USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 67
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( Wain ) Filling
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.
R-301A 1
CTIONS OR CERTIFICATE
iving F DEATH t enter han one for each ) and (c)
es not mean of dying, art failure, c. It means , or compli- rich caused
s, if any, ve rise to tuse (a), he under- use last.
ons contrib- ath but not the terminal dition given
Chapter 137, 54, requires s to print or cause or death on
tificates.
4.5 .
INTERVAL BETWEEN ONSET ANO DEATH 24 hrs.
years
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- te n, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall. for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two. and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the. person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be. SE a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied. in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical. thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38. Sec. 6., as amended by Chap. 632. Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such 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
[ R-301A 1
PLACE OF DEATH
SUFFOLK (County) Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
180
Winthrop Community Hospe No .. Joseph H VanTané
(If deceased is a married, widowed or divorced woman, give also maiden name.)
45 Cross
St
50 мин. (If nonresident, give city or town and State)
Length of stay: In place of death. ........... years. months. days. In place of residence 50 years. .months ....... ... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Sept
26
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Sepr 26,
195
to ...
Sept 26
19.
I last saw h.l/kalive on
Sepr 26, 1956, death is said to
have occurred on the date stated above, at 10:30 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
acute left Ventricular
ditaxation
Due To
Coronary occlusion
(b)
(massive)
(c) Due To achero sclerosis
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so,
M. D. Address) 14 Washnapadlo Date 9-28 1956
6 Winthrop
WinThay
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Sept 29, 56 19
7 NAME OF FUNERAL DIRECTOR .. Maurice W Kirby
ADDRESS Winthrop
Received and filed SEP 28. 1956 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
10a If married, widowed, or divorced
HUSBAND of ......
Virginia (Walker
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGES 2Years. .Months .......... Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Laborer
(Kind of work done during most of working life)
14 Industry
or Business:
Town OF Winthrop
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Providence RIL
17 NAME OF
FATHER
David VanTyne
18 BIRTHPLACE OF
FATHER (City)
Brooklyn
(State or country)
n.y.
19 MAIDEN NAME
OF MOTHER
Grace Harriman
20 BIRTHPLACE OF
MOTHER (City).
Haverhill
(State or country) mass
21 mr Virginia Vantyne
(Address)
45 Cross ST
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued: Halter & TO aker. (Signature of Agent of Board of Health or other) Jealte Affiche 9/25/56
(Official Designation )
(Date of Issue of Permit)
5
--
ns, if any, ave rise to cause (a), the under. ause last.
ions contrib- icath but not the terminal ndition given
Chapter 137, 1954, requires ns to print or e
cause or of death on rtificates.
1
100M-11.55-916145
INTERVAL BETWEEN ONSET AND DEATH
minutes
2-3Ers
years
PARENTS
Registered No.
$ (If death occurred in a hospital or institution,, ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
2 FULL NAME
(a) Residence. No. (Usual place of abode)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
loes not mean of dying, heart failure, tc. It means > e, or compli- which caused
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- te ·n, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall. for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose. the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ...- General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
1
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-302 1
PLACE OF DEATH
SUFFOLK BOSTON
The Commonwealth of Massachusetts) EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or Town making this return)
181
(City or Town) New England Center Hospital
No.
Thelma I. O'Connell
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
180 Somerset Avenue,
Winthrop,
Mass.
(a) Residence. No .. (Usual place of abode)
11
25
months ...
......
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
19, 1956
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
Married
or DIVORCED
4 I HEREBY CERTIFY,
June 8,
56
June 19
19
I last saw h ....
Calive on
'June 19,
56
19 ..
death is said to
9:35₽
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
3 Months2
AGE
Years.
47
.9
12
If under 24 hours
Hours ........ Minutes
Clerk
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
Insurance Agency
15 Social Security No.
Maynard
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Robert Voitch
Was autopsy performed?
Yos
Peripheral blood amear 18 BIRTHPLACE O NO
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
J. C. Twitcholl
(Address)
N.E. Center Hosp.
6/20/ 56
Winthrop Cem. Winthrop, Mass 6
Place of Burial or Cremation June 23,
(City or Town)
56 21
Informant
Winthrop, Mass.
(Address)
A TRUE COPY charles H. mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
June
26,
19
56
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Eunice Wilson
Quebec
20 BIRTHPLACE OF
canada
MOTHER (City) ......
(State or country)
Daniel J. O'Connell
DATE OF BURIAL
H. Reynolds
7 NAME OF
FUNERAL DIRECTOR
Winthrop, Mass.
ADDRESS.
Received and filed. C.T. 15.1156 19
19
50M-11.55-916145
resided as soon as possible, after the close of the month in which the death occurred. (Sec Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R.302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Acute granulocytic
leukemia
That I attended deceased from
19 50
10a If married, widowed, or divorced HUSBAND of
Daniel J. 8"connell
have occurred on the date stated above, at
m.
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
OTHER SIGNIFICANT CONDITIONS
What test confirmed diagnosis?
FATHER (City)
(State or country)
Quebec
Canada
or Business :
012-20-5539
Months.
Days
Registered No.
"(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
months
days. In place of residence
....... years.
M1. 5.
Ver
UCT: 6
R-302 1
Tewksbury, Mass.
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
TEWKSBURY STATE HOSPITAL AND ... INFIRMARY
(City or Town making this return)
129.82
§(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME Albert W .Rich
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
16 Madison Ave
(Usual place of abode)
St
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
0 years 0
months.
17days. In place of residence.
......... years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
June
30 19.56
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 13
19.
56
to ...
June.30
19 ..
.56
I last saw
hi malive on
June 30,, 19 56
h is said to
have occurred on the date stated above, at
11: 16a.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Carcinoma of lung
Due To (1)) Pulmonary tuberculosis advanced
mos .
Due To (c) Arteriosclerotic heart disease
yrs.
OTHER
SIGNIFICANT
Adenomatous ..... prostate
yrs.
Was autopsy performed?
No.
Clinical
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?.......... O If so, specify
(Signed) S ........ PhillipCrucilla M. D.
(Address) T. S. H. and I. Tewksbury Date 6/30/ 19 56
6 Winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL July10 19.5.6
7 NAME OF FUNERAL DIRECTOR. E. B. Caggins & Son
ADDRESS. 147 Winthrop St. Winthrop
Received and filed.
OCT 25 1966
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
Single
or DIVORCED
10a If married, widowed, or divorced HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
66
Qionths.L.9. Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Sim painter
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No. Cannot be learned
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF FATHER Gilbert Rich
18 BIRTHPLACE OF
FATHER (City)
Cape Cod
(State or country)
Massachusetts
19 MAIDEN NAME OF MOTHER Elizabeth Wilson
20 BIRTHPLACE OF
Boston
MOTHER (City).
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