USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 68
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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
X
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.
Registered No.
1.91
J(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
2 FULL NAME
Alice M (Weare) Benson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1 Bellevue Terr.
St.
25
(If nonresident, give city or town and State)
Length of stay: In place of death ... years months 1
days. In place of residence
years
months.
.. days.
MEDICAL CERTIFICATE OF DEATH 1958
3 DATE OF
DEATH
SEPT
29
(Month) (Day) (Year)
4 I HEREBY CERTIFY,
FEB
1951,
to ...
9/29
19
9/29
19 52, death is said to
I last saw heRalive on
have occurred on the date stated above, at
840P.
m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
NEPHROSCLEROSIS WITH
UREMIA.
INTERVAL
BETWEEN
ONSET AND
DEATH
IWK.
(b) ARTERIO SCLEROTIC
HEART DISEASE
Due To
GENERAL ARTERIO-SKERES
5 YRS.
OTHER
SIGNIFICANT
CONDITIONS
CARCINOMA OF C.VY.
3 YRS.
Was autopsy performed?
NO .
What test confirmed diagnosis?
CLINICAL.
5 Was disease or injury in any way related to occupation of deceased NO. If so, specify
(Signed)
(Address)
222 PLEASANT ST Date 9/24
58
Everett
Place of Burial or Cremation
DATE OF BURIAL
Oct. 2
1958
7 NAME OF
FUNERAL DIRECTOR
Howard S Vyrutel.
ADDRESS
ViVerni,
Received and filed
OCT 1 1958 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Henry W Benson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
85
AGE
Years
7
Months
26
Days
If under 24 hours
Hours ....... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own home
15 Social Security No ..
023-07-1613
Hieshla
16 BIRTHPLACE (Cit
(State or country)
Ontario Canada
17 NAME OF
FATHER
Edward Weare
PARENTS
18 BIRTHPLACE OF
Leeds
FATHER (City)
(State or country) England
19 MAIDEN NAME
OF MOTHER
Julia Newton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Leeds
England
21
Informant
Cyril Benson
Address
1 Bellevue Terr. Winthrop
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)
(Official Designation)
(Date of Issue of Permit)
10/58
Y
10NS
TIFICATE
Ing DEATH nter n one each and (c)
not mean of dying, t failure, It means r compli- caused
if any, rise to 2
(a), under- e last.
pter 137, requires print or ause or leath on ates.
SOM-5-56-917573
-301A 1
PLACE OF DEATH
No.
Winthrop Community Hospital
PHYSICIAN - IMPORTANT -
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence. No. (Usual place of abode)
That I attended deceased from
55
I ye.
(c)
M. D.
Woodlawn Crematory
6
(City or Town)
contrib .. but not terminal ion given
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 by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the hest 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-scven 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, eightcen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and ninetcen 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 be obtained as to the deceased, or as to the manner of 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 discase, 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
OCI -11950 PM
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)
25M-8-56-916227
PLACE OF DEATH
Suffolk
(County)
[ R-302 1 Revere
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN
Revere SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Registered No. 192
$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME GeorgeWendell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. 46 Washington Ave. (Usual place of abode)
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death. ........ „years.24. months2 .days. In place of residence. ........... years. months ... .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
September 29,
(Month)
(Day)
1958
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
May 27
58
to
Sept. 29
58
I last sawAn .... alive on S.e.p.t ........ 29.
158 ... , death is said to
have occurred on the date stated above, at 10:05A. m.
INTERVAL
BETWEEN
ONSET AND
DEATH
48hrs.
(b) Carcinoma of esophagus l2yrs.
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?.
Pathology
5 Was disease or injury in any way related to occupation of deceased ?!! O If so, specify
(Sign James F. Burns M. D.
Broadway (Address).Verett.
Date9./29
19.5.8.
Woodlawn Cemetery
6
Everett
Place of Burial or Cremation
October 2,
DATE OF BURIAL
7 NAME OF
Russell Shea
FUNERAL.
512 Centre St., Jam. Plain
ADDRESS
Received and filed.
ALI 2 1958
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
white
10 SINGLE
MARRIED
WIDOWĘD
or DIVORCEDgle
(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.
12
AGE3
Years
Months ....
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business :
Police Officer
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Boston
17 NAME OF
FATHER
George Wendell
18 BIRTHPLACE OF
FATHER (City)
(State or country) England
19 MAIDEN NAME
OF MOTHER
Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21 Informant Dan Whalen (Address)7 Levant St., Dorchester
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
ctober
2,
.. 58
19.
WRITE PLAINLY, WITH UNFADING BLACK INE - THIS IS A PERMANENT RECORD
PARENTS
(City or Town) 58
(City or Town making this return)
No. Grover Manor Hospital
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Male
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)Uremia
BEOL
OCT - 171952 00
-301A 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
To be filed for burial permit with Board of Health or its Agent.
Registered No.
193
[(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).
120
(a) Residence. No. (Usual place of abode)
42 Irwin St.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death ..
years
1
months
/ 7 days. In place of residence.
16
years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Sept.
30
DEATH
(Month) (Day)/
1958 (Year)
4 Į HEREBY CERTIFY,
may
to.
Sept
30
That I attended deceased from
1955
I last saw h Yalive on
Sept 36, 1953, death is said to
have occurred on the date stated above, at
11:30A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Hypertensive-Coronary
Artery Heart Disease
1
Due To Cardiac Deser pensation
(b)
Due To Mesenteric Thrombosis
(c)
OTHER
SIGNIFICANT Diabetes Mellitus
5yrs.
CONDITIONS under of Urinary Blackles 22435
Was autopsy performed?
What test confirmed diagnosis ?..
Clinical
5 Was disease or injury in any way related to occupation of deceased? AF If so, specify
(Signed)
Unthrop Muss Date 9/201
6 Quelchty Soc
Place of Burial of Cremation
mellose
(City or Town)
DATE OF BURIAL activer 2 19:58
7 NAME OF
ADDRESS / SiMarhunston Que chilno-
OCT I 1958 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10-SINGLE
(write the word)
MARRIED
WIDOWED
o+ DIVORCED
mauricio
10a If married, widowed, or divorced
HUSBAND of
Charles Morris
(Husband's name in full)
(or) WIFE of
11 IF STILLBORN, enter that fact here.
12
62
AGE
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:
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Jacob- Butter
18 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
(C.BL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant
(Address)
12 Irwinst Winchway
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 Healthior other)
ecaille
Finder
10 , 28
(Official Designation) (Date of Issue of Permit)
TIONS R RTIFICATE
ring DEATH enter an one r each and (c)
· not mean of dying, rt failure, It means or compli- ch caused
if any, rise to se
(a), e under- se last.
s contrib- - th but not te terminal ition given
apter 137, , requires to print or cause or death on
cates.
SOM-5-56-917573
No.
Winthrop Community' Hospital
2 FULL NAME. Rose Dorris
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Received and filed
Iwik
PARENTS
Charles Carris
(Give maiden name of wife in full)
INTERVAL
BETWEEN
ONSET AND
DEATH
3yrs
3 mois
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 hody, 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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