Town of Winthrop : Record of Deaths 1955, Part 19

Author: Winthrop (Mass.)
Publication date: 1955
Publisher:
Number of Pages: 570


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 19


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STATEMENT OF CAUSE OF DEATH


Medical Examiners in certifying to a death will state the cause and manner .thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2)' under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."


If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1)Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


Malden 3-24-55


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filed for burlal permit with Board of Health or its Agent.


53


Registered No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


Parkering Duwarst Puray 2 FULL NAME ..


(If deceased is a married, widowed or divorced woman, give also maiden name.)


46 Leur LI


St. Magicem meds


(If nonresident, give city or town and State)


Length of stay: In place of death .years


months. 1 days. In place of residence V .years. months .. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


MARCH 11 1955 (Year)


(Month)


(Day}


8 SEX


Imale


9 COLOR OR RACE


10 SINGLE


(write the word)


WIDOWED


or DIVORCED


4 I HEREBY CERTIFY.


That I attended deceased from


MAR. 4 1955 to ... MARCHI 1955


I last saw h .... alive on


MAR. /1, 19 87, death is said to


have occurred on the date stated above, at 9:20 A.m.


DISEASE OR CONDITION DIRECTLY LEADING


TO DEATH


ACUTE BRONCHO-


PITEUMONIA -RT.


INTERVAL BE- TWEEN ONSET AND DEATH 3 DAYS.


ANTE Due To CEDENT (b) CAUSES


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


ARTERIOSCLEROTiC +


HYPERTENSIVE MT DISEASE


2 YRS


Major findings:


Of operations.


NONE


Date of operation.


Was autopsy performed ?.


NO


What test confirmed diagnosis? CLINICAL + LAB.


5 Was disease or injury in any way related to occupation of deceased? 170.


If so, specify.


(Signed) Maurice Trauden Dr.


(Address) SG2SHIRLEY ST. WINTHROP Date MARK


M. D.


19 45


Calvary 4 concenter


6 Place of Burial or Cremation


DATE OF BURIAL .. microta 14 19


7 NAME OF


FUNERAL DIRECTOR.


James G greely


ADDRESS 7,Placesunt bouclier


Received and filed 19


march 14 155


(Registrar)


11 IF STILLBORN. enter that fact here.


12


AGE.


86


Years


.....


.. Months


Days


If under 24 hours


Hours ....


.. Minutes


13 Usual


Occupation :


1 (Kind of work done during most of working life)


14 Industry


or Business


Retired Javi Ruamne Us


15 Social Security No ..


16 BIRTHPLACE (City).


(State or country)


17 NAME OF


FATHER


Dobua étécant


18 BIRTHPLACE OF FATHER (City) (State or country)


19 MAIDEN NAME


OF MOTHER


20 BIRTHPLACE OF MOTHER (City) (State or country)


-


21 Informant :


(Address) 134 Roulleet Rd Beulerof


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Mauer


(Signature of Agent of Board of Health or other)


3/14/55


(Official Designation) (Date of Issue of Permit)


50M-5-52-907046


ORM R-301A 1


INSTRUCTIONS FOR ICAL CERTIFICATE In giving ISE OF DEATH do not enter more than one use for each (a), (b) and (c)


This does not mean tode of dying, such art failure, asthenia. t means the disease. m plications which d death.


Morbid conditions. , giving rise to the cause (a) stating underlying cause


Conditions contrib- to the death but not i to the disease or ion causing death.


PLACE OF DEATH Livs full2 L. L(County)


(City or Town)


Tuttoinital


(a) Residence. No. (Usual place of abode)


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran.


if so specify WAR)


no


Widowe cj


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Francs / wirdly


] (Husband's name in full)


PARENTS


(City or Town)


0


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 elerk, 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 he 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).


RECEIVED


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{ifThese include not only deaths caused directly or indirectly by traumatisme (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from hisease 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 ean 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


.......


ORM 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 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,


PLACE OF DEATH


Middlesex


(County)


Lexington


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Lexington


(City or town making return)


54


Registered No.


[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME


John Pavey


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No. 94 Cottage Ave.


Wintrhop,


(Was deceased a


U. S. War Veteran,


if so specify WAR)


Mass.


(Usual place of abode)


Length of stay: In place of death.


.years ..


1


months 14


35


days.


In place of residence


.years.


.. months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OFMarch


DEATH


12


1955


(Month)


(Day)


(Year)


8 SEX


Male


9 COLOR OR RACE


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Idowed


4 I HEREBY CERTIFY,


That I attended deceased from


September 14.


54


March 12,


19.


to


I last saw


im


March 10, 55


death is said to


(or) WIFE of.


(Husband's name in full)


DISEASE OR CONDITION DIRECTLY LEADING~teriosclerotic


TO DEATH (a)


Myocarditis


years


11 IF STILLBORN, enter that fact here.


12


AGE


33


Year


16


Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation:


Carpenter


14 Industry


or Business:


Building


15 Social Security No.


Bristol


16 BIRTHPLACE (City England


(State or country)


17 NAME OF


FATHER


Jeremiah Pavey


18 BIRTHPLACE


FATHER (City).


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Unable to obtain


20 BIRTHPLACE OF


MOTHER (City)


Unable to obtain


(State or country)


England


21


Elizabeth Cooper


Informant


191 Lincoln St. Lexington


7 NAME OF


FUNERAL DIRECTOR


Howard Reynolds


ADDRESS


Winthrop, Mass.


Received and filed.


MAR 2.8 1955


19


(Registrar of City or Town where deceased resided)


PARENTS


Unable to obtain


Date of operation


.Was autopsy performed ?.


What test confirmed diagnosis?


NO


5 Was disease or injury in any way related to occupation of deceased?


If so, specify. Harold J. Crumb


(Signed) ..


(Address) Lexington, Ma SS. Dat 3/14/


M. D. 155


Woodlawn CREMATORY


6


Everett ,Mass (City or Town)


Place of Burial or Cremation


DATE OF BURIAL


March 15,


55


A TRUE COPY


ATTEST:


James J. Carroll,


(Registrar of City or Town where death occurred)


DATE FILED


March 14, 1955


... 19.


VVV


MARGIN RESERVED FOR BINDING


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


25M· 10-53-910621


Due Generalized Arterio


ANTE CEDENT (b) CAUSES sclerosis


Due To (c)


OTHER SIGNIFICANT CONDITIONS


10a If married, widersdorfotte Benson


HUSBAND of


(Give maiden name of wife in full)


have occurred on the date stated above, a


m.


INTERVAL BE- TWEEN ONSET AND DEATH


alive on


10:20P.


55


St.


(If nonresident, give city or town and State)


191 Lincoln Street No.


hr


(Kind of work done during most of working life)


Major findings:


Of operations.


RECEIVED


TOWA


11 12 1


-



5


Wli


6


IROF


MAR28 AM


PLACE OF DEATH


Suffolk


(County)


371-55


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


inthree Convalescent Hore Pleasant No.


J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)


2 FULL NAME ALBERT K. BISHOP


(If deceased is a married, widowed or divorced woman, give also maiden name.) 15 Avon St.


St.


Revere


(If nonresident, give city or town and State)


months .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF Z anch 13 DEATH


(Month)


(Day)


1955 (Year)


8 SEX


Male


9 COLOR OR RACE


'hite


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


idowed


4 I HEREBY CERTIFY,


11.10


19


5%


55


That I attended deceased from


3.13


19


10a If married, widowed, or divorced. HUSBAND of Haith 3. Fitter


(Give maiden name of wife in full)


I last saw h


.alive on 3 13


, death is said to


have occurred on the date stated above. at/ 2


m.


INTERVAL BE-


TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


2 Ca GE 79 Years. 7 Months. 3 Days


If under 24 hours


Hours .. ... Minutes


13 Usual Occupation: Currenter


"(Kind of work done during most of working life)


14 Industry or Business: Tone


15 Social Security No. one


16 BIRTHPLACE (City) (State or country) Scotland


17 NAME OF


FATHER


Albert T. Pishon


18 BIRTHPLACE OF FATHER (City) (State or country)


19 MAIDEN NAME


OF MOTHER


20 BIRTHPLACE OF MOTHER (City) (State or country) Tnknown


Rowlands.


21 Informant (Address) 79 hitin Ave Revere


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: / Walter & Gakery (Signature of Agent of Board of Health or other)


Idealthe Muleek 3/15/50


(Official Designation) (Date of Issue of Permit)


X


A TRUE COPY ATTEST:


(Registrar)


PARENTS


5 Was disease or injury in any way related to occupation of deceased ?.


If so, speedy


(Signed


(Address)


centro de 314 1955 Peabody


6 Puritan awn Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


March .... 15, 1955


19


7 NAME OF


FUNERAL DIRECTOR.


Leslie ". Pike


ADDRESS


305 Beach St. Revere


Received and filed.


MAR 15 1955


19


50M-3-53-909098


To ArtarioSulerotic


ANTE CEDENT (b) CAUSES Heart Disease 3 400


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Major findings:


Of operations.


Date of operation


Was autopsy performed ?.


clinical


What test confirmed diagnosis ?.


(or) WIFE of


(Husband's name in full)


(Was deceased a U. S. War Veteran, if so specify WAR)


(a) Residence. No. (Usual place of abode)


Length of stay: In place of death ........ .years. @ ... months ........... .. days. In place of residence. 4.5.years.


(City or Town making this return) 55


RM R-301 1 "inthrop


(City or Town)


ISTRUCTIONS FOR CAL CERTIFICATE In giving SE OF DEATH o not enter ore than one use for each ), (b) and (c)


his does not mean ode of dying, such t failure, asthenia, means the disease, nplications which death.


orbid conditions, giving rise to the cause (a) stating nderlying cause


ditions contrib- o the death but not to the disease or on causing death.


DISEASE OR CONDITION


DIRECTLY LEADING Monary


TO DEATH


Edema


to


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 of officer furnishing a certificate of death as required by. the 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.


MAR 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 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 A af 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.


preceding section or by section forty-five of chapter one hundred and four -. .. if there is no such board, from the clerk of the town where the body is to be buried


OF a 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 &d.to do from the board of health or its agent appointed to issue such permits, or 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. 1-14, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


6 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.


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.




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