USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 5
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16 BIRTHPLACE (City)
.
Cambridge
(State or country)
ass.
17 NAME OF
FATHER
Patrick Hayes
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Newfoundland
19 MAIDEN NAME
OF MOTHER
Mary Roach
20 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
L'ass.
21 Les. Lichael
Haves
Informant
(Address)
902 Winthrop Ave., Revere
7 NAME OF
FUNERAL DIRECTOR
Arthur S.Porcello
ADDRESS
876 Winthrop Ave. , Revere, L'ass.
4
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
white
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
10a If married, widowed, or divorced-
Rose E. Dolan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Congestive Cardiac Failure
Due To
Arteriosclerotic Heart Disease
(b)
5 yrs.
Due To
Generalized Arteriosclerosis
8 yrs.
OTHER
SIGNIFICANT
CONDITIONS
Secondary Anemia
2 yrs
Was autopsy performed?
No
What test confirmed diagnosis?
No Test
5 Was disease or injury in any way related to occupation of deceased?NO.
If so, specify
(Signed)
(Address)27 Bennington St.
M. D.
Date. Jan. 12_19 .... 57
Revere SI, Mass.
Talden
6 Holy Cross Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January, 14,
1957
SOM-5-56-917573
R-301A 1
UCTIONS FOR CERTIFICATE giving OF DEATH t enter than one for each b) and (c)
oes not mean of dying, heart failure, tc. It means .. or compli- which caused
, if any, ave rise to ause (a). the under- ause last.
ons contrib- - eath but not the terminal ndition given
Chapter 137, 954, requires s to print or cause or f death on tificates.
PARENTS
Registered No.
[(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)
No
I HEREBY CERTIFY that a sarlfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Tarih C. SVil anul. (Signature of Agent of Board of Health or other)
Theatthe Officer
(Official Designation)
(Date of Issue of P'ermity
1/14/57
Received and filed
(c)
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 cleath 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 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 tosuch 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 Examinersivil 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
X
Suffolk
(County)
Chelsea
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
14
11
{ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Nomia Ruth Ratliff
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
97 Locust
Winthrop, Mass.
St
(If nonresident, give city or town and State)
Length of stay: In place of death.
........... years.
.. months
Ca
.days. In place of residence.
.... years.
=
.. months ...
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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
Years.
3
Months.
Days
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Chelsea, Mass.
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?.
yes
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) Sam O.Cornwell USNH,Chelsea
M. D.
(Address).
Vanhouse Cem. , Patrick, Ky.
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL. Jan. 17,1957 19
Marsh Fun. Home
ADDRESS
Received and filed.
FEB 6 19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Patrick, Ky.
19 MAIDEN NAME OF MOTIIER Sarah Meade
20 BIRTHPLACE OF MOTHER (City). (State or country)
West Virginia
21 Informant
(Address)
97 Locust St., Winthrop
A TRUE COPY
ATTEST: 4. Tyrrell.
(Registrar of City or Towy where death occurred )
DATE FILED
Jan. 14,1957
19
X
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 Due To (c) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50MI.11.55.916145
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY Jan.8 57 Jan. 11,
57
19
to
19
19
57 death is said to
have occurred on the date stated above, at
7:00 P
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a) Transposition of great
Due To
vessels
(Congenital heart disease) ;.
3 das
3 DATE OF
DEATH
Jan. 11, 1957
PLACE OF DEATH
No.
U. S.Naval Hospital
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No .. (Usual place of abode)
That I attended deceased from
I last saw h
Estive on
Jan. 11
If under 24 hours
17 NAME OF FATIIER Fdgil
Fdgil Ratliff
7 NAME OF FUNERAL DIREST 174 Winthrop St . , Winthrop
Date
1/14/
57
.19.
RECEIVED
OF TOWA
1/ 12 1
OFFIC
CLERK
1.1
5
ASE
TROP M
FEB 61957 PM
RM R-305 1
PLACE OF DEATH
Middlesex (County)
.. Cambridg (City of Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Cambridge
(City or town making return) 12
Registered No.
2 FULL NAME.
Mary E. Gorman
(a) Residence. No.
124 Circuit Road
(Usual place of abode)
Length of stay: In place of death
0
.. years.
0
.months.
9
MEDICAL CERTIFICATE OF DEATH
(Month)
Terminal ...... ronchopneumonia
5 Accident, suicide, or homicide (specify) ........ Accident
Date and hour of injury
Dec. 5.
Where did
(City or town and State)
Manner of
(Specify type of place)
Injury
(How did injury occur?)
Accidental ... Fall
If so, specify.
(Signed)
David e. Dow
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
25m-(h)-10-48-24658
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-305 to the clerk of the city or town in which the deceased resided as soon as possible
Injury occur?
Winthrop. .... Mass ..
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Female
White
10 COLOR OR RACE
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widower
11a If married, widowed, or divorced
HUSBAND of.
william J.
Gorman
{Give maiden pame of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN. enter that fact here.
13
AGE
Years
Months.
.. Days
If under 24 hours
Hours .....
Minutes
14 Usual
Housewife
Occupation:
(Kind of work done during most of working life)
15 Industry
or Business:
none
16 Social Security No.
Chelsea
17 BIRTHPLACE (City)
(State or country)
Mass
18 NAME OF
FATHER
Jeremiah Driscoll
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
20 MAIDEN NAME
OF MOTHER
llen Carey
21 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
Laura R. Gorman
Informant1.2 Circuit Rd. Winthrop
(Address)
22
A TRUE COPY.
Fredericd Ht. Kunde
ATTEST:
(Registrar of City or Town where death occurred)
Jan. 1 !!
19
57
X
(Registrar of City or Town where deceased resided)
J (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
St.
Winthrop, Massachusetts
20
(If nonresident, give city or town and State)
days. In place of residence.
.years.
.months.
.. days.
3 DATE OF
DEATH
January 12, 1957
(Day)
(Year)
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
Intertrochanteric Fracture of Right Hip Injury received in Fall at home. Accident
56
Did injury occur in or about home, on farm, in industrial place, or in public place? in home
Nature of
Intertrochanteric Fracture of
Injury
wir ight hip
.M.o
.Was autopsy performed?
NO
6 Was disease or injury in any way related to occupation of deceased?
....
No
(Address)
Cambridge ,Mass . Date
1-12,57
7 Holy Cross Cemetery Malden Mass
Place of Burial, or Cremation. (City or Town)
DATE OP BURIAL
January.15,
1957
8 NAME OF
FUNERAL DIRECTOR
winthrop, Mass.
Arthur J. O'Maley
ADDRESS
Received and filed
1 1957/ 19
PARENTS
M. P.
No. HolyGhost Hospital
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
DATE FILED
95
Own Home
RECEIVED
TOM
11.17
ERK
كـ
6
IN
קה
FEB -41057 AM
×
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.
13
No. Winthrop Community Hospital
Ellen Gertrude Cawthorne
(If deceased is a married, widowed or divorced woman, give also maiden name.)
59 Sunnyside Ave
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. months years. 7 days. In place of residence 30 years months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
14
1957
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
Dec
1953, to.
jan 13
1957
I last saw h.M_alive on
Jan
13
19 57, death is said to
have occurred on the date stated above, at
7:45 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Congestive heart failure
Congestive heart Failure
INTERVAL BETWEEN ONSET AND DEATH 4 years
Due To
- (b)
Due To (c)
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, specify .
(Signed).
, M. D.
(Address)
6 Holy Cros
Ma Iden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January 17, 1959
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Waley
Vinthron, Mass.
ADDRESS
Received and filed
JAN 1- 1957 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
(write the word)
or DIVORCEDSingle
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 71
AGE
Years.
Months
Days
If under 24 hours
.Hours ...... Minutes
13 Usual
Occupation:
Housekeeper
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City)
Bast Boston
(State or country)
17 NAME OF
FATHER
lilliam R. Cawthorne
18 BIRTHPLACE OF
FATHER (City) (State or country) England
19 MAIDEN NAME
OF MOTHER
Mary Kelleher
20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
21 Rita Coughlan
Informant
(Address)
584 Riverside Ave Medford
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial. or transit permit was issued: Ralph C. Percaunes (Signature of Agent of Board of Health or other) Health Grieks 1/16/57
(Official Designationy
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure, tc. It means . or compli- which caused
ns, if any, ave rise to cause (a), the under- last. ause
ions contrib -- > death but not the terminal ndition given
Chapter 137, 954, requires as to print or cause or f death on tifcates.
SOM-3-36-917575
Registered No.
[(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
SWas deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
2 FULL NAME
IR-301A 1
PARENTS
Date Jan14 .9 5-
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, Scc. 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 clerk, as the casc 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 sooncr obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased scrvcd 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.
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