USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 30
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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 domestie service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no oceupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-302 1
PLACE OF DEATH
Suffolk
(County) Chelsea
LITERTATE WILLEM
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Chelsea
(City or Town making this return)
148
Registered No.
(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.)
Quarters 12, Ft.Banks
/
Winthrop, Mass.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ....
..... years .......
.months.
.days. In place of residence.
3
years
months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Apr.15,1958
DEATH
(Month) (Day) (Year)
4 I HEREBY CERTIFY,
Apr. 15
19
58
to
Apr.15
58
I last saw h ........ alive on 19 ., death is said to
have occurred on the date stated above, at
.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Stillbirth
Due To
(b) ..... Anencephaly
OTHER
SIGNIFICANT
CONDITIONS
no
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
H.R.Houston, Lt. MC
(Signed)
USNH, Chelsea
4/15/58
19
Mt. Hope, Dorchester, Mass.
Place of Burial or CremApr. 17, 1958 City or Town) DATE OF BURIAL. 19
7 NAME OF
Fudge & Son, Inc.
FUNERAL OREHighland Ave . , Somerville"
ADDRESS.
Received
file
May 9, 1958
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDngle
(write the word)
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 ........ 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,
17 NAME David H. FATHER
18 BIRTHPLACE OFSomerville, Mass. FATHER (City) (State or country)
MAIDEN N.
OF MOTHER
Lespa Cuciufiti
20 BIRTHPLACE OF MOTHER (City). Newport , N. H.
(State or country)
21 D.H.Ward (father) Informanpt . Banks, Winthrop, Mass.
A TRUE COPY
ATTEST:
Joseph a Turrell
(Registrar of City or Town where death occurred)
DATE FILED
Apr.16,1958
19 ..
6 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)
(City or Town)
CERTIFICATE OF DEATH
U.S.Naval Hospital
No. Baby Girl Ward
5011.11.58.9:5145
M. D.
Date
PARENTS
(Address)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
That I attended deceased from
1
X SUFFOLK (County)
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.
78
18 WADSWORTH AVE No ..
$(If death occurred in a hospital or institution,,
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT 1
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No ...
(Usual place of abode)
18 WADSWORTH AVE St
(If nonresident, give city or town and State)
Length of stay: In place of death 35 years. months. days. In place of residence 36 years. months. .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
18
1958
(Year)
(Month)
(Day)
That I attended deceased from
1958
to ...
April 18, 1958
I last saw h.amalive on 1 pril 18, 1958, death is said to
have occurred on the date stated above, at 9:00A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) Coronary Occlusion
Due To Hypertensive- Coronary (b)
Artery Heart Disease
Due To
(c)
OTHER
SIGNIFICANT
None
CONDITIONS
Was autopsy performed ?.
No
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? A/r If so, specify.
(Signed).
Charles Liber man
M. D.
(Address) WINTHROP, MASS Dat
4/19/
1958
0 CALVERY
BROCTON
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL APRIL 21
1958
7 NAME OF
FUNERAL DIRECTOR
Maxence 7/ 1 Jahr
ADDRESS
Received and filed APR 2 :1358 .19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
Or DIVORCED MARRIED
10a If married, widowed, or divorced
HUSBAND of.
MARY A (REARDON) CARRELL
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGEL 4 years.
.Months.
.. Days®
If under 24 hours
Hours ........ Minutes
13 Usual
LABORER
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
GENERAL
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
JEREMIAH CARROLL
18 BIRTHPLACE OF
FATHER (City)
(State or country)
IRELAND
19 MAIDEN NAME
OF MOTHER
MARGARET COTTER
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
MPS AGNES 1 CARROLL
21
Informant,
(Address)
IS WADSWORTH SEANWINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
HO
akul 21/58
(Official Designation)
(Date of Issue of Permit)
UFV
CTIONS R ERTIFICATE
iving F DEATH enter han one or each ) and (c)
us not mean of dying, art failure, c. It means or compli- ich caused
s, if any, ve rise to use (a), he under- use last.
ons contrib- ath but not the terminal dition given
Chapter 137, 54, requires to print or cause or death on
ificates.
100M· 11.55-916146
PLACE OF DEATH
R-301A 1
WINTHROP
(City or Town)
PATRICK J CARROLL 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4 I HEREBY CERTIFY,
april 17
INTERVAL BETWEEN ONSET AND DEATH
3 Days
10 yrs.
IRELAND
PARENTS
IRELAND
Registered No.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- te n, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending
physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary, Edition).
RULES OF: PRACTICE :
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia),"and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
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.
Winthrop Comm Hospital [(If death occurred in a hospital or institution, St. [give its NAME instead of street and number) No.
2 FULL NAME
Elizabeth W Lentz ( Mac Causland
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
784 Winthrop Ave Revere
St
Rovere
Mass
(Usual place of abode)
Length of stay: In place of death
years
months
1
days. In place of residence.
years
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
april
19
1958
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY, That I attended deceased from
, 19
... , to
19
-
I last saw h ___ alive on
19., death is said to
have occurred on the date stated above, at
2:25 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
-
Du
To Presumably Coronary
(b)
6 hrs.
Occlusion
Due To Arteriosclerotic Heart
(c)
Disease
years
OTHER
SIGNIFICANT
Diabetes Mellitus
years
Was autopsy performed? no
What test confirmed diagnosis
post-mortem opinion
5 Was disease or injury in any way related to occupation of deceased ?/70 If so, specify.
Arthur C. Murray M. D. Winthrop Board of Health, 9 april 1958
6 Skautsheen Place of Burial or Cremation
DATE OF BURIAL Apr 22 1958
7 NAME OF
FUNERAL DIRECTOR
Arthur Porcella
ADDRE 176 Winthrop Dve Beachmont Rev.
Received and filed IAPR 22 1958
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
White
9 COLOR
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.
Harry Mae Gausland LenTz
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
AGE
12
7 5years.
4
Months
19 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.
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
John Mac Caucland
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Georgiana Ware
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
21
Informant
(Address)
Mrs Georgmana Collar
784 Winthrop Ave Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was/ficd with me BEFORE the burial or transit permit was issucd :
(Signature of Agent of Koard of Health or other)
(offices
4/11/98
Coralthe
(Official Designation)
(Date of Issue of Permity
CTIONS DR CERTIFICATE
iving F DEATH
rt enter han one For each ) and (c)
it's not mean of dying. part failure, . It means or compli- ich caused
. if any, ve rise to (a). he under- last.
uns contrib- ath but not the terminal ndition given
"hapter 137, 54, requires 1; to print or cause or death on : ifcates.
50M-5-57-920345
R-301A 1
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(If nonresident, give city or town and State)
60
TEVERE 5-8-38
0 Bedford Mass
(City or Town)
Bedford
CONDITIONS
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registercd 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 diseasc of which he dicd, 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 decmed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, ninetcen hundred and two, and the Mexican border service of nineteen hundred and sixtcen and nineteen hundred and seventecn. 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 i 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 hercinafter 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 he 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, G. L., (Tercentenary Edition).
RULES OF PRACTICE
: PIThe fulfillment of the purpose of these laws calls for the observance of the follow- ling 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 fron disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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