USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 63
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(Official Designation)
(Date of Issue of Permit))
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, cations which th.
id conditions, ing rise to the se (a) stating Flying cause
tions contrib- e death but not the disease or causing death.
100M-10-53-910621
Winthrop
6 Place of Burial or Cremation
DATE OF BURIAL.
September 23,
155
7 NAME OF
Arthur J .O'Maley
FUNERAL DIRECTOR
Winthrop Mass
ADDRESS
Received and filed SEP 23 1955 19
(Registrar)
8 YRS
Due To
(c)
OTHER
NONE.
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
NONE
Date of operation
Was autopsy performed?
No
What test confirmed diagn
CLINICAL + LABORATORY
5 Was disease or injury in any way related to occupation of deceased? NO
If so, specify ......
(Signed) m. Trannesin
(Address) SULSHIREY ST. WalDate SEPT. 201955
M. D.
PARENTS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John B. Peters
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) CEREBRAL HEMOR-
RHAGE & Lt. HEMIplegia
ANTE
Due To ESSENTIAL HYPER
CEDENT (b)
CAUSES
TENSION.
(write the word)
DEATH
3 DATE OF
September 20, 1955
(Month)
(Day)
(Year)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(Usual place of abode)
Winthrop Community Hospital
A R-301A 1
1
inthrop
(City or Town)
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, See. 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 iba . E :\ 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 r shall have been delivered to such board, agent or clerk, as the case may bex a satisfactory written statement containing the facts required by law to bè returned and recorded, which shall be accompanied, in case of an original inter- / /2. 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 DO of health, or employed by it or by the selectmen for the purpose, shall upon. I 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:
T(!), 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.
1 (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
×
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No.
99 Main Street. Winthrop
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME.
Charles D. Cullinane
(If deceased is a married, widowed or divorced woman, give also maiden name.)
99 Main Street, Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. .1 .years. months days.
In place of residence.
1
.. years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Siggle
4 I HEREBY CERTIFY,
That I attended deceased from
19
-
have occurred on the date stated above, at
1 P.
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Natural Causes
TWEEN ONSET AND DEATH
Presumably
ANTE CEDENT (b) CAUSES
Due To Coronary Occlus
10h hrs
Due Arteriosclerotic (c)
Heart Disease
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed? no
What test confirmed diagnosis ?.
5 Was disease of Duty in any way related to occupation of deceased? no murray If so, specie trebuie (Signe Winthrop Board of Health M. D.
) Date 2 3 Sept 1955
Holy Cross Cemetery, Malden 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL. September 24th 19
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDR 917 Bennington St. E .Boston
Received and filed
SEP 23 .1955
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Charlestown
(State or country)
Mass.
19 MAIDEN NAME OF MOTHER Cora L. Rea
20 BIRTHPLACE OF Charlestown MOTHER (City) (State or country) Mass.
21
Informant Mrs. Eleanor D. Campbell-sis. (Address) 99 Main St., Winthrop, Mass I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial of transit permit was issued:
Watter & Takers. (Signature of Agent of Board of Health or other)
Health Officer 9/23/55
(Official Designation) (Date of Issue of Permit)
+
Somerville
16 BIRTHPLACE (City) .. (State or country) Mass.
(Kind of work done during most of working life)
14 Industry
or Business:
Mail Order House
15 Social Security No ...
024-16-2479
yrs
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
I last saw h
... alive on
19.
death is said to
-
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
57
AGE
Years
5
Months.
1.5Days
If under 24 hours
Hours .....
. Minutes
13 Usual
Occupation:
Shipper
17 NAME OF FATHER Daniel F. Cullinane
50M-5-55-915025
R-301A 1
UCTIONS FOR CERTIFICATE giving OF DEATH t enter than one for each b) and (c)
does not mean f dying, such ure, asthenia, ns the disease. ations which h.
d conditions. ng rise to the : (a) stating lying cause
ions contrib- death but not he disease or ausing death.
Chapter 137. 1954, requires ns to print or ause or causes h on death .es.
15.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial -pormit with Board of Health or its Agent. 191
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No. (Usual place of abode)
3 DATE OF
DEATH
September
22
1955
(Year)
(Month)
(Day)
19 to
-
(Address)
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 effec., 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 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).
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
A R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town) 175 Somerset Ave .
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.
Registered No. 1.92
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)
175 Somerset Ave. (a) Residence. No.
St.
(Usual place of abode)
40
40
(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
3 DATE OF
DEATH
September 22
1955
(Month)
(Day)
(Year)'
4 I HEREBY CERTIFY.
That I attended deceased from
19
48
to.
September 221955
I last saw
er
alive on
September, 1955, death is said to
have occurred on the date stated above, at 12:20 P.m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary Occlusion
INTERVAL BE- TWEEN ONSET AND DEATH 6 hrs
11 IF STILLBORN, enter that fact here.
12
82
AGE
Years
1
Months.
15 Days
If under 24 hours
.Hours ...
Minutes
13 Usual
Housewife
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Own home
15 Social Security No.
None
16 BIRTHPLACE (City) Mass.
(State or country)
17 NAME OF FATHER John Kiander
PARENTS
18 BIRTHPLACE OF
Unable to obtain
FATHER (City)
(State or country)
Sweeden
19 MAIDEN NAME OF MOTHER Sophia
20 BIRTHPLACE OF
MOTHER (City)
Unable to obtain
(State or country) Sweeden
21 Arthur L vonBetzen
Informant (Address) 175 Somerset Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Ageht of Board of Health or other)
10/23/53
(Official Designation)
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease, cations which th.
id conditions. ing rise to the se (a) stating lying cause
tions contrib- e death but not the disease or causing death.
TOOM-10-53-910621
7 NAME OF
FUNERAL DIRECTOR ...
ADDRESS
Minimis mas.
Received and filed. SEP 26 1955 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEBidow
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
John vonBetzen
(or) WIFE of
(Husband's name in full)
ANTE
CEDENT
CAUSES
Heart Disease
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation.
Was autopsy performed? no
What test confirmed diagnosis ?.
clinical
5 Was disease of Injury in any way related to occupation of deceased? no Spect Arthur/0. (Signed) (Address) Winthrop Winthrop
M./D. Date 23 Sept 1955 Winthrop.
6 Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Sept. 24
19 55
Howard SOMynolds
No.
Anna S (Kinader) vonBetzen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
2 FULL NAME
Due To Arteriosclerotic
yrs
East Boston
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 dollar's. 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 ninetcen hundred and seventeen. G. L. Chap. 46, Sec. 10.
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