUSBAND of. There Given
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE Z.
Years
Months
.. ..
Days
If under 24 hours
Hours .
.Minutes
13 Usual
Occupation:
Saleswomen
(Kind of work done during most of working life)
14 Industry or Business: Department Store
15 Social Security No.
16 BIRTHPLACE (City) .
(State or country)
17 NAME OF FATHER
Carl Zeleke
18 BIRTHPLACE OF FATHER (City) (State or country)
liambrida
19 MAIDEN NAME OF MOTHER Johanna Back
20 BIRTHPLACE OF MOTHER (City) (State or country)
leumbridge
21 Informant (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter G. Bater
(Signature of Agent of Board of Health or other)
HO april 10- 53
(Official Designation) (Date of Issue of Permit)
50M-2-19-25666
7 NAME OF
ADDRESS
Received and filed.
FEB 101955
19
(Registrar)
2 YRS.
Due To (c) 1 ULCER RT. LEG
OTHER
SIGNIFICANT
CONDITIONS
PHLEBITIS
RT. SAPHENOUS THROMBO.
2 WKS.
Major findings:
Of operations.
VENOUS CLOT
Date of operation
JAN 1955
Was autopsy performed ?. No-
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? NO
If so, specify
(Signed)
myson b. King M. D. (Address) 222 PLEASANT SEURop Day 2/ 8 × 1253
Tambude Place of Burial or Cremation
DATE OF BUR
Fleby
19
21.S.
Feb. (Month)
(Day)
8 1955 (Year)
4 I HEREBY CERTIFY,
12/12
54
19
to
That I
2/
8
attended deceased from
1955
د ک 19
death is said to
I last saw HER.
.. alive on
2/2
83º A.m.
have occurred on the date stated above, at
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
ACUTE CORONARY OCEL
INTERVAL BE- TWEEN ONSET AND DEATH 10 min
ANTE CEDENT (b) CAUSES
ARTERIO-SCLEROTIC HEART DISEASE
(City or To ) 896 Shirley St. Numeticolo No.
2 FULL NAME.
Johanna Milion (gelek) (If deceased is a married, widowed or divorced woman, give also maiden name.) 894 A Shirley SL St.
(If nonresident, give city or town and State)
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.
id conditions, ring rise to the se (a) stating erlying cause
itions contrib -- e death but not the disease or causing death.
M R-301A 1
PARENTS
3 DATE OF
DEATH
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 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 wat, 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, bé 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- Bp 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
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