USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 44
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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, hy 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, Gi.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 hot 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 ÓF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT. SERVICE NUMBER
X
£301A 1
PLACE OF DEATH
Suffolk
(County)
Winthrop (City of Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or its Agent.
130
St. (give its NAME instead of street and number) No. Cor. Underhill and Shirley Sts.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO.
(a) Residence. No.
500 Shirley
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
months
O days. In place of residence.31 years
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
9
1957
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Dec
19
54
to
June 24
1957
I last saw hi walive on
June 24
, 19.51, death is said to
have occurred on the date stated above, at
1110 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cerebro vascular accident
INTERVAL
BETWEEN
ONSET AND
DEATH
(b)
Due To
arterial hypertension
hypertensive heart disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis?
none
5 Was disease or injury in any way related to occupation of deceased?
If so, specify .. NO
(Signed)
447
(Address).
Winthrop Mass Date July 7 1957
6
DATE OF BURIAL July 19 1957
7 NAME OF
FUNERAL DIRECTOR
alfred 13. March
ADDRESS
174 Winthrop St. Winthrop,
Received and filed
JUL-9 1957
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX male
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
10a If married, widowed, or divorced
HUSBAND of
Lillian Murdockin full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
71 Years.6.
... Months
11Days
If under 24 hours
Hours ...... Minutes
13 Usual
Occupation:retired house painter
(Kind of work done during most of working life)
14 Industry
or Business:
self employed
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Maine
Calias
17 NAME OF
FATHER
George Johnson
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Canada
19 MAIDEN NAME
OF MOTHER
Nellie Spinney
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
(Address)
500 Shirley St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE Me bufial pr transit permit was issued :
Mas8.
Halka C. ) ircannes
(Signature of Agent of Board of Health or other)
Theatile Officer
7/8/57
(Official Designation)
(Date of Issue of Permit)
V.BV
UCIONS 0: CETIFICATE
DI DEATH it nter hi one fe each b,and (c)
ie not mean dying, failure, It means compli- caused
if any, rise to (a), under- last.
: contrib- - las but not terminal kion given
Capter 137, requires so print or cause or death on tates.
SOM- 5-56-917573
f(If death occurred in a hospital or institution,
2 FULL NAME Ernest Linwood Johnson (If deceased is a married, widowed or divorced woman, give also maiden name.)
Registered No.
(write the word)
PARENTS
, M. D.
Calias Cemetery, Calias, Maine Place of Burial or Cremation Rtity or Town) 21 Informant Mrs. Ernest L.Johnson
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 seventcen. 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; See 16, G. L., (Tercentenary Edition). . .
12 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.cettify 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 rosahing from injury or infection related to occupation, the sudden death 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
:
.
-
-
.. .
-
-
IR-302 1
PLACE OF DEATH
Suffolk
(County)
Bosta
(City or Town)
CERTIFICATE OF DEATH
Registered No.
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
110 Hermon St.
Winthrop Magy specify WAR)
St
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years.
.. months.
35 days. In place of residence.
2
.years.
.months
......... days.
Helen E Whaland
(a) Residence. No ..
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July8/57
(Month)
(Day)
June 3, 19.
57
to
I last saw h .. Eralive on
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Pelvic peritonitis
(b)
(c)
SIGNIFICANT
Was autopsy performed?
What test confirmed diagnosis?O
(Signed)
Philip H Walker
6
7 NAME OF
FUNERAL DIRECTOR
J C Kelly
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
CONDITIONS
of rectum, recurrent
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
Recurrent carcinoma rectum
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
July
8
19.
57
July 8 19 57 death is said to
have occurred on the date stated above, at
5 PM
m.
INTERVAL BETWEEN ONSET AND DEATH 25 Days
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
Widowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Philip P Whaland
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
.. 5.7 .. Years.
Months ..
.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 ..
034-28-3408
16 BIRTHPLACE (City)
Boston Mass ..
(State or country)
17 NAME OF FATHER James A Harris
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
Anna Hickok
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Virginia
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
July 11/57
19
21
Informant
( Address)
James A Harris
13 Wellesley Fark Dor"
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July 12/57
19
(Registrar of City or Town where deceased resided)
PARENTS
M. D.
Lemuel Shattuck Hospt
Date
7-8 19 57
(Address)
St Joseph's Boston Mass
25M-8-56-910227
ADDRESS
LAUG 5
Received and filed. 19
Lemuel Shattuck Hospt Boston
No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
(City or ToBOSting this return)
6461 31
(Was deceased a
U. S. War Veteran,
(write the word)
Due To
Post operative fecal fistula
OTHER
Post operative carcinoma
5 Was disease or injury in any way related to occupation of deceased ? If so, specify.
East Boston Mass.
X
11 12 1
6
AUG - 91957 AM
01A
1
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.
132
[(If death occurred in a hospital or institution, St. (give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
112 Bartlett Road
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
... years
months
days. In place of residence.
6.3 years
months.
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
July 9,1957
DEATH
(Month)
(Day)
(Year)
19.57
4 I HEREBY CERTIFY,
That I attended deceased from
JAN 13
1949,
to
July 9
I last saw HER alive on
July 8
, 1957, death is said to
have occurred on the date stated above, at
5:10 A .m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
MYOCARDIAL INSUFFICIENCY
·
INTERVAL
BETWEEN
ONSET AND
DEATH
9 DAYS
11 IF STILLBORN, enter that fact here.
12
AGE 88 Years ...
8
Months
7 Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
At Home
(Kind of work done during most of working life)
14 Industry
or Business:
Own,
15 Social Security No ..
none
16 BIRTHPLACE (City)
(State or country)
England,
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
16
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ? Vo
If so, specify
(Signed)
Northy Chency appleton
M. D.
(Address 197 Woodridge any Date July 9. 1955
6 Winthrop, Winthrop, Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July 12, 1957
19
7 NAME OF
FUNERAL DIRECTOR
J .E.Henderson Co.,
ADDRESS 517 Broadway, Everett Mass.
Received and filed JUL 10 1957 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Walter P.Simonds
(Husband's name in full)
Due To ASTERIOSCLEROTIC HEART DISEASE
(b)
4 YEARS
(c)
Due To ARTERIOSCLEROSIS
10 YEARS
17 NAME OF
FATHER
H.Bloomfield,
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England,
19 MAIDEN NAME
OF MOTHER
Maria J.Stewart,
20 BIRTHPLACE OF
MOTIIER (City)
(State or country)
England,
21 Walter P.Simonds
Informant
(Address)
112 Bartlett Road Winthrop Mass.
U.R. Greve I HEREBY CERTIFY that a satisfactory standard certificate of death was/filed with me BEFORE the burial or transit permit was issucd: Malku( Sercaunder (Signature of Agent of Board of Health of other)
(Official Designation)
(Date of Issue of P'ermit)
7/10/17 VIL V
INS
FICATE
DEATH ter one ach ad (c)
ot mean dying, failure, t means compli- caused
any, ise to (a), under- last.
ontrib -- but not terminal n given
ter 137, requires print or use
or ath on ites.
50M-11-56-918978
PLACE OF DEATH
Suffolk (County)
No.
112 Bartlett Road,
Sibella R.Simonds.
PHYSICIAN - IMPORTANT
Registered No.
PARENTS
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 behef, served in the army, navy or marine corps of the United States in any war in which it has been engaged, isert 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- 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. 1 .. Chap. 46, Scc. 10.
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