Town of Winthrop : Record of Deaths 1958, Part 52

Author: Winthrop (Mass.)
Publication date: 1958
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 52


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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


JUL -71958 AM


a


INTURAR


MINY


11 12


6


5


RECEIVED


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


To be filed for burial permit with Board of Health or its Agent.


No. .. 22 Wheelock street


2 FULL NAME


Ernest Pepper


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


(a) Residence. No .. 22 Wheelock Street St.


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death3.5


years


months


days. In place of residence35.


years


months.


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


July


9


1958


(Year)


(Month)


(Day)


4 I HEREBY CERTIFY


July


8


1958 to


July 9


That I attended deceased from 1958


last saw his salive on


July 18 , 1958, death is said to


have occurred on the date stated above, at 5:30 pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


CORONARY OCCLUSION


INTERVAL BETWEEN ONSET AND DEATH


DAYS


Due To


ARTERIOSCLEROSIS


(b)


(c)


Due To


RALES IN LOWER


LEFT LUNG. POSTERITY


OTHER


SIGNIFICANT


NONE


CONDITIONS


Was autopsy performed?


NO


What test confirmed diagnosis? CLINICAI


5 Was disease or injury in any way related to occupation of deceased ? If so, specify NO.


(Addr


DATE OF BURIAL July 12.1958 19


7 NAME OF


FUNERAL DIRECTOR


alpin 13. Marsh


ADDRESS


174 Winthrop St. Winthrop, Mass.


Received and filed


JUL 11 1958


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


White


10 SINGLĖ


(write the word)


MARRIED


WIDOWED Single


or DIVORCED


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


AGE62 Years


Months


17


Days


If under 24 hours


Hours ..... Minutes


13 Usual


Occupation :


Printer


(Kind of work done during most of working life)


14 Industry


Commercial Printing Co.


15 Social Security No ..


010-05-7255


16 BIRTHPLACE (City) Leicester


(State or country)


England


17 NAME OF


FATHER


Thomas Pepper


PARENTS


18 BIRTHPLACE OF


FATHER (City) (State or country)


England


19 MAIDEN NAME


(Signed).


, M. D.


OF MOT11ER


Mary Taylor


20 BIRTHPLACE OF MOTIIER (City) (State or country) England


6 Winthrop Cemetery Winthrop Mass Place of Burial of Cremation (City of Town) 21 Informant Mrs. Ada Tansley (Address) 22 Wheelock St. Winthrop


1 11EREBY CERTIFY that a satisfactory standard certificate of death was hled with me DEFORE the burial of transit permit was issued : Ralph Sirianni


(Signature of Agent of


&that of (icalth or other)


H.O.


July 11/ 55


(Official Designation)


(Date of Issue of Dermin)


V.B;


1A


NS


ICATE


EATH er ne Ich d (c) t mean dying, failure, means compli- caused


any, se to (a), inder- last.


ontrib -- ut not erminal given


er 137, quires rint or or


se th on es.


SOM-11-56-918978


1


Registered No.


132


[(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.


Male


YEARS


Date 7.14, a


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 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 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 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


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


.


JUL 111958 41


C


6


RECEIVED


X


PLACE OF DEATH


Suffolk


(County)


Chelsea


(City or Town)


U. S.Naval Hospital No.


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF . GVILTEM CERTIFICATE OF DEATH


Chelsea


(City or Town making this return)


Registered No.


298 435


$ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


2 FULL NAME


Baby Boy Millar


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


37 Floyd


Winthrop,


lass.


(a) Residence. No ... (Usual place of abode)


(If nonresident, give city or town and State)


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


months .....


.days. In place of residence ......... years.


Imonths. days.


MEDICAL CERTIFICATE OF DEATH


July 16,1958


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


--


19


to


19


19.


........ , death is said to


have occurred on the date stated above, at


10:05A.M


INTERVAL BETWEEN ONSET AND DEATH


Due To


Abruptio placenta


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 USN M. D. USNH, Chelsea, Masa, 7/17/58


Winthrop Com. , Winthrop, Mass. 6 Place of Burial or Cremation July 19, 1958 Town)


DATE OF BURIAL. 19


7 NAME OF J.F.O' Maley


FUNERAL DIRELEYBrop, Mass. ADDRESS


Received and filed.


AUG 1 1 1958 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


White


MARRIED


WIDOWED


or DIVORORDgle


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 stillborn


12


If under 24 hours


AGE


Years ...


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)-Chelsea, Mass. (State or country)


17 NAME OF Wesley ( Dec.) FATHER


PARENTS


18 BIRTHPLACE OF


FATHER (CitChelsea, Mass. (State or country)


19 MAIDEN NAME OF MOTHER Louise Lundburg


20 BIRTHPLACE OF


MOTHER (City)


......


Winthrop, Mass.


(State or country)


21 L.Millar (mother)


Informant Winthrop, Hass. (Address)


A TRUE COPY ATTEST: Joseph a Tyrrell


DATE FILED


Registrar of City or Town Chere death occurred) July 17, 1958


19


-302


1


3 DATE OF DEATH I last saw h ........ alive on (a) Anoxia. (b) Due To (c) OTHER SIGNIFICANT CONDITIONS (Signed) (Address). 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 no


50MI 11.58-916145


(Was deceased a


U. S. War Veteran,


if so specify WAR)


10 SINGLE


(write the word)


líale


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


AUG 111958 AM


PLACE OF DEATH


X Suffolk (County) Winthrop 1 (City or Town)


Boston


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD


CERTIFICATE OF DEATH


Corn,


1tos /2.


J(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


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


120 London


St.


St


& Bostonsos


(Was deceased a


U. S. War Veteran,


if so specify WAR) ..


MASS


no


(a) Residence.


No.


(Usual place of abode)


Length of stay: In place of death


years


0


months.


15


20


days. In place of residence.


.years.


........ months ......


. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


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


73 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:


B.YA. R.R. E. Boston


15 Social Security No .....


714-10-6561


16 BIRTHPLACE (City)


(State or country)


Lakeport


2.H.


17 NAME OF


FATHER


Fred Titis


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Littleton


19 MAIDEN NAME


OF MOTHER


Era A. Wheelock


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Littleton


21 Helen J. Lane


Informant


(Address)


118 Barney Ave. E. B


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


(Signature of Agent al Board of Health or other)


HO


July 28-1958


(Official Designation)


(Date of Issue of Permit)


X


NS


FICATE


DEATH ter one ach ad (c) ot mean dying, failure, t means compli- caused


any, ise to (a), under - last


contrib- - but not terminal n given


Was autopsy performed?


NO


What test confirmed diagnosis?


Phys FRAM


5 Was disease or injury in any way related to occupation of deceased: 10 If so, specify_


(Signed) Latino 7 Celui


(Address)


Levere Mass Date 26 July 19


M. D. 18


Landaff Cemetery Liches Kille ICH, N.H.


6 Place of Bodal or Cremation


DATE OF BURIAL


July 29,


19


SheKelly


7 NAME OF FUNERAL DIRECTOR ADDRESSON Meridiane Boston


Received and filed JUL 28 1958


19


(Registrar)


INTERVAL BETWEEN ONSET AND DEATH


1 Day


Due


· Arterioscleratic


1 Year


- (b) Heart Disease


Due


To Arteriosclerosis


5 years


(c)


OTHER


SIGNIFICANT


CONDITIONS


26


1958


(Month)


(Day)


(Year)


4 LHEREBY CERTIFY ,That I attended deceased from July 11 19 58


to


July


26


19


53 8


I last saw halive on


July


26, 19 5 , death is said to


have occurred on the date stated above, at


2.40 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Congestive Cardiac


(a)


Failure


50M-5-57-920345


No.


Winthrop


2 FULL NAME HERMAN A


EUGENE TITUS


Registered No.


136


(If nonresident, give city or town and State)


To be filled for burial permit with Board of Health or its Agent.


01A


ter 137, requires print or use or ath on tes.


PARENTS


or Town)


Yard Master


3 DATE OF


DEATH


July


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 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 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 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 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).




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