USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 20
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(Signed)
Lewis N.Cahill
M. D.
(Address)
USNH.Chelsea
Dat2/28/58.19
Amanda, Ohio (Amanda Cemetery) 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Mar.3,1958
19
A TRUE COPY Cooph & Tyrrell
ATTEST:
DATE FILED
(Registrar of City or Towi where death occurred)
Feb.28,1958
19
X
R-302 1
-
(City or Town)
No ..
U. S.Naval Hospital
(City or Theking this return)
72
Patty Lou Campton Balthaser
(Was deceased a
U. S. War Veteran,
46
if so specify WAR)
10 SINGLE
(write the word)
Female
Due To (b) resided as soon as possible, after the close of the month in which the death occurred. (See 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)
SOM . 11 55.916145
1
MAR 1 01033 /*
X
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
Registered No.
42
St. [give its NAME instead of street and number) No. Winthrop Community Hospital
Male Dietz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
87 Summit Avenue, Winthrop
St
(If nonresident, give city or town and State)
Length of stay: In place of death. years months _ days. In place of residence. years. months _... _ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
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. Stillborn
12
AGE
Years.
Months
.Days
If under 24 hours
Hours.L. Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
None
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Winthrop
Mass.
17 NAME OF
FATHER
Joel P. Dietz
18 BIRTHPLACE OF
FATHER (City).
Roxbury
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Sandra Jamieson
20 BIRTHPLACE OF
MOTHER (City) ..
Winthrop
(State or country)
Mass.
21
Informant
Mr. Joel P. Dietz-father
(Address) 87 Summit Ave., Winthrop
7 NAME OF
DIRECT
Richard C. Kirby
ADDRESS 917 Bennington St. ,E.Boston
Received and filed HAR 3 19
1958
(Registrar)
2 WKS
Due To (c)
OTHER
BREATHED-15. MIN.
SIGNIFICANT
CONDITIONS
PRONOUNCED 3.500Mg
Was autopsy performed?
NO
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
a.n. Caplan
M. D.
(Signed).
186 Princeein 89. Barlan
Address)
Date 2-28-158
6
Winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL March 3rd
19 58
SOM-3-56.917573
-301A
TIONS
RTIFICATE ring DEATH enter in one r each and (c)
not mean of dying, rt failure. It means or compli- caused
if any, rise to se
-
Due To
(b)
PREMATURE
SEPARATION-PLACENTA
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE .
(a)
PREMATURITY
WEIGHT /16/202.
FEB.
28
1958
(Year)
(Month)
(Day)
That I attended deceased from
4 I HEREBY CERTIFY,
FEB 28
, 1958
to
FEB 28, 1958
I last saw hiMalive on
FEB
28, 1958, death is said to
have occurred on the date stated above, at
3:50P.m.
PHYSICIAN - IMPORTANT -
‹‹Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence.
No.
(Usual place of abode)
[(If death occurred in a hospital or institution,
To be filed for burial permit with Board of Health or its Agent.
9:1
PARENTS
I MIEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Jacke ( -). cc access (Signature of Agent of Board of 11catthi or other)
Lucie
3/3/58
(Official Designation)
(Date of Issue of Permit)
None
(a), under- se last.
s contrib- th but not e terminal tion given
apter 137, , requires to print or cause or death on cates.
2 FULL NAME
DATE
DEATH
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 sixtecn 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 examiner's, 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 of 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 funeraf 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).
6 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 fare during a last illness from disease unrelated to any form of bruk.' 1958 MM
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .-- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
Suffolk
REVERE
4-7-58
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.
48
[(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
No.
2 FULL NAME MCCARTHY
ALMA (REED)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
109 PROSTOR ALLE
Under 24 hrs.
St.
REVERE
(If nonresident, give city or town and State)
Length of stay: In place of death
years
months
days. In place of residence
35
. years
.months ..........
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MARCH
1
1958
(Month) (Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
FEB
75, 1956
to.
MAR 1
195€
I last saw hisalive on
MARCH / 1918, death is said to
have occurred on the date stated above, at
1.13P
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
NIYOCARDIAL INFARCTION
(b)
Due To
CORONARY OCCLUSION
2 AYS
Due To CORONARY
ARTERIO SÉEROSAS
(c)
OTHER SIGNIFICANT CONDITIONS
DIABETES MELLITUS
11 YRS
Was autopsy performed?
NO
What test confirmed diagnosis?
5KG- LAB TESTS
5 Was disease or injury in any way related to occupation of deceased? No If so, specify .. ... ...
(Signed) Haritada Nuograsa , M. D. 670 Beach@Cypel Date! te 3-1-58 19
(Address)
6 Holy Cross
Malden (City or Town)
DATE OF BURIAL
March 4,1958 19
7 NAME OF
FUNERAL DIRECTOR
J. Vincent Murray
Revere as8.
ADDRESS
Received and filed
AR 3 19
1958
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
femal
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John J. McCarthy
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGES2
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:
at home
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Boston Mass.
17 NAME OF
FATHER
Norman Reed
18 BIRTHPLACE OF
FATHER (City)
(State or country)
New York
19 MAIDEN NAME
OF MOTHER
Lillian Daley
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Ireland
21 John J. Mccarthy
Informant
(Address)
109 Proctor Ave., Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the hurial or transit permit was issued:
(Signature of Agent of Board of llealth or other)
Vidine CALICE
3/3/50
(Official Designation)
(Date of Issue of l'ermit)
X
TIONS
TIFICATE
ing DEATH nter n one each and (c)
not mean of dying, t failure, It means or compli- h caused
if any, rise to e (a). under- e last.
contrib- h but not terminal ion given
apter 137, requires o print or cause death on cates.
SOM-3-36-917573
X -
-301A 1
PLACE OF DEATH
(County) WINTHROP (City or Town)
Wintrhop Community Hospital
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
no
if so specify WAR).
(a) Residence. No .... (Usual place 'of abode)
INTERVAL
BETWEEN
ONSET AND
DEATH
2 w/s
PARENTS
Place of Burial or Cremation
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 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 huried 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 physician's will certiff) to such deathsonly as those of persons who, though disabled byl recognized disease uhrelated 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
.
01A 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
Registered No. AS
[(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
Length of stay: In place of death
.years.
months
7
days. In place of residence
(If nonresident, give city or town and State)
10 years
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March
r. 1956
(Month)
(Day)
(Year)
4 I HEREBY CERTIF
That I attended deceased from
Fc6. 23
58
to.
March 2
1950
I last saw hlealive on
March 2, 1958, death is said to
(Give maiden name of wife in full)
James T. Cadigan
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
87Years.
2
Months
28 Days
If under 24 hours
....
.Hours ....... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
At home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Michael Finley
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Ellen Cadigan (OK)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England IREland S.L.Cl
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS917 Bennington St., E.Boston
Received and filed
MAR 3 1958
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
10a If married, widowed, or divorced
HUSBAND of
have occurred on the date stated above, at
9,50 A.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Pulmonary
Edema
INTERVAL BETWEEN ONSET AND DEATH 2 Days.
2485
Due To
Matiquant Hypertension
(c)
OTHER
SIGNIFICANT
CONDITIONS
grippe
Was autopsy performed?
NO
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?
If so. specify
(Signed)
Jeongs: H. Schwartz
, M. D.
(Address)
19 Princelin Src /200312
1958
Holy Cross Cemetery, Malden
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