USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 28
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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 beard, 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 deathsonly 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
IR-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No.
33 Banks Street
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. 87
f(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
Alice Jane (Good) Campbell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No
33 Banks Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years
months ....
days. In place of residence
30
years.
.months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
26
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Sepri
19
to
may 26
1959
I last saw hvalive on
may 25, 1959,
is said to
have occurred on the date stated above, at
7:47Rx
m.
INTERVAL BETWEEN ONSET AND
DEATH
24hr
Due To
Carcinomatos,5
(b)
Due
Carcinoma of Bowel
(c)
OTHER
SIGNIFICANT
Senility
CONDITIONS
Was autopsy performed?
120
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed).
(Address).
6
Woodlawn
Everett (City or Town)
DATE OF BURIAL
May 28
19.59
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed
MAY 28 1959
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Frank G Campbell
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 89 Years
5
.Months ..
2
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. None
16 BIRTHPLACE (City).
(State or country)
New Brunswick
17 NAME OF
FATHER
Robert Good
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Unable to obtain
19 MAIDEN NAME
OF MOTHER
Elizabeth Eddy
20 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
Unable to obtain
21
Informant
Ruth L Smith
(Address)
33 Banks St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Palkle C. Percannes (Signature of Agent of Board of Health or other)
He allthe Office
5/25/59
(Official Designation) (Date of Issue of Permit)
IUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure, tc. It means e, or compli- which caused
ns, if any, ave rise to cause (a), the ause under- last.
dions contrib -- oleath but not the terminal ndition given
Chapter 137, 954, requires lis to print or cause or f death on c tificates.
SOM-5-56-917573
Place of Burial or Cremation
Legol 4. D.
PARENTS
PHYSICIAN - IMPORTANT -
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
30
That I attended deceased from
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bronchopneumonia
(a)
(terminal)
marta
Monthly
West Bathurst
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 eath of a person whom he has attended during his last illness, at the request fan undertaker or other authorized person or of any member of the family of e deceased. furnish for registration a standard certificate of death, stating to the est of his knowledge and belicf the name of the deceased. his supposed age, the isease of which he died, defined as required by section one, where same was ontracted, the duration of his last illness, when last seen alive by the physician 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 receding section or by section forty-five of chapter one hundred and four- en, shall, if the deceased, to the best of his knowledge and belief. served in the rmy, navy or marine corps of the United States in any war in which it has been ngaged, insert in the certificate a recital to that effect, specifying the war, and iall also certify in such certificate both the primary and the secondary or imme- ate cause of death as nearly as he can state the same. For neglect to comply ith any provision of this section, such physician or officer, shall forfeit ten dollars. or the purposes of this section and of sections forty-five. forty-six and forty-seven isaid chapter one hundred and fourteen, the word "war" shall include the China lief expedition and the Philippine insurrection, which shall, for said purposes, be eemed to have taken place between February fourteenth, eighteen hundred and nety-eight and July fourth, nineteen hundred and two, and the Mexican border rvice of nineteen hundred and sixteen and nineteen hundred and seventeen. . L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body a town. or remove therefrom a human body which has not been buried, until he as received a permit from the board of health, or its agent appointed to issue ich permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shall exhume a human body and move it from a town, from one cemetery to another, or from one grave or tomb her than the receiving tomb to another in the same cemetery, until he has ceived a permit from the board of health or its agent aforesaid or from the clerk the town where the body is buried. No such permit shall be issued until there all have been delivered to such board, agent or clerk, as the case may be, satisfactory written statement containing the facts required by law to be turned and recorded, which shall be accompanied, in case of an original inter- ent, by a satisfactory certificate of the attending physician, if any, as required by w, or in lieu thereof a certificate as hereinafter provided. If there is no attending hysician, or if, for sufficient reasons, his certificate cannot be obtained early hough for the purpose, or is insufficient, a physician who is a member of the board { health, or employed by it or by the selectmen for the purpose, shall upon pplication make the certificate required of the attending physician. If death is aused by violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from one town another within the commonwealth cannot be obtained early enough for the urpose, the certificate of death made as above provided and in the possession of ne undertaker desiring to make such removal shall constitute a permit for such moval; provided, that such body shall be returned to the town from which it was emoved within thirty-six hours after such removal. unless a permit in the usual orm 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 'ofily tleaths eaused 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
5
Миккиру (County)
1
(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.
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 2 5 L'Adevaitte Che
St
(If nonresident, give city or town and State)
3years.
months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF My == 128 DEATH
(Month)
(Day)
1959
(Year)
8 SEX 9 COLOR Female Il fut.
10 SINGLE
(write the word)
1
MARRIED
WIDOWED-
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
AGED
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),
17 NAME OF
FATHER
Querasotirante
18 BIRTHPLACE OF FATHER (City) (State or country)
italy
19 MAIDEN NAME
OF MOTHER
da Letmant
20 BIRTHPLACE OF MOTHER (City) (State or country) 7
Italy
21
Informant
(Address)
175 Madurarthe Que
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)
-THIS IS A VENT RECORD. se only APPROVED ink or black riter ribbon.
RUCTIONS FOR CERTIFICATE
giving OF DEATH
not enter than one I: for each (b) and (c)
Hoes not mean le of dying, heart failure, vetc. It means se. or compli- which caused
ons, if any, gave rise to cause (a). the under- cause
lions contrib -- udeath but not the terminal ondition given
: Chapter 137, £ 954, requires iis to print or 1: cause or f death on c tificates. JAP. 46, 55 9 & I.P. 114 $$ 45, (AP. 38$ 6,)
2522
MO-58-923886
PLACE OF DEATH
No.
f(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) 260
(Usual place of abode)
Length of stay: In place of death
4 years
months __ days. In place of residence
PERSONAL AND STATISTICAL PARTICULARS
PARENTS
(Signed)
mascon C .Salini
, M. D.
(Address)
241 Manusuit SI, ¿. STAB
Date Miny 29 1959
6
Place of Burial or Cremation DATE OF BURIAL " freni/
(City or Town)
7 NAME OF
FUNERAL DIRECTOR Sosyal Licença se
ADDRESS-5-8, Thu Suite che Bestens
Received and filed. JUN 1 1959 19
(Registrar)
y
I last saw h. C/alive on
May 27, 1959, death is said to
have occurred on the date stated above, at
1: 30Am:
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CANCER of &All b/Addie
with meTASTIsis to liver And
Due To
PANCREAS
(b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
Registered No.
-
4 Į HEREBY CERTIFY,
april 25
19.59
to
May 28
That I attended deceased from
, 19 ..
INTERVAL BETWEEN ONSET AND
last.
MR-301A
SPACE FOR ADDITIONAL INFORMATION
RECEIVED
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
JUN -1 1959 FM
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.
PLACE OF DEATH
X Suffolk (County) 1 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.
322 Pleasant No.
Thomas L. Regan
2 FULL NAME
f(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.
(If deceased is a married, widowed or divorced woman, give also maiden name.) 322 Pleasant
St.
Winthrop
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death years months days. In place of residence.
... months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
may
30
(Day)
1959
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
ana
19
51
to
30 may
1959
I last saw h./p alive on
30 May
1939, death is said to
have occurred on the date stated above, at
10:00 P.
.. m.
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here. .
12
AGE 66 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
Automobile Legal Asso.
15 Social Security No ...
022-03-0174
TBoston
16 BIRTHPLACE (City)
(State or country)
mais
17 NAME OF
FATHER
Joseph G. Regan
PARENTS
18 BIRTHPLACE OF
FATHER (City) ...
(State or country)
new York
19 MAIDEN NAME
OF MOTHER
Mary Lahey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
mass.
21 Mrs. 4. Frances Pegan
Informant
(Address)
322 Pleasant St. Wine
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Hairy d' Aireane,6 (Signature of Agent of Board of Health or other)
6/1/59
(Official Designation) Vi
(Date of Issue of Permit) /
VIS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorced
HUSBAND of
M. Frances Lane
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Due To
Multiple Myeloma
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
sternal biopsy
5 Was disease or injury in any way related to occupation of deceased? no If so, speeity).
Arthur C. Mmay
(Signed) Winthrop
Date 31 May 1959
6 Winthrop Gem
Winthrop (City or Town)
Place of Burial or Cremation
DATE OF BURIAL June 3,
59 19
7 NAME OF
FUNERAL DIRECTOR
John @ Kelly
ADDRESS 286 Queridien St, 50B.
Received and filed JUN 1 1959 19
(Registrar)
6 mo.
-
MR-301A
-THIS IS A NENT RECORD. ie only APPROVED ink or black eriter ribbon.
: RUCTIONS FOR CERTIFICATE 1 giving 1OF DEATH
olot enter than one a for each ; (b) and (c)
usdoes not mean ne of dying, a.| heart failure, aetc. It means sie, or compli- which caused
ns, if any, gave rise to cause (a). the under- cause last.
mions contrib -- tideath but not the terminal indition given
:Chapter 137, 1 954, requires chis to print or cause or f death on c'tificates. CIAP. 46, 59 9 & CAP. 114 $$ 45, (IAP. 38$ 6.)
5.
MO-58-923886
PERSONAL AND STATISTICAL PARTICULARS
(Month)
3/year
(If nonresident, give city or town and State)
3 years-
Registered No.
Boston
Sales Manager
SPACE FOR ADDITIONAL INFORMATION
--
DATE OF ENTERING MILITARY SERVICE
1
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
JUN ---- 14959-1 **
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.
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