Town of Winthrop : Record of Deaths 1957, Part 63

Author: Winthrop (Mass.)
Publication date: 1957
Publisher:
Number of Pages: 566

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 63

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MEDICAL CERTIFICATE OF DEATH

3 DATE OF

DEATH

Sept.

(Day)

1957 (Year)

That I attended deceased from

I last saw h ___ alive on

1927

death is said to

have occurred on the date stated above, at

9€

.m.

10a If married, widowed, or divorced

HUSBAND of

Edward d' morvan

(Husband's name in full)

(or) WIFE of

11 IF STILLBORN, enter that fact hereV

AGES Of Tears

Months .... Days

If under 24 hours

Hours _.__ Minutes

13 Usual

Occupation :

(Kind of work done during most of working life)

14 Industry

or Business:

15 Social Security No .... Boston

16 BIRTHPLACE (City)

(State or country)

mass,

17 NAME OF

FATHER

Michael Griffin

18 BIRTHPLACE OF

FATHER (City)

(State or country )

chietanel

19 MAIDEN NAME

OF MOTHER

NECatherine Sullivan

20 BIRTHPLACE OF MOTHER (City) Theland

21 mary P. mora

Informant Address) 16 Celams ST. - Minttut

I HEREBY CERTIFY that a satisfactory standard certificate of death was/filed with me BEFORE the burial or transit perinit was issued : ,

(Signature of Agent, of Board of Health or other)

Daltie (Official Designation)

9/30/57

(Date of Issue of Permits

DEATH ter one each nđ (c)

ot mean dying, failure, It means compli- caused

/ any, rise to ( a ) , under- last.

Due To

(b)

Due To

arteriosole 2015

(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):

Deple fregene, M

(Ad(eps).

All Calvary. Place of Burial or Cremation

- Boston-Mars, (St) (City or Town) 30 - 19

DATE OF BURIAL. Dept.

7 NAME OF

FUNERAL DIRECTOR

ADDRESS

Received and filed SEP 3. 1957 19

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

9 COLOR

Female White

10 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

4 I HEREBY CERTIFY,

, 19. .. , to ..

DEATH WAS CAUSED BY: IMMEDIATE CAUSE

(a)

Gente lejr ventegola,

INTERVAL BETWEEN ONSET AND DEATH

477

PARENTS

SOM-3-56-917573

2 FULL NAME

No.

12 Adans

moren

(Was deceased a

U. S. War Veteran,

if, so specify WAR).

310-

mass

ONS

IFICATE

contrib- but not terminal in given

ter 137, requires print or .use OF :ath on ites.

301A 1

Registered No.

AT Home

(Month)

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.

1 1 ( 1

A physician or officer furnishing a certificate of death as required by the preceding section or hy 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 hy 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.

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

1 ORGANIZATION AND OUTFIT

SERVICE NUMBER ...

( 1 1 I I C T C S I T 1 € C € I 1 1 t

.301A 1

PLACE OF DEATH

Suffolk.

(City of 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.

188

Ninthre. Community Hospital

2 FULL NAME Crocker, Frederick

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

(a) Residence. No ...... 10 Sea View Ave., St

(If nonresident, give city or town and State)

Length of stay: In place of death. .......... years ..... .] ... months. days. In place of residence ... 3 5years .. .months ............ days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF

DEATH

(Month)

(Day)

1957

(Year)

4 I HEREBY CERTIFY,

That I attended deceased from

Sept1,

Sept 28

1957

I last saw h ........ alive on

death is said to

have occurred on the date stated above, at .. m.

DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a)

Coronary

Mount Disease

Due To

(b)

Due To (c)

OTHER SIGNIFICANT CONDITIONS

Was autopsy performed: 70MP What test confirmed diagnosis?

5 Was disease or injury in any way related to occupation of deceased ?....... If so, specify.

(Address)

6 Hope Cemetery Worcester City or Town)

Plate of Burial or Cremation

DATE OF BURIAL. October 1,1957 19

7 NAME OF

FUNERAL DIRECTOR

Alfred B. Marsh

ADDRESS

174 Winthrop St. winthrop,

Received and filed OCT 2 1957

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

9 COLOR

10 SINGLE

(write the word)

MARRIED married

WIDOWED

or DIVORCED

male white

10a If married, widowed, or divorced

HUSBAND

of Nellie Anna Chamberlain

(Give maiden name of wife in fun)

(or) WIFE of

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

CHE AGEN0 Years 9 Months 26 Days

If under 24 hours

Hours ........ Minutes

13 Usual

Occupation: retired salesman

(Kind of work done during most of working life)

14 Industry

or Business:

retail typewriter sales

15 Social Security No .....

010-07-4403

16 BIRTHPLACE (City)

Ipswich

(State or country)

Massachusetts

17 NAME OF FATHER John Russell Israel

PARENTS

18 BIRTHPLACE OF

FATHER

(City).

Freeport

... .......

(State or country)

Nova Scotia

19 MAIDEN NAME

20 BIRTHPLACE OF

29 MOTHER (City). Freport

Massachusettstate or country)

Nova Scotia

21 Informant Nellie A. Crocker (Address)

10 Sea View Avenue Winthrop

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

Mass . (Signataire of Agent of Board of Health or other)

10/1/57

(Official Designation )

(Date of Issue of Permits

not mean f dying, failure, It means r compli- ' caused

if any, rise to € (a), under- e last.

contrib- 4 but not terminal ion given

apter 137, , requires o print or cause or death on icates.

100M.11.55.016145

ITIFICATE

ing DEATH :nter 1 one each and (c)

(Usual place of abode)

$ (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.

Registered No.

12.55

INTERVAL BETWEEN ONSET AND DEATH

(Signed). 2 M. D. OF MOTHER Charity Ann Lent

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

A physician or officer furnishing a certificate of death as required by the preceding section or hy 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 saine. 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.

E CNo 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 Itraumatism (noluding 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.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK, RATING ........

ORGANIZATION AND OUTFIT

SERVICE NUMBER.

.....

R3,1-1-56 MAINE ENT OF HEALTH AND WELFARE

CERTIFICATE OF DEATH

STATE FILE NO.

055

189

PLACE OF DEATH

COUNTY

York

2. USUAL RESIDENCE Where deceased lived. If Institution: residence before admission

a. STATE

LASS.

COUNTY

b. CITY, TOWN, OR LOCATION

Biddeford

c. LENGTH OF STAY IN 1b

c. CITY, TOWN, OR LOCATION

Winthrop

d. NAME OF

(If not in hospital, give street address)

HOSPITAL OR

INSTITUTION Webber Hospital

d. STREET ADDRESS

187 Lincoln

(If ruroi give location)

.. IS PLACE OF DEATH IN RURAL AREA?

YES O

.. IS RESIDENCE IN RURAL AREA? | f. IS RESIDENCE ON A FARM?

YES

NO 著

YES

3a. NAME OF DECEASED-First Name! 3b. Middle Name

Edward

3c. Last Name

Rivette

DATE

Day

Month

DEATHJULY 25, 1:57

Year

SEX

6. COLOR OR RACE

7. Married

Never Married

Widowed :"

Divorced

DATE OF BIRTH

Boot. 17, 1883

PAGE (In yearspi under 1 year

kant buthday)

Hrs.

Mir.

10a. USUAL OCCUPATION(Give kind of 10b.

work the most of working life, even if retired

KIND OF BUSINESS OR | 11. BIRTHPLACE (State or foreign country)

INDUSTRY

Turner Falls, Mass.

12. CITIZEN OF WHAT

COUNTRY ?

13. FATHER'S NAME

Eugene Rivet.e

14.

MOTHER'S MAIDEN NAME

rry McCartny

15. NAME OF SPOUSE (If Married)

Chrion Kinney

Address

19. CAUSE OF DEATH (Enter only one cause per line for (a), (b), and (c).)

PART I. DEATH WAS CAUSED BY:

USE IF MATH

U: TYPE RINT

PART 11. OTHER SIGNIFICANT CONDITIONS contributing to death but not related to the terminal disease condition given in Part I(a)

20. WAS AUTOPSY

PERFORMED?

YES O NO C

21a. ACCIDENT

SUICIDE

HOMICIDE

21b. DESCRIBE HOW INJURY OCCURRED. (Enter nature of injury In Part I or Part 11 of item 19)

NATH L. TO TRNAL CENCE

STIAN'S MDICAL ANER'S FLATION

22a.

MEDICAL EXAMINER: I hereby certify that death occurred at the time

and from the causes stated above, and that I held on (investigation) (autopsy)

on the remains of the deceased as required by low.

22b. PHYSICIAN: I hereby certify that I attended the deceased from

ond lau sow him olive on

m on the date and from the covim itated above

Deatn ·xcurred

23a. SIONATURE

Leopold A. Vizer

(Degres or title)

M.D.

23b. ADDRESS

Biddeford

23c. DATE SIGNED

7/25/57

240. BURIAL, CREMATION, 24b. DATE

REMOVAL (Sapcity)

Burial

7/27/57

24c. NAME OF CEMETERY OR CREMATORY

Winthrop

24d. LOCATION (City, town, or county)

Winthrop, les.

(State)

25. FUNERAL DIRECTOR

ADDRESS

Howard S. Reynolds, Winthrop

26. DATE RECD, BY LOCAL REG.(2)& REGISTRAR'S SHENATURE 7/25/57

Playa

TRUE COPY, ATTEST

C:DENT RONAL DATA

: OR NAME

16. WAS DECEASED EVER IN U S. ARMED FORCES?

(Yo. no, or unm.} (It yes, give war or dates of service)

17. SOC.SECURITY NO. 18.

INFORMANT

Marion Rivette, Winthrop

INTERVAL BETWEEN ONSET AND DEATH

IMMEDIATE CAUSE (a)

Acute pulmonary edema

1201

Conditions, if any, which gave rise to above cause (0) stoting the under- lying cause last. DUE TO (c)

DUE TO (b)

Coronary thrombosis

hour

Arteriosclerosis

years

21c.

TIME OF

INJURY

Hour

a.m.

p.m.

Month, Day, Year

21d. INJURY OCCURRED

WHILE AT

WORK

NOT WHILE

AT WORK D

21 .. PLACE OF INJURY ( ... in or about home,

form, factory, street, office bldg, etc.)

21f. CITY, TOWN, OR LOCATION

COUNTY

STATE

FRAL ME.TOR AID HITKAR

VI LUWIN WINCIG UELLALU ICOIULU/

:È OF '1 AND QUAL DENCE

If under 24 hrs.

TOWA

1 72. 1

ILERK

THREE

OCT 221957 1M

PLACE OF DEATH

Suffolk

(County) Boston

(City or Town)

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) .

8539 90

S(If death occurred in a hospital or institution,

St. { give its NAME instead of street and number)

2 FULL NAME

Carl Hathaway

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

49 Prospect Ave.

Winthrop Mass.

(If nonresident, give city or town and State)

Length of stay: In place of death ............ years.

months.2

.days. In place of residence

50, ears.

months

days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF

DEATH

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Town of Winthrop : Record of Deaths 1957, Part 63

Author: Winthrop (Mass.) Publication date: 1957 Publisher: Number of Pages: 566

Author: Winthrop (Mass.)
Publication date: 1957
Publisher:
Number of Pages: 566